Sclerotherapy

What is sclerotherapy?

Sclerotherapy is the treatment of spider and varicose veins by injection of a sclerosant into the diseased veins that causes them to plug up, harden, and eventually disappear. The process was first done as far back as the 1840’s, and became a routine part of the treatment of varicose vein disease by the 1920’s. Over the course of the years the various medications used as sclerosants changed. The process by which the sclerosants evolved is a fascinating story in itself that can be found under history in the treatments section.

How is sclerotherapy done?

The sclerotherapy injection procedure itself can be done in one of two ways—either by surface sclerotherapy or by ultrasound guided sclerotherapy. Surface sclerotherapy, which was the original way of doing sclerotherapy, can be done on both large and small surface veins. It is normally done using small needles with the patient laying down. The physician uses magnification and polarized light illumination to inject veins that can be seen on the surface of the skin. Depending on each patient’s specific needs, the injections will include sodium tetradecyl sulfate or polidocanol, and glycerine.

What is ultrasound guided sclerotherapy?

High tech ultrasound machines are used in many areas of clinical medicine to provide a visual window to structures beneath the skin. Ultrasound guided sclerotherapy is the use of these machines by specially trained doctors to inject the actual leaking veins which are located deep under the surface of the skin. As opposed to conventional surface sclerotherapy, with ultrasound guided sclerotherapy a foamed solution consisting of carbon dioxide with sodium tetradecyl sulfate or polidocanol is injected into the diseased veins.

What are the benefits of ultrasound guided sclerotherapy as compared to more conventional surface sclerotherapy?

Ultrasound guided sclerotherapy gets to the source of the disease—the refluxing or leaking veins—and in doing so treats all types of diseased varicose and spider veins better, quicker, and more effectively. Spider veins and so-called feeder veins (reticular veins) often fade with fewer treatments and cosmetically better results than when treated with surface sclerotherapy or laser alone.

Is ultrasound guided sclerotherapy only for large varicose veins?

No. Remember that all diseased veins on the surface of the skin—even spider veins—are caused, to some degree, by reflux. Only with ultrasound guidance can you see the veins that cause spider veins.

What kind of follow-up treatment is needed?

At the conclusion of the sclerotherapy session, a thigh high surgical compression stocking is placed on the patient. The patient is sent on a fifteen minute walk. The stocking is worn overnight the first night, and is then worn whenever the patient is out of bed for the next two weeks. They usually can return to work and normal activities immediately with no interruption in their daily schedule.

In two to four weeks the areas that have been treated are again examined with the ultrasound machine. If things have gone as expected, treated veins have begun to dry up and disappear. If additional treatments are necessary, the persistent veins are simply treated again. It is rare that patients will require more than three sclerotherapy sessions to treat the diseased veins.