Although recent advance in laser vein removal technology has given various options to treat spider veins and varicose veins, sclerotherapy still remains the primary treatment of choice. Sclerotherapy procedure involves injecting a sclerosing solution directly to target vein. The solution causes the vein to collapse with scarring which usually fades after several weeks. In some cases it might take months and multiple sclerotherapy treatment may be required.
There are various classes of sclerosing agents available that are used for spider vein removal or varicose vein removal . These agents includes detergents (Polidocanol, Sodium tetradecyl sulfate, Sodium morrhuate, Ethanolamine Oleate), Osmotic agents (Sodium chloride solution with dextrose, Hypertonic sodium chloride solution) and Chemical irritants (Polyiodinated iodine, Chromated glycerin). The most commonly used agents are hypertonic saline, sodium tetradecyl sulfate, polidocanol, and chromated glycerin.
Are You the Right Candidate for Sclerotherapy?
Not all patients may be a good candidate for Sclerotherapy. Sclerotherapy is usually indicated for the following reasons:
- Pain, burning and night cramps
- Major perforator reflux
- Lateral venous system varicosities
- Major tributaries of greater and lesser saphenous veins
- Cosmetic purposes to improve the appearance of spider and varicose veins
Prior to sclerotherapy, your dermatologist will examine your veins with details past and present history of any disease and decide if you are a good candidate for Sclerotherapy. Sclerotherapy is contraindicated if you have the following:
- Pregnancy ( can be done after pregnancy)
- Known allergy to sclerosing agent
- Arterial obstruction
- Reflux at sapheno-popliteal or sapheno-femoral junction
- Non-ambulatory patients
- Deep Vein thrombosis
Sclerotherapy Side Effects and Complications
Although Sclerotherapy is a safe procedure, few complications may occur which will subsides within few weeks.
Bruising may occur immediately after procedure which will clear within few days.
Swelling or edema may occur after procedure which can be managed and prevented with compression stockings.
Post Sclerotherapy hyperpigmentation: This is a common complication which clears within 6 months, may rarely persist for a year or more. Bleaching agents (hydroquinone), exfoliants (retinoic acid, trichloroacetic acid or phenol), Cryotherapy, and other laser treatment may help improve the pigmentation, but studies shows these agents have limited success in treatment of post Sclerotherapy hiperpigmentation. Few studies have shown Q-switched ruby lasers have excellent outcome.
Telangiectatic Matting: It refers to the appearance of new groups of fine telangiectasias at the site of previously treated veins. This usually resolves spontaneously within 3-12 months time.
Cutaneous Ulceration and Necrosis: Cutaneous ulceration may occur with all the sclerosing solutions, even if it’s on the hand of skilled dermatologist. Sclerosing solution may sometimes leak out into the skin through the small puncture sites of vessel cannulation and cause necrosis. This is usually managed and prevented by injecting normal saline in a ratio of 10:1 over sclerosant into the leakage site.
Allergic Reaction: Some people may have allergic reaction to the sclerosing agents but this is usually uncommon.
Superficial Thrombophlebitis: Superficial thrombophlebitis is a rare complication of Sclerotherapy, although recent reports indicated that the incidence is higher than previously suspected. It can be managed by leg elevation and the use of compression and regular use of aspirin or other nonsteroidal anti-inflammatory medications.
Pulmonary Embolism: Pulmonary embolism is extremely rare complication. It has been associated with injection of large quantities of sclerosing agent at a single site.