A number of factors may contribute to the development of spider veins in the legs, including heredity, hormonal shifts, occupations or activities that require prolonged sitting or standing. Whatever the reason, there are effective, safe and relatively painless methods available for reducing these unsightly veins.
What is Sclerotherapy?
Sclerotherapy is a medical procedure used to eliminate varicose veins and spider veins which has been safely and effectively performed for over 50 years. It involves an injection of a solution directly into the vein. The solution irritates the lining of the blood vessel, causing it to swell and stick together, and the blood to clot.
Does Sclerotherapy work for everyone?
Prior to the procedure you will have a consultation with a provider who will advise you of your eligibility for sclerotherapy. You are not eligible if you are pregnant, breastfeeding or have limited mobility. If you have a history of a blood clot your eligibility will be determined on an individual basis. Other contraindications include history of breast cancer treated with Tamoxifen, current anticoagulation, acute infection and/or fever and history of allergic reaction to the sclerosing agent(s).
How many treatments will I need?
The number of treatments varies from patient to patient depending on the extent of varicosities present. On average, patients require 3-4 sessions for satisfactory results. Unfortunately, there is no guarantee that sclerotherapy will be effective in every case. Approximately 10% of patients who undergo this procedure do not respond to the injections at all.
What are the side effects and complications of Sclerotherapy?
Sclerotherapy side effects and complications include, but are not limited to hyperpigmentation, temporary swelling, capillary dilation (telangiectatic matting), pain from the injection, localized hives, tape compression blister, folliculitis, treatment failure, recurrence, vasovagal reflex, localized hair growth, ulceration, skin necrosis, allergic reaction, superficial thrombophlebitis, arterial injection, pulmonary embolism, deep vein thrombosis, nerve damage, and migraine headaches.
What happens after treatment?
After the treatment you will be able to drive yourself home and resume your regular daily activities. Walking is encouraged. You will be instructed to wear medical grade support hosiery to "compress" the treated vessels for 14 days following treatment. Department store support stockings will not be adequate.
Avoid aspirin, ibuprofen or other anti-inflammatory medications for 7 days before and after treatment to minimize the risk of bruising. Tylenol may be used if needed. You should also avoid hot baths, warm compresses, hot tub or sauna use and direct exposure to sunlight for 14 days following treatment. Showers are permitted and the injection sites may be washed with a mild soap.
Will my insurance cover Sclerotherapy?
Insurance coverage varies though if you are pursuing sclerotherapy for cosmetic purposes your insurance carrier most likely will not provide coverage. If you have questions, please call your insurance company.
What to Expect
Photographs will be taken before treatment is initiated. This helps to monitor your progress. Your legs will look worse before they look better. After the vein is damaged the body needs time to heal. Most people will notice a dramatic improvement approximately four weeks after their initial treatment. Maximal improvement often takes several months and several treatments. There is no guarantee sclerotherapy will be effective in every case. Some veins and areas will need to be retreated. Recurrence of the same vein treated rarely occurs with proper injection technique and compliance with post treatment instructions. New varicose veins or “spider” veins may form requiring subsequent treatment. Periodic re-evaluations are encouraged so that any new veins that develop can be injected before they become too large or too numerous.
Sclerotherapy Pre-Treatment Instructions
Compression Hose. They are required to be worn immediately after each injection treatment or if you have had aspiration of trapped blood from an injected vein. You will be given a prescription to purchase these at a local pharmacy or medical supply store. You cannot be injected without your compression hose. The hose must be worn continuously 24 hours a day and for 14 days. The hose can be removed to be laundered or while bathing, preferably at night while you are inactive. Your doctor may adjust the length of time you wear your hose. The compression hose are critical to the success of the treatment.
Regarding Leg Preparation. Do not apply oil, lotion or powder to your legs the night before or the day of your injections. Use of these toiletries will not allow the cotton balls and tape (if needed), to adhere to your skin. Do not shave your legs the day of the procedure.
Clothing. Bring a pair of loose, comfortable shorts to wear during your treatment. Dress in loose clothes and comfortable shoes to accommodate the cotton balls, tape and hose after your treatment.
Medications. Discontinue Aspirin (Bufferin, Anacin, etc.) and Ibuprofen (Motrin, Advil, Aleve etc.) for 7 days before and after injections to reduce bruising. Acetaminophen (Tylenol) is allowed.
Time Allotment. A sclerotherapy treatment should last approximately 30 minutes. You should arrive 10-15 minutes early for your first sclerotherapy treatment to allow time for photographs and to sign your consents. You should then allow an additional 10 minutes to apply your support hose, get dressed and to check out of the office. If you need to cancel or reschedule your sclerotherapy treatment, please give our office at least 72 hours notice.
Photographs. Photographs will be taken before your first treatment to document progress and/or for the purpose of medical education, research, scientific publication or educational presentations. You will not be identified in your photographs and informed consent will be obtained before you are photographed.
Sclerotherapy Post-Treatment Instructions
Compression. Before standing, you will put on your compression hose. Proper compression is very important because it minimizes the blood re-entering the injected vein, decreases the incidence of post-sclerotherapy hyper pigmentation and improves venous blood flow. The cotton balls and tape can be very uncomfortable and may even irritate and blister sensitive skin. The hose should be worn for 24 hours a day continuous for 14 days. They may be removed to launder or while bathing, preferably at night when you are inactive.
Bathing. A shower is allowed after the first 24 hours. Hot baths, hot tubs and saunas should be avoided for two weeks after sclerotherapy to avoid venous dilatation.
Hyperpigmentation. If you develop hyper pigmentation after sclerotherapy you should apply sun block to those areas when sun exposure is anticipated to avoid increasing the hyper pigmentation. Continue to use sun block until the hyper pigmentation has resolved.
Driving. You may drive immediately after your treatment. If your trip home is longer than an hour we recommend you stop hourly to stretch your legs.
Activity. In most cases, you may return to work and resume normal activity after treatment. Please take a 15-minute walk immediately following your treatment. This will help circulate the solution that was injected. Walking is encouraged as it promotes efficient venous circulation. Avoid sitting and standing for extended periods and elevate your leg(s) above the level of your heart when possible for the next two to three days. Avoid high impact aerobics, jogging, running, leg weight lifting and sit-ups for one week after each injection treatment.
Medications. Do not use Aspirin or Ibuprofen products for 7 days after each treatment to reduce bruising. Acetaminophen (Tylenol) can be used if you experience any discomfort from sclerotherapy.
Follow-Up. Subsequent treatments are usually every four to six weeks. Your doctor will advise you if and when you should return. If you notice dark knots or cords at your injection sites please call our office as you may need to return sooner to have these areas aspirated.
Remember it is important to call our office if you have any questions or concerns before or after your sclerotherapy treatment. Please keep your follow-up appointment after treatment. It is important for the provider to assess the results you achieved from each treatment. If you need to cancel or reschedule your sclerotherapy treatment or follow up appointment, please give our office at least 72 hours notice.