Q What is Sclerotherapy?

A Sclerotherapy is a popular method of eliminating varicose veins and superficial telangiectasias (“spider veins”) in which a solution, called a “sclerosing agent,” is injected into the veins causing them to collapse. The procedure may also remedy the bothersome symptoms associated with spider veins, including aching, burning, swelling and night cramps. Sclerosing agents that are mild enough to be used in small veins have made sclerotherapy predictable and quite painless.

Q What are spider veins?

A Spider veins usually take on one of three basic patterns. They may appear in a true spider shape with a group of veins radiating outward from a dark central point; they may be arborizing and will resemble tiny branch-like shapes; or they may be linear and appear as thin distinct lines. They represent a dilation of surface vessels secondary to increased pressure in the deeper veins. Spider veins do not serve any physiological purpose. For all intents and purposes, they are considered “redundant vessels.”

Varicose veins differ from spider veins in a number of ways. Varicose veins are larger in diameter, darker in color, and tend to bulge. Varicose veins are also more likely to cause pain and be related to more serious vein disorders. For many patients, sclerotherapy can be used to treat varicose veins. For others, Dr. Ali uses the combination of sclerotherapy and laser treatments to give excellent results. In extreme conditions, surgical treatment is necessary for this condition.

Q Who are the best candidates for sclerotherapy?

A Women of any age may be good candidates for sclerotherapy, but the typical patient is in the 30 and above category. Spider veins in men aren't nearly as common as they are in women. Men who do have spider veins often do not consider them to be a problem as the veins are concealed by hair. However, sclerotherapy is just as effective for men, and Dr. Ali has several male patients.

Q What should I expect from sclerotherapy?

A After each sclerotherapy session, the veins may appear to be worse until they begin to fade. Two or more sessions are usually required to achieve optimal results. Bruising after each session can last up to six weeks.

You should also be aware that the procedure treats only those veins that are currently visible; it does nothing to prevent new veins from surfacing in the future.

Before you decide to have sclerotherapy, think carefully about your expectations and discuss them with Dr. Ali.

Q What are the risks related to treatment?

A Serious medical complications from sclerotherapy are extremely rare when the procedure is performed by a qualified practitioner. However, they may occur. Risks include the formation of blood clots in the veins, severe inflammation, adverse allergic reactions to the sclerosing solution, and skin injury that could leave a small but permanent scar.

A common cosmetic complication is pigmentation irregularity - brownish splotches on the affected skin that may take months to fade. Another problem that can occur is "Telangiectatic matting," fine reddish blood vessels around the treated area, can occur which will require further injections or treatment with the Vbeam laser.

The risks are reduced when you work with a qualified doctor who is well versed in the different types of sclerosing agents available. Dr. Ali will decide which sclerosing agent is appropriate for your condition.

Q How many treatments will I need?

A The number of treatments needed differs from patient to patient, depending on the extent of varicose and spider veins present. The average is three to four. Individual veins usually require one to three treatments. Dr. Ali believes that a combination of sclerotherapy and Vbeam or GentleLASE laser yield optimal results.

Q What are the most common side effects?

A The most common side effects experienced with sclerotherapy treatment are as follows:

1. Itching. Depending on the type of solution used, you may experience mild itching along the vein route. This itching can last anywhere from a couple to one to two days.
2. Transient Hyperpigmentation. Approximately 30% of patients who undergo sclerotherapy notice a discoloration of light brown streaks after treatment. In almost every patient, the veins become darker immediately after the procedure. In rare instances, this darkening of the vein may persist for 4 to 12 months.
3. Sloughing. Sloughing occurs in less than 3% of patients who receive sclerotherapy. Sloughing consists of a small ulceration at the injection site that heals slowly. A blister may form, open, and become ulcerated. The scar that follows should return to a normal color.
4. Allergic Reactions. Although it is extremely rare, a patient may have an allergic reaction to the sclerosing agent used. The risk of an allergic reaction is greater in patients who are treated with solutions other than saline-based solutions.
5. Pain. A few patients may experience mild to moderate pain and some bruising, usually at the site of the injection. The veins may be tender after treatment, and an uncomfortable sensation may run along the vein route. This pain is usually temporary, in most cases lasting one to, at most, seven days.
   

Q What are the other possible side effects?

A Other side effects include a burning sensation during injection of some solutions, neovascularization (the development —usually temporary —of new tiny blood vessels), transient phlebitic-type reactions (swelling of the vein might cause the ankles to swell), temporary superficial blebs or wheals (similar to hives), and, very rarely, wound infection, poor healing, or scarring. Phlebitis is a very rare complication, seen in approximately 1 of every 1000 patients treated for varicose veins greater than 3 to 4 mm in diameter. The dangers of phlebitis include the possibility of pulmonary embolus (a blood clot to the lungs) and postphlebitis syndrome, in which the blood clot is not carried out of the legs, resulting in permanent swelling of the legs.

Q Are there other types of procedures to treat varicos veins and telangiectasias? What are their side effects?

A Vein striping and/or ligation may also be used to treat large varicose veins. This generally may require a hospital stay and is performed while the patient is under general anesthesia. Risks of vein stripping or ligation include permanent nerve paralysis in up to 30% of patients and possible pulmonary emboli, infection, and permanent scarring. We do not perform this vein stripping or ligation at our center.

Q How do I get started?

A Arrange a consultation with Dr. Ali to discuss your expectations and the estimated number of treatment sessions you will need.