Increased superficial leg veins, such as telangiectasias (spider veins), or larger varicose veins, are common. Often there is a family tendency, and they may be worsened by hormones (including pregnancy), prolonged periods of standing or sitting, being heavy, or certain underlying diseases. While many patients have no discomfort, some have itching, burning, or aching of these leg veins, and symptoms may worsen with menstrual periods. These superficial leg veins may be removed or closed without affecting the circulatory system in the body.
What is Sclerotherapy?
Sclerotherapy is a non-surgical procedure for closing unwanted superficial leg veins. A sclerosing solution is injected into the veins using a tiny needle. The solution can be a detergent (made specifically for sclerotherapy), irritant, or hypertonic solution (such as concentrated saline). Multiple small injections will result in some temporary stinging and localized swelling of the treated veins. Immediately after the procedure, tight compression stockings are worn continuously for 3-7 days. This combination of injections and compression leads to gradual closure of the veins. We recommend 20-30 mmHg medical compression stockings (thigh-high with gripper tops, or pantyhose). If larger veins are treated, higher compression and longer wearing time may be needed. Walking for 30 minutes per day, for at least one week following the procedure, will help speed the improvement, and help with any discomfort.
What can I expect during the consultation?
Before you schedule sclerotherapy, a vein consultation appointment is necessary. At that time, the practitioner will discuss your medical history, examine your leg veins, and let you know what specific treatment is recommended in your case. In preparation for your treatment session, you should discontinue aspirin and non-steroidal anti-inflammatory medications for one week (consult your prescribing practitioner). You should avoid sun exposure to the legs for a few weeks before and after the session, to minimize hyperpigmentation. Wear loose clothing, and bring your compression stockings with you to the appointment.
What can I expect after treatment?
After the session, you should be able to return to normal activity. Temporary bruises are common, and will fade over 1-2 weeks, followed by gradual improvement of the leg veins. Treated vessels become less defined, then gradually thinner, finer, and less apparent. Sometimes, tan color develops, and the vessels may become darker, firm, or lumpy, especially if larger veins are treated. This normal reaction will improve, though small amounts of tan pigment may occasionally persist. Fading of the veins may be noticed at 1-2 months, but gradual fading will continue for 3-6 months after injections. Multiple treatments are required for best results, usually 2-6 treatments spaced one to a few months apart. We can’t eliminate all unwanted veins, or guarantee results, but most patients improve with sclerotherapy. Usually 50-70% of veins will fade after multiple treatments. Whether treated or not, most patients will continue to develop new veins, which may be treated periodically, as desired. Continued use of support hose may help in prevention.
What risks are involved?
All medical procedures have some risks. In addition to expected reactions already discussed, a small scab or open sore may occur at an injection site. This will heal, but could leave a small scar. Patients should call the office if any scabs or sores are noticed. Occasionally, a network of tiny veins may develop around an injection site. This is called “matting”, and the new veins often improve without further treatment. If persistent, they may respond to additional injection or laser treatment. Rarely, inflamed, painful veins (thrombophlebitis) may occur, and very rarely, blood clots in the deeper veins may occur, which have a remote chance of traveling to the lungs. Allergic reactions to sclerosing solution are rare, but notify your practitioner of any allergies before the procedure. You should also let your practitioner know if you suffer from thrombophlebitis, deep vein thrombosis, poor circulation, clotting disorders, history of pulmonary embolus, or swelling of the legs or feet.
Are there other options for treating leg veins?
Laser treatment is also available in our office, however, only the tiny leg veins respond to laser, and most cases require additional treatment for best results. Larger varicose veins may have underlying venous reflux (abnormal blood flow), and other treatments such as surgery, endovenous laser ablation, or ultrasound-guided sclerotherapy might be recommended. These are not performed in our office, but we can refer you to the appropriate physicians if needed.
Sclerotherapy for leg veins, as performed in our office, is considered an elective, cosmetic procedure, and is not billed to insurance.