Debra Weissman MD
40 Cross Street
Norwalk, CT 06851
203-847-1500

 

Sclerotherapy is the method of eliminating superficial telangiectases ("spider veins") and some varicose veins by the injection of a solution or foam called a "sclerosing agent" into the unwanted veins. A tiny needle is threaded into the blood vessel and a small amount of the sclerosing agent is gently injected. The injection "flushes out" the blood temporarily and produces an inflammatory reaction in the wall of the blood vessel. This reaction produces "sclerosis" or the formation of fibrous tissue within the vessel, leading to its gradual disappearance. This fading can take from a few weeks to a few months.

Individual veins or groups of veins may need to be treated on more than one occasion to achieve optimum results. The total number of treatment sessions depends on the amount and severity of the abnormal veins. The vast majority of patients who have sclerotherapy will have significant clearing of the veins with at least good improvement. There can be no guarantee, however, that it will be effective in every case.

The exact sclerosing agent to be used for a particular vein will depend on its size, color and location. For very small, red to purple veins, a concentrated salt-sugar solution may be appropriate. For larger, blue veins, stronger solutions or foams are needed. This may also be the case where clusters of apparently small veins are found to be connected to larger, deeper ones. The agent(s) to be used will be discussed with each patient depending on the characteristics of that individual's particular veins.

It is important to realize that sclerotherapy does not prevent the development of new spider veins or varicose veins, and some people may need periodic treatments to keep their legs clear.

All medical and surgical procedures have some potential side effects, and sclerotherapy is no exception. Among the known side effects of small vessel sclerotherapy are discomfort at the time of injection; bruising; brown spots or lines (hyperpigmentation) at the sites of treated vessels, which usually disappear, but can occasionally persist; development of small networks of tiny blood vessels ("matting") near injection sites, which may require further therapy or persist; and small ulcers, which may heal with scars. Additionally, treatment of larger veins can occasionally be complicated by allergic reactions to the sclerosing agents or by tenderness or firmness along the course of the treated vein. Foam sclerosants have rarely been associated with visual and neurological symptoms which have usually been temporary. Sclerotherapy is generally very well tolerated and the vast majority of patients experience minimal side effects (bruising and discomfort/cramping at the time of injection are not uncommon).

Alternative treatments for unwanted leg veins exist. The use of compression stockings can help with symptoms such as tiredness or leg pain, but they do little for the appearance of the veins. Large veins can be treated by surgical procedures such as vein stripping or vein ligation, which may be appropriate for some conditions, but may leave scars. Newer techniques whereby fine catheters with radiofreqency or laser tips are inserted into these large veins to treat them from the inside are rapidly replacing the traditional stripping procedures. Certain types of superficial, bulging varicose veins may be treated by ambulatory phlebectomy, a procedure in which veins are removed using small hooks through tiny incision under local anesthesia. Recently, external lasers and flashlamp light systems for treatment of leg veins have been developed and touted. They have promise, especially for the smallest veins (spider veins, telangiectasia), but have as yet proven less effective for larger ones. Individual vessels may need multiple treatments and the incidence of unsatisfactory results is still quite high. The main problem is scarring, but pigment changes (skin over and around the treated veins becoming darker or lighter than the surrounding skin) are common. Laser treatments of leg veins are generally much more painful than sclerotherapy. We have explored the use of lasers and other light sources and are incorporating them when appropriate. They may find their greatest use in treating small, residual vessels, as well as secondary matting, after the larger vessels have been removed by sclerotherapy. The role that lasers and similar light sources will ultimately play in the overall treatment of leg veins has yet to be determined.

Appropriate treatment for leg vein problems involves tailoring the treatment to the specific types and sizes of unwanted veins present in any given individual. The best treatment program may involve more that one treatment modality. Proper diagnosis and analysis of each person's leg vein problems is critical to planning appropriate therapy. We will be happy to discuss with you the nature of your problem and what treatments will likely work for you (and what will not).

 

 

(Revised 12/09)