What is Sclerotherapy Vein Treatment?
Sclerotherapy is one of the most common treatments for smaller Diseased Veins of the lower body including:
- Eliminating Spider veins,
- Removal of smaller Varicose Veins,
- Treating Vascular Malformations in children and young adults (rare).
Sclerotherapy is also known as “Chemical Sclerosis” “Endovenous Chemo-ablation” “Ultrasound Guided Sclerotherapy” and “Micro-Sclerotherapy”.
The term “Sclerotherapy” comes from the Greek word “sclero” which means ‘to make hard’.
Sclerotherapy has been used for Vein Treatment for over 100 years. In recent years, Sclerotherapy techniques have changed with the use of improved imaging technology and injection solutions.
How does Sclerotherapy Work?
Sclerotherapy involves injecting a solution (Sclerosant) into the Diseased Veins. The solution is designed to cause vein wall lining irritation, inflammation and death of the cells lining the wall. This causes the targeted vein walls to collapse, stick together and become hard to the touch.
Once the damaged vein is closed shut and the blood flow is stopped, the vein turns into scar tissue which is eventually absorbed.
Most people who receive this treatment see at the very least a 50 percent improvement after a single treatment.
What Vein Disease does Sclerotherapy Treat?
Sclerotherapy is one of the most common treatments for Spider Veins and smaller Varicose Veins. Blood vessels that can be treated using Sclerotherapy include:
- Spider Veins - the most common treatment.
- Telangiectasias - flat red veins that are smaller than 1 mm in diameter.
- Venulectasias - blue veins that are sometimes swollen above the skin surface, and smaller than 2 mm in diameter.
- Reticular ectasias - blue or purplish discoloration and are 2-4 mm in diameter.
Sclerotherapy works best when the Sclerosant material can directly contact the vein wall. This means that it works best in small (<6mm) veins and veins that are relatively “empty” of blood.
Why Consider Sclerotherapy
Elimination of Diseased Truncal Veins helps reduce the risk of new Venous Disease and Deep Venous Thrombosis (Venous Blood Clot.)
Approximately 75% of patients can expect to have their Truncal Venous Disease treatment complete after a single Ultrasound Guided Sclerotherapy session to the affected leg.
Approximately 25% of patients require a second or subsequent Ultrasound Guided Sclerotherapy session to control the Truncal Venous Disease in the affected limb.
Benefits of Sclerotherapy
Sclerotherapy has the following benefits;
- Virtually pain free
- Safe for patients
- Proven over many years
- Continually being improved.
Sclerotherapy is said to eliminate much of the vein condition in just one treatment. Spider Veins respond in weeks, while larger Varicose Veins may take up to three to four months.
Successful Sclerotherapy Treatment
Successful Sclerotherapy treatment can be encompassed by three points:
- Preparation of affected area
- Injection of sclerosants
- Post-op compression stockings
Sclerotherapy Treatment Process
Due to limits in the volumes and concentration of Sclerosant that can safely be used in any single treatment session, ONLY ONE LEG is treated at a time.
The number of veins treated in one session will be decided by our Doctors and be based on the size and location of the veins. Typically, there is a two week interval between first and second treatments and then a 1-month period to assess response.
The same leg may be retreated as early as 2 weeks, but as mentioned earlier; optimal re-treatment intervals are approximately 9-12 weeks. This assures minimal treatment sessions, improves results and helps reduce costs. The other leg may be treated the following week.
Selecting The Right Treatment
The Doctor will discuss your possibilities and treatment choices. Treatment choices will vary depending on the location and size of the Diseased Veins and other patient needs.
Diseased Truncal Vessels, which are not readily visible, require the use of Ultrasound. Ultrasound helps the Surgeon to identify and clearly visualise the affected area and enable accurate guidance of the needle into the blood vessel for the purpose of injecting the Sclerosant.
Sclerotherapy Treatment can vary based on the choice of the injected Sclerosant, as well as the volume and concentration required. Common Sclerosant used are:
- Sodium Tetradecyl Sulphate and Aethoxysklerol that can be directly injected as a solution, or combined with CO2 to create a micro-bubble foam
- Nitrogen Free Foam is used to treat larger veins, as this penetrates better than its liquid sclerosant.
Sclerotherapy Treatment Types
Sclerotherapy can be broken down into two separate treatments:
- Ultrasound Guided Sclerotherapy
There are four common types of Sclerotherapy
- MicroSclerotherapy (visible, small, surface veins)
- Ultrasound Guided Sclerotherapy using a liquid solution
- Ultrasound Guided Sclerotherapy using a Nitrogen Free Foam
- Fluoroscopic Guided Sclerotherapy.
MicroSclerotherapy is also known as direct injection Sclerotherapy or fine needle Sclerotherapy. This method involves the direct injection of a solution into Visible Spider or Varicose Veins.
Superficial Veins or those on the skin’s surface that are visible veins can treated using MicroSclerotherapy because the diseased vessels can be directly visualised and do not require an Ultrasound device.
MicroSclerotherapy is a relatively straightforward using tiny needles to inject the abnormal tiny veins to close off the vein.
How successful is MicroSclerotherapy?
Success in treatment of surface veins is measured in terms of cosmetic appearance.
After one treatment session of MicroSclerotherapy to one leg, most patients can expect a 50% improvement in the appearance of unsightly veins.
A second treatment session to the same leg usually results in a further 20% improvement. A third and subsequent treatment provide another 5 to 10%.
The fading process is gradual so the full benefit of a single treatment session may not be fully realised until 2 to 3 months later.
It is important to understand that perfection is seldom achieved.
Ultrasound Guided Sclerotherapy
In Ultrasound-Guided Sclerotherapy, Ultrasound is used to visualise the underlying vein so the doctor can monitor the injection accurately and deliver the solution or Sclerosant.
Ultrasound Guided Sclerotherapy is used for treating some Superficial Veins as well as Deeper Truncal Veins, as these veins cannot be visualised on the surface.
In Ultrasound Guided Sclerotherapy, an Ultrasound is used to visualise the underlying vein in real time. The Doctor can then:
- Clearly map the Varicose Veins
- Accurately monitor the injection
- Effectively deliver the solution to the Varicose Vein.
Like MicroSclerotherapy, Ultrasound Guided Sclerotherapy technique involves injecting a Sclerosant substance, directly into the Varicose or Spider Vein using a very fine needle.
The Sclerosant can be observed entering the vein, and further injections performed so that all the abnormal veins are treated.
Benefits of Ultrasound Guided Sclerotherapy
The advantages of using Ultrasound Guided Sclerotherapy is that it:
- is quick - taking about 15 to 30 minutes,
- requires no incision,
- less time for recovery,
- no scar formation and
- does not require an overnight stay in the hospital.
This method has been shown to be effective in controlling Reflux from the Sapheno-Femoral and Sapheno-Popliteal Junction.
Where is Ultrasound Guided Sclerotherapy Not Suitable?
Large Varicosities do not respond as well as small Varicosities to Sclerotherapy.
How successful is Ultrasound Guided Sclerotherapy?
Ultrasound Guided Sclerotherapy is extremely safe and effective with no downtime. so you will be back on your feet as soon as treatment has been completed.
Success in treatment of Truncal Veins is measured in terms of closure of Diseased Veins and reduction of symptoms such as leg pain, heaviness and aches etc.
Frequently, patients report a 10 to 20% improvement in the cosmetic appearance also.
Ultrasound Guided Sclerotherapy - Foam Injection
In order to improve the efficacy of Sclerotherapy, several modifications of the original technique have occurred. The most popular of these being “Foam Sclerotherapy” also referred to as UGFS (Ultrasound Guided Foam Sclerotherapy.)
Ultrasound Guided Sclerotherapy with Foam Injection is generally used to treat larger veins, as this penetrates better than its liquid counterpart. An Ultrasound is used to track the foam to ensure that foam enters the Varicose Veins and not normal veins.
The Sclerosant can be mixed with gas to form a “foam”, so named for its similar appearance to shaving foam.
How does Foam Sclerotherapy Work?
The foam Sclerosant drug delivers better results because when the Sclerosant is injected into a vein, the foam displaces the blood improving contact of the Sclerosant with the vein wall.
Nitrogen Free Foam Sclerotherapy
Because Nitrogen does not dissolve very well in the blood and in some people (particularly those with a history of migraine), it may pass through a small hole in the heart directly to the brain.
In most people, side effects are few and mainly consist of temporary (20 min) visual disturbance. In order to reduce this side effect, the clinic uses a “Nitrogen Free Foam” pure Oxygen or Carbon-Dioxide Gas, which greatly reduces the risk of any such problems.
Ultrasound Guided Sclerotherapy with Foam Injection can also be used in conjunction with Laser Ablation Therapy.
How Long does Foam Sclerotherapy Take?
The Sclerotherapy procedure is performed in the treatment room and takes approximately 1 hour for the entire process. This includes set-up, pack-up, application of stockings etc.
The Ultrasound Guided Sclerotherapy procedure takes approximately the same amount of time but is performed in the Vascular Laboratory at the same premises.
As the session progresses, the doctor will be able to see the effect of each individual injection through the monitor, and so ensure the safety of any adjacent blood vessels.
This may be done multiple times, the total procedure taking anywhere from five to thirty minutes, depending on how many veins need to be treated.
Usually, several injections will be needed along the vein to ensure that the targeted vein is collapsed completely.
Is Sclerotherapy Painful?
No. Sclerotherapy is generally very well tolerated. Patients with a fear or phobia to needles have been treated successfully.
MicroSclerotherapy may involve up to 20 to 30 injections in a single treatment session. The type of needle used for this technique is the similar in size to that used for acupuncture.
Most often, Sclerotherapy is pain-free, however slight pain or superficial burning sensation is felt over the treated area.
Is Sclerotherapy Safe?
Patients who are either immobile or unable to wear grade 2 compressive stockings are not suitable for Sclerotherapy. Also patients with a strong history of Deep Venous Thrombosis (DVT) or Blood Clotting Disorder must be treated with extreme caution.
Deep Venous Thrombosis risk factors can be readily identified during the initial consultation. The risk of Deep Venous Thrombosis per Sclerotherapy treatment has been reported in the scientific literature as ranging from 1 in 100 to 1 in 1000.
Also untreated Varicose Veins are a risk on their own. Early detection and prompt treatment remain the best option for managing this complication.
In patients with no additional risk factor, Sclerotherapy is a very safe treatment option.
Pregnancy and Breastfeeding
Sclerotherapy should not be performed on patients who are pregnant or intending to become pregnant. The same rule applies to mothers who are breast feeding. There is no current data available on the effect of using Sclerosants during pregnancy or breastfeeding.
Sclerotherapy Treatment well in advance of becoming pregnant is advisable as it may assist in reducing the overall disease progression during pregnancy. Unlike surgical stripping, new Varicose Veins that may appear following pregnancy can be quite easily managed with Sclerotherapy.
Costs of Sclerotherapy
Treatment may cost somewhere upwards of $350. Where the condition is severe and many veins are needed to be treated, the cost will increase and may be in the order of $600.