Sclerotherapy is a procedure used to treat blood vessels or blood vessel malformations. A medicine or detergent is injected into the vessels, which makes them shrink. Sclerotherapy is most often used to treat spider veins, reticular veins and smaller varicose veins. Please refer to the before and after photos on the this site. Only a licensed and trained health care professional should perform this procedure. He or she will use a very small needle to inject an FDA approved sclerosant agent or detergent called Polydocanol. Injecting the unwanted veins with this sclerosing agent causes the target vein to immediately shrink, and then dissolve over a period of weeks as the body naturally absorbs the treated vein.
Sclerotherapy is the "Gold Standard" and is preferred over laser therapy for eliminating large spider veins and small varicose veins. Unlike a laser, the sclerosing solution additionally closes the "feeder veins." After the treatment the patient's leg is then compressed with either stockings or bandages that they wear up to two weeks after. Patients are also encouraged to stay active and walk regularly during this time. Common practice requires the patient to have at least 2-3 treatments separated by 2-3 weeks to improve the appearance of their legs.
Spider veins are tiny dilated blood vessels visible as purple, blue or red streaks, located just below the surface of the skin and sometimes occurring in web-like groups. Spider veins can occur on the face, chest, and abdomen, but are more common on the thigh, calves, and ankles. Unless treated, they are permanent and tend to increase in number over time. Although spider veins are mainly a cosmetic problem, they can be an indication of venous disease below the surface of the skin. Spider veins drain into deeper veins called reticular veins. Reticular veins may or may not be visible to the naked eye, or can be easily seen with the use of high intensity light applied directly to the skin (transillumination). Identification and treatment of reticular veins is an important aspect of the successful treatment of spider veins.
Spider veins are usually of cosmetic concern, but may be associated with itching or burning. If spider veins are associated with leg heaviness, fatigue, and/or swelling, dilated veins below the skin surface may be to blame. Occasionally spider veins spontaneously rupture and bleed, or they may bleed with trauma such as may occur during shaving.
The exact cause of spider veins is unknown. The presence of spider veins is sometimes an inherited trait. Spider veins may also appear after trauma or surgery. No correlation exists between crossing the legs, wearing constrictive clothing or garters and the occurrence of spider veins. More common in women, spider veins may be triggered by hormonal variations such as occur in pregnancy. Spider veins may be associated with venous hypertension due to larger diseased veins causing pressure on tiny veins which then dilate at the skin surface. If this possibility is considered, duplex ultrasound imaging can evaluate for underlying venous disease, which should be treated prior to treatment of spider veins.
Sclerotherapy is often used to treat varicose and spider veins. Using a tiny needle, veins are injected with a solution that irritates the lining of the vein wall, causing them to collapse and gradually fade away. This procedure is performed in office, usually lasting approximately 30-60 minutes. Multiple treatments may be needed to reach desired results. For optimal results, reticular veins associated with spider veins also need to be sclerosed. Compression stockings are worn for about one week post procedure. Most patients resume normal activities immediately. An allergic reaction to a sclerosant is rare, but has been reported. Staining, or brown discoloration on the skin is a possible side effect of sclerotherapy. This staining may take six months or longer to fade. Rarely sclerotherapy may result in the breakdown of a small area of skin resulting in an open wound (an ulcer). Some patients may develop lace-like matted webs of tiny, dilated, red, blue, or purple capillaries, arterioles, or venules visible just below the skin surface after sclerotherapy. Despite appropriate treatment, spider veins may recur later in life, possibly due to the underlying genetic predisposition that led to the development of spider veins in the first place. Treating spider veins does not keep new ones from appearing, but treating new ones every few years may be appropriate to keep them from becoming too extensive. After childbearing years, which are associated with hormonal swings, spider veins may develop more slowly.