Sclerotherapy is the standard treatment for small varicose and spider veins. A sclerosing solution is injected into the vein. The vein becomes irritated, collapses and is gradually absorbed by the body. It is very common for the vein to appear darker and more visible immediately after the injection session. Compression hose-Prescription-strength compression stockings will enhance the results of treatment and reduce potential side effects. This process causes a gradual fading of the treated vessel over a period of several weeks to several months. The legs, ankles, feet, breast and hand small varicose veins and spider veins are usual treatment locations.
The needles used for the injections are as fine as your hair and typically not painful. Most patients agree that sclerotherapy is less painful then laser treatment. Since a solution is injected along the length of the vein, a large treatment area can be performed during one session. In the past, the pain associated with this therapy was not the injections but rather due to the solutions utilized. With today's newer medications there is no pain from the solutions. Certain medications can be foamed to increase their effectiveness.
The most important reason why sclerotherapy is still the gold standard for leg vein treatment is that you can treat the entire vein and the underlying skin veins known as reticulars, which feed the spider veins on your legs. This is analogous to removing the branches on a tree rather than just the leaves. This results in more durable results and a longer time before recurrence. To see the underlying veins a high power painless fiberoptic light is used to help guide the injections.
These underlying reticular veins often cannot be seen by the naked eye and therefore a laser beam, resulting in inadequate results with laser. By the end of the treatment program, the veins are not visible on the skin surface. Sclerotherapy is most effective on smaller surface veins, less than 1-2mm in diameter.
- Click here to read an in-depth article on Sclerotherapy authored by Dr. Dietzek
Ultrasound Guided Sclerotherapy
To ensure precision, sclerotherapy is performed with the aid of ultrasound imaging. Ultrasound is a primary diagnostic and visualization tool because of its convenience, safety and effectiveness. Ultrasound produces images of internal structures through the use of high-frequency sound waves, whose echoes are used to create moving and still images. This visualization allows the doctor to target the location and precise nature of the problem area.
The ultrasound guided sclerotherapy procedure begins with the patient lying down on the examination table as a water-based gel is applied to the area on their body that will be observed. This gel allows consistent contact between the body and the transducer, free of any air pockets that could get in the way. The transducer is kept firmly against the skin and is moved back and forth across the area to allow for the most detailed observation possible. The ultrasound is instrumental in locating the diseased portion of the vein in order to guide the doctor in exactly where to place the needle as well as in determining the number of injections that will be necessary.
Once the treatment site has been identified by ultrasound, the affected veins are injected with a sclerosant solution, which causes the veins to eventually collapse and be absorbed into the bloodstream. This safe procedure can be performed on an outpatient basis in the doctor's office and takes less than an hour to complete. Anesthesia is not needed for sclerotherapy. After the sclerotherapy procedure, cotton balls and compression tape are applied to the injection site. Patients usually report only a mild burning sensation during the treatment.