What are the veins that we treat?
- Spider veins or telangiectases - tiny short unconnected or spidery branching vessels.
- Reticular veins - smaller blue veins that do not protrude.
- Smaller varicose veins - veins that bulge above the skin surface
The cause of reticular and spider veins is not known. However, studies show that approximately 25% have disease in bigger deeper veins that is not yet apparent and that treating the surface veins without controlling diseased deep veins leads to poor outcome. For this reason, we advise that all patients with superficial cosmetic veins have an ultrasound scan to look for deeper disease.
Sclerotherapy
Sclerotherapy involves injecting a "sclerosant" directly into each vein with very fine needles. The sclerosant used (Aethoxysklerol - polidocanol) is a detergent and acts by washing away the lining of the vein allowing the two walls to stick together. Sclerotherapy was introduced in the 1920s and made popular in the 1960s when it was shown to be effective for non-saphenous varicosities. Polidocanol was introduced into Australia nearly 20 years ago and was extensively investigated here in a trial involving more than 30,000 patients.
Sclerotherapy is used to treat smaller veins that are not associated with reflux into the main saphenous veins and also to treat residual veins left after other forms of treatment. Most patients can expect at least a 75 percent improvement in the appearance of their legs.
Multiple treatment sessions are frequently required. It takes up to several weeks to show maximum benefit after one treatment session. Perfection cannot be guaranteed.
What should you do before sclerotherapy?
- Do not cease medications prior to treatment unless otherwise advised.
- Do not apply moisturiser on the day of treatment.
- Wear slacks or loose trousers and sandals or loose shoes to your appointment to conceal and allow for the thickness of the stockings.
- Take two Panadol tablets about one hour before the appointment if you wish.
- Avoid treatment if you intend to fly overseas within the following four weeks or during the two weeks after you return.
What happens during sclerotherapy?
- Multiple injections are given using very fine needles.
- A compression stocking is applied to reduce pigmentation, the number of treatment sessions, risk of deep vein thrombosis and risk of recurrence.
What should you do after sclerotherapy?
- Wear the stockings continuously overnight. Then wear stockings only through the day, remove them at night and replace them in the morning after the shower for a further week.
- Continue with stockings for approximately 2-3 weeks or longer if pain develops after the recommended one week.
- Walk for 30 minutes each day. Maintain normal daytime activities. Avoid standing still for long periods of time. Continue with normal exercise activities.
- Ask for advice if it is necessary to fly for more than 4 hours within 4 weeks after last treatment
What can you expect following sclerotherapy?
The following features are expected and do not need to be reported:
- Mild pain. This is usually slight at first because of the fine needles used but some injections can sting. Aching in the leg can persist for several days and this shows that the injections are working. Pain is usually improved by walking or by Panadol. Soreness behind the knee can result from rubbing by the stocking.
- Discolouration. This looks like bruising early on and usually disappears within 2-3 weeks and is not a cause of concern.
- Tender lumps. These are common in the treated vein and persist for the first few weeks. This is an early sign that treatment has been successful. Clot is slowly absorbed by the body. It may be necessary to prick lumpy veins to squeeze out "trapped blood".
- Phlebitis. Inflammation of the treated veins can occur due to reaction to the sclerosant. It is treated by further compression and regular walking.
What are the possible complications from sclerotherapy?
Complications can occur even with perfect technique.
- Deep vein thrombosis (DVT). Clots can extend into deep veins but this is rare if the protocol of compression and regular daily walking is followed. We consider that it is not necessary to stop hormone preparations as there is no evidence that they increase the risk of DVT - if uncertain discuss this with the prescribing doctor.
- Allergic reaction. This is rare but can present immediately as an anaphylactic reaction with generalised rash, constriction in the throat or difficulty with breathing. This is immediately treated by injecting cortisone or adrenaline. Allergy may cause a skin rash after treatment requiring antihistamines. Allergy is slightly more common in asthmatics. Patients should stay in the building for 20 minutes after any form of treatment to ensure that no allergic reactions occur.
- Pigmentation. Haemosiderin which is a form of iron from the blood can be deposited along the treated veins. This is more frequent with large surface veins but can occur with spider veins. Most disappear within 12 months but there is permanent staining in about 5% and this is of cosmetic significance. It is more likely in patients with a dark complexion. Persistent pigmentation can respond to laser treatment.
- Matting. This consists of networks of fine dilated capillaries near the injection sites. It appears shortly after treatment in approximately 10% of patients. Most resolve spontaneously, some resolve with injection treatment, and a few persist.
- Skin ulceration. This is very uncommon. It occurs because of an abnormal connection between small veins and arteries. Most injection ulcers are small and heal over a few weeks leaving a small pale scar.
- Intra-arterial injection. This is very rare but has been reported resulting in muscle and skin damage.
