Sclerotherapy & Other Varicose Vein Therapies

What are varicose veins?
Varicose veins are dilated, bulging and twisted veins that form due to circulatory problems of the venous system.
This can be caused by a majority of reasons, but genes play a major role in their appearance.

Varicose veins are visible in more than 20% of men and over 40% of woman.
The most common site for varicose veins is on the legs.



What causes varicose veins?
Veins carry de-oxygenated (oxygen poor) blood from the body towards the heart. This backflow of the oxygen poor blood is ensured by normal function of the veins, their walls and their valves. Varicose veins have weakened walls and valves causing them to dilate and become twisted. This can be seen especially with the superficial veins close to the skin. The abnormal valves combined with gravity causes pooling of the blood that gives rise to the swelling (dilating) of the veins.

This abnormal functioning can result because of genetic predisposition (runs in the family), overweight, hormonal changes, pregnancy, long periods of standing (occupation related) and other medical diseases may also aggravate this condition.



Varicose veins can lead to venous thrombosis (blood clots) that will further affect the circulation. The poor circulation leads to swollen and painful ankles, feet and legs; skin changes on the lower legs (darkening, scaling, itchiness, skin temperature changes) and even ulcers on the lower legs. This condition is called venous stasis. Blood clots in the legs can be very serious and symptoms include swelling, redness and pain especially around the affected vein.



Varicose veins become more bluish with time due to the blood pooling in the veins. Spider veins are the very fine veins surrounding the larger veins.

It is important to treat varicose veins to prevent blood clotting, improve deeper vein circulation and improve other problems such as leg pains, swelling and skin changes.


WHAT IS SCLEROTHERAPY?
Sclerotherapy is a “non-surgical” method for the treatment of unwanted varicose veins.
A doctor uses a very fine needle to inject a sclerosing solution into the veins that causes the vein to contract and the vein walls to stick to each other which will cause the vein to disappear. The injected veins become inflamed, blood is then unable to flow through them and ultimately, the body absorbs these non-functioning vessels.

DOES SCLEROTHERAPY WORK FOR EVERYONE?
The majority of persons who have Sclerotherapy will see good improvement. Unfortunately, there is no guarantee that sclerotherapy will be effective in every case. Approximately 10% of patients who undergo sclerotherapy have poor to fair results. (“Poor results” means that the veins have not totally disappeared after six treatments.) In very rare instances, the patient’s condition may become worse after sclerotherapy treatment.

HOW MANY TREATMENTS WILL YOU NEED?
The number of treatments needed to clear or improve the condition differs from patient to patient depending on the extents of varicose and spider veins present. Six (6) or more treatments may be needed. The average is three (3) to four (4) treatments. However, there is no guarantee that multiple treatments will clear all veins. While Sclerotherapy is a safe and highly effective, more than one treatment is usually required to clear or improve unsightly veins to a patient’s satisfaction. A small minority of patients do not improve even after six treatments. In rare instances the patient’s condition may worsen after treatment.

WHAT ARE THE MOST COMMON SIDE EFFECTS?

::	Itching: Depending upon the type of solution used, you may experience mild itching along the vein route. This itching normally lasts one 1 -2 hours but may persist for a day or so.
::	Bruising: Lasts from one to several weeks. Use of support hose may be recommended and avoidance of alcohol and anticoagulant medication for 72 hours prior to each treatment session may minimize effect.
::	Transient Hyperpigmentation: Approximately ten percent (10%) of the patients who undergo sclerotherapy notice a discoloration of light brown streaks after treatment. In almost every patient, the veins become darker immediately after the procedure (but then go away). In rare instances, this darkening of the vein may persist for 4 -12 months.
::	Pain: A few patients may experience moderate to severe pain and some bruising, usually at the site of the injection. The veins may be tender to the touch after treatment and an uncomfortable sensation may run along the vein route. This pain is usually temporary, in most cases lasting 1 to at most 7 days.
::	Sloughing: Sloughing occurs in less than one percent (1%) of the patients who receives Sclerotherapy. Sloughing consists of a small ulceration at the injection site, which heals slowly over 1 to 2 months. A blister may form, open and become ulcerated. The scar that follows should return to a normal color. This usually represents injection into or near a small artery and is not preventable.
::	Allergic Reactions: Very rarely a patient may have an allergic reaction to the sclerosing agent used. The risk of an allergic reaction is greater in patients who have a history of allergies.
::	Blood accumulation in treated vessel: This may present as a tender bump at a treatment site. The use of prescribed compression hosiery will minimize this possibility. (especially when treating Reticular Veins)
::	Telanglectatic Matting: This term refers to the development of tiny new blood vessels in the treated area. This temporary phenomenon occurs 2 to 4 weeks after treatment and usually resolves within 4 to 6 months. It occurs in up to eighteen percent (18%) of women on estrogen therapy and in two percent (2%) to four percent (4%) of all patients.
::	Ankle Swelling: Ankle swelling may occur after treatment of blood vessels in the foot or ankle. It usually resolves in a few days and is lessened by wearing the prescribed support stockings.
::	Phlebitis: Phlebitis is a very rare complication seen in approximately 1 out of every one thousand (1,000 patients treated for varicose veins greater than 3 to 4 millimeters in diameter. The possible dangers of phlebitis include a pulmonary embolus or blood clot, which travels to the lungs and post-phlebitis syndrome, which can result in permanent swelling of the legs.

What are the possible complications if I do not have Sclerotherapy?
In cases of large varicose veins, greater than 3 to 4 mm in diameter, spontaneous phlebitis (infection/ inflammation around the vein) and/or thrombosis (clotting) may occur with the associated risk of pulmonary emboli (blood clot in the lungs). Additionally large skin ulcerations (sores) may develop in the ankle region of patients with long-standing varicose veins with underlying venous insufficiency (poor circulation). Rarely, these ulcers may bleed or become cancerous.

Are there other procedures to treat varicose veins and telanglectasias? What are their side effects?
Because varicose and telanglectatic leg veins are not life-threatening conditions, treatment is not mandatory in every patient. Some patents may get adequate relief of symptoms from wearing graduated support stockings. Ambulatory Phlebectomy is a procedure where certain types of veins can be removed through small surgical incisions. The complications of this procedure are similar to Sclerotherapy with the addition of small surgical scars.
Vein stripping and/or ligation may also be utilized to treat large varicose veins. This may require a hospital stay and is performed while the patient is under general anesthesia. Risks of vein stripping and/or ligation include permanent nerve paralysis in up to thirty percent (30%) of patients, possible pulmonary emboli, infection, and permanent scarring. General anesthesia has some associated serious risks, including paralysis, brain damage, and death.
Large veins can also be removed with new lasers (endovenous laser ablation) which is very successful.

Other types of procedure to treat fine veins/ spider veins/ telangiectasias?
Laser and Filtered Flash-Lamp therapies can be utilized to treat small spider veins less than 1mm in size, which are more difficult to treat with conventional Sclerotherapy injections.
Various types of lasers are used for these ranging form IPL, Yag, KTP, etc.
Laser treatments are very successful for the very fine veins and is ideal for areas where sclerotherapy is too risky (ankles and feet, as well as facial veins).
New developments in laser technologies has made this more successful than a few years ago.

What if I experience a problem after receiving Sclerotherapy?
If you notice any type of adverse reaction, please call your doctor immediately.