In the majority of cases a procedure called “Sclerotherapy” is used. This involves injecting a solution, called a sclerosing solution, directly into the blood vessel with a very fine needle. This procedure has been used for spider veins since the 1930s. The solution irritates the lining of the vessel causing it to swell and stick together. Over a period of weeks the vessel fades from view, eventually becoming barely or not at all visible. Depending on its size, a single blood vessel may have to be injected more than once. Because larger veins (reticular veins) often underlie spider veins these vessels must be treated as well.
Different doctors use different solutions. The amount of discomfort you may feel will depend on the skills of the doctor, the solution used, the concentration of the solution and most importantly your pain tolerance! In each treatment session many vessels are injected but in general the treatment involves minimal discomfort because of the tiny diameter of the needles. Some injections give a feeling like a bull ant bite.
There is debate amongst the experts regarding the use of compression following Sclerotherapy. Those who believe in compression still disagree upon the optimal length of time the compression should be applied.
It is commonly believed that compression should be used following treatment of larger varicose veins. This minimizes the formation of haematoma (trapped blood) and pigmentation, reduces the number of treatments necessary, reduces the risk of deep venous thrombosis (blood clot) and reduces the possibility of recurrence. Depending on the opinion of your doctor and the severity of the disease, this can range from 3 days to 3 weeks.
After several treatments most patients can expect at least a 75 percent improvement in the appearance of their legs. You may find your legs initially look worse because of bruising. The improvement may be very gradual with some vessels taking up to 3 months to show maximum benefit. Perfection is seldom achieved (but always strived for!).
In Australia, Medicare provides a rebate for Sclerotherapy of symptomatic varicose veins larger than 2.5mm in diameter. Charges, however, vary amongst different clinics.
Red, raised areas at the sites of injection. These should disappear within a day. Bruises may occur at injected site. These will disappear in a few weeks and are probably related to the fragility of blood vessel walls.
Blood trapped in the sclerosed vein may cause the vein to become more noticeable in the first few weeks following treatment, and is an early sign that the treatment has been successful. Aching in the leg for the first day or two following treatments is another potential side effect. This is usually relieved by walking. You may also take paracetamol to relieve this aching.
Even when a highly experienced physician is performing the treatment, there are a number of possible side effects, including the following:
Staining of the skin: This is the appearance of brown marks on the skin after treatment. Some studies showing an incidence as high as 16% at 6 months and 5% at 2 years. These pigmented areas are mainly composed of haemosiderin, an iron pigment stored in the blood .This is more likely to occur in patients who have larger veins treated or those patients who have a lot of bruising. In most cases they disappear completely within a year. Persistent pigmentation may respond to laser treatment. In order to minimize this side effect we advise that you do not take any iron supplements (including most multivitamins) before, during or for 3 months after the course of treatment.
Matting: This is the development of networks of fine red blood vessels near the sites of injection of larger vessels, especially on the thighs. It is reported that about 10% of patients develop these. Most resolve spontaneously, some resolve with injection treatment, and a few persist. Matting is more common in patients with extensive surface veins, deep vein problems, patients who have a family history of surface veins and in obese patients who have poor muscle tone.
Ulcers: Very occasionally there is the formation of small, painful ulcers at treatment sites within 2 weeks of injection. These may occur because the solution has escaped into the surrounding skin and sometimes they occur because there is an abnormal connection between small veins and arteries. They are more common in patients who smoke cigarettes. They heal slowly and may leave a small pale scar.
Allergic reactions: Although on rare occasions (2 per 10,000) such reactions may be serious, they can be treated by immediate injections of adrenaline. Less serious reactions are treated with antihistamines. Minor rashes require no specific treatment but you should inform the doctor if they occur. Rarely, inflammation of the gums (gingivitis) appears as a reaction to a specific sclerosing solution. If this occurs, a different solution can be used for subsequent treatments.
Phlebitis: This is an inflammation of the treated blood vessels which may also be associated with tender lumps along the line of the treated veins. This is due to the reaction of the sclerosant on the blood vessel wall and entrapment of “old” blood. When it occurs to a large or prolonged extent it may be treated by draining the blood out of the painful lumps by a small needle puncture. Other treatments for this may include anti-inflammatory medication, heat packs, massage with a special cream, compression and regular walking.
DVT (Deep vein thrombosis): This is a clot in a deep vein. This is quite rare following sclerotherapy especially if compression and regular daily walking are adhered to. It is important to discuss the use of contraceptive pill prior to Sclerotherapy with the practitioner as it may increases the risk of DVT.
Intra-arterial injection: This is an extremely uncommon complication which may result in muscle and skin damage.
There are no known long term side effects of Sclerotherapy.