Sclerotherapy is an injection of a medical solution into varicose and spider veins leading to collapse and subsequent reabsorption of the veins. This procedure can be done for spider veins, called cosmetic sclerotherapy, or can be used to treat the larger veins in which we use ultrasound to guide us as we inject sequential locations along the veins. Hypertonic saline was previously used as an agent for sclerotherapy but caused a painful sensation as it was injected. We now use a formula called Polidocanol which is more effective, has a proven history of minimal side effects, and is less painful when injecting. This medication has been formulated to appear as a white color under ultrasound which allows us to identify the proper injection of the sclerotherapy into targeted veins. Sclerotherapy agents work by irritating the inner lining or endothelium of the vein. This causes disruption of the cell membrane, which leads to collapse of the vein. This works most effectively if the solution continues to adhere to the wall of the vein. For this purpose, we ask our patients to wear compression stockings for one week following treatment, compressing the veins and improving the binding of the medication. Over the first few days it is not uncommon for the veins to appear red, inflamed or irritated as this therapy takes effect. This can take up to several weeks to resolve. It is also important to recognize that most patients will need two or more sessions of sclerotherapy to achieve optimal results.
Sclerotherapy is an important adjunct to treat varicosities and tributaries of the saphenous veins where catheters and guide-wires cannot reach to ablate, or seal incompetent veins. Our providers are highly experienced in performing these procedures. This can be done as an outpatient in-office as no anesthesia is needed. The procedures generally take between 20 and 60 minutes. Patients can return to normal activities the same day as the procedure.