Sclerotherapy

Sclerotherapy is indicated for varicose veins or spider veins. It is done by injecting an irritant into the veins to damage the vessel, induce inflammation, and close the vessel to reduce the varicosity. This makes the vein look better. This is mostly done to treat the varicosity of the legs.

Varicose veins:

Varicose veins are the twisted, tortuous, and large veins of the legs. They develop due to insufficient blood supply and inappropriate backflow from the deep to the superficial vessels leading to varicosity. The varicose veins have increased collagen and decreased elastin as a result of which increased pressure causes distention of the veins superficially.

Varicosity of the veins causes itching, pain, swelling, heaviness, and bleeding. They can also cause swelling of the lower legs, increased pigmentation, hardness, and ulceration of the area. Based on the diameter varicose veins are of different types.

Varicose veins are more than 5mm in diameter

reticular veins are 1-4 mm in diameter, and

spider veins measure < 1 mm in diameter.

Sclerotherapy technique:

Sclerotherapy works on the principle of injecting irritants called sclerosing agents into the blood vessels. These agents damage the blood vessel wall, induce inflammation, and fibrosis, and close the blood vessel. There are various types of sclerosing agents. They are:

Osmotic agents like glycerin and concentrated saline – These cause rapid dehydration of the blood vessels leading to fibrosis

Irritant sclerosants like ethanol, and phenol – This damage the cells lining the blood vessel wall and cause fibrosis.

A few detergents like polidocanol and sodium tetradecyl sulfate (STS) – These damage the proteins of the cells lining the blood vessels.

Some types of iodinated substances

Indications:

Sclerotherapy is the gold-standard treatment for treating conditions like varicose veins, reticular veins, and spider veins. Apart from the varicose veins, it is also indicated for:

Hemorrhoids (piles) that are symptomatic and bleeding

A condition in which valves in the leg veins are damaged, called saphenous vein reflux

Malformations of certain blood vessels

Small vessels that cannot be treated by phlebotomy or ablation

Ulcerations of the vessels

Contraindications:

Sclerotherapy is not indicated for everyone. It is not indicated in:

Pregnancy and breastfeeding

Active Deep or superficial vein thrombosis, a condition that causes blood clots

Bed-ridden individuals

Advantages:

Sclerotherapy has many advantages.

It does not require anaesthesia and has minimal risk

It can be done as an in-office procedure

It gives good and effective results and much faster results for small veins.

Before the procedure:

Before undergoing sclerotherapy, an individual should understand the importance and necessity of the procedure by discussing it with the healthcare provider (HCP). All the medications taken by the individual should be informed to the HCP along with the history of previous diseases, infections, surgeries, and allergies. The HCP will prescribe medicines before undergoing sclerotherapy. Certain routine blood and urine investigations are carried out to rule out any infections or other conditions not known to the individual.

An ultrasound examination will be done along with tests to study the extent of the enlargement, visualize the narrowing of the blood vessels, assess the extent of the damage, and decide on the type of sclerotherapy. It is advisable not to shave or apply cream to avoid infection to the area.

During the procedure:

An individual is made to lie on the table on their back with their legs raised. The skin around the target area is rubbed with an antiseptic and stretched. Using a small needle the solution is slowly injected into the vein. Based on the consistency of the sclerosing agents, they can be foam-type or liquid type of sclerosing agents. This solution irritates the blood vessels and blocks the blood vessels.

Minor stinging pain may be felt as the needle enters the blood vessel. After the entire solution is sent into the vessel, the needle is removed, and pressure is applied over the area. The area is massaged to spread the solution. Then, the procedure is continued in the next target area till the target vein is sclerosed. Ultrasound-guided sclerotherapy has been used in recent times to identify the exact site of the target vein.

After the procedure:

An individual has to walk around after the procedure to prevent clot formation. One can take painkillers if there is mild pain associated with the procedure. Antibiotics are prescribed to ward off infection after the procedure. Compression bandages or stockings have to be used to apply pressure on the veins.

One can return to the activities of daily living on the same day. Instructions to avoid strenuous exercises for two weeks are advised. It is advisable not to take too hot baths, or sit in a sauna. The injection site should be cleaned with soap and lukewarm water. Hot compresses should not be applied for pain.

Follow-ups are given after a month of sclerotherapy. There should be a gap of at least 6 weeks between two sclerotherapy sessions.

Effectiveness of sclerotherapy:

Sclerotherapy is an effective procedure. Small varicose veins and spider veins show the result in 3-6 weeks while large varicosities show the result in 3-4 months.

Side effects:

Side effects of the procedure comprise swelling, redness, bruising at the injection site, skin sores, hives, pigmented skin, and the development of tiny blood vessels. These subside in a few weeks after the therapy.

Risks and complications:

Complications include:

blood clots that can lead to the development of deep vein thrombosis,

formation of air bubbles while injecting the solution that can cause headaches, light flashes, and giddiness, and

allergic reaction to the sclerosing agents.

Conclusion:

Sclerotherapy is a gold-standard treatment for small varicose veins and spider veins. sclerosing agents close the blood vessels by irritating the blood vessel wall. This can alleviate the symptoms and improve the quality of life of individuals.

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