Embarrassed by varicose or spider veins?

• Do you wear stockings all summer long?
• Are you self-conscious about unsightly spider veins?
• Do varicose or spider veins make you look older than you feel?

You should know about sclerotherapy

What is sclerotherapy?

Sclerotherapy is a minimally invasive, in-office medical procedure that eliminates reticular varicose or spider veins by injecting special solutions directly into them. This treatment is considered the gold standard in reticular varicose and spider vein treatment; sclerotherapy has been used since the 1930s, although new solutions have been developed over the years.

In March 2010, the FDA approved polidocanol (under the brand name Asclera^TM) for the treatment of spider veins and varicose veins up to three millimeters in diameter. “Asclera^TM is the first sclerotherapy solution approved by the FDA in more than 60 years,” Dr. Rappaport notes.

Polidocanol has been safely used in Europe for more than 40 years. Asclera^TM also has anesthetic properties that may make sclerotherapy treatments more comfortable.

“In recent studies, polidocanol and sodium tetradactyl have been shown to be more effective sclerotherapy solutions than hypertonic saline, so we use them unless a patient is allergic to them,” says Dr. Rappaport.

How does sclerotherapy work?

Sclerotherapy injections contain a solution designed to irritate the interior walls of reticular varicose veins and spider veins, causing them to constrict and close. This prevents blood flow through the injected veins and can get rid of the swelling, bulging and discoloration of small varicose or spider veins.

Dr. Rappaport answers questions
about sclerotherapy

Who is a good candidate for sclerotherapy?

You may be a candidate for sclerotherapy if you have spider veins less than 1 millimeter in diameter, or reticular veins from 1-3 millimeters in diameter.

First, we need to determine the underlying cause of your vein condition. If you have significant varicose veins or a history of them, the deep vein system in your legs needs to be investigated to make sure there's not an incompetency of the deeper blood vessels. We work closely with vascular surgeons in that regard.

Once we've determined that your reticular (blue) veins are within 1-3 millimeters in width or that spider veins are present, we can consider treatment by injection in the office.

Is sclerotherapy appropriate
for large, ropy varicose veins?

For varicose veins more than 3 millimeters in diameter, sclerotherapy may not be the best option. If you come in with large, ropy varicose veins or evidence of physical changes such as hair loss, darkening of the skin or ulceration, we'll have the vascular surgeon evaluate you.

There's a big difference between vein therapies such as stripping or ligation, which are usually therapeutic, and sclerotherapy treatment of spider veins, which is considered a cosmetic procedure.

How long does a sclerotherapy treatment take?

A typical sclerotherapy treatment lasts about 45 minutes in the office.

How many sclerotherapy treatments are needed?

Some patients may require 3-5 sclerotherapy treatments. If you have only a few spider veins, one treatment may be enough. We will evaluate you during your initial consultation and advise you on how many treatments we recommend.

How should I prepare for a sclerotherapy treatment?

If you take medications or supplements that may thin your blood, such as ibuprofen, aspirin or fish oil, we recommend that you stop taking them about two weeks before your sclerotherapy treatment. This will decrease the potential for bruising.

You might want to take bromelain supplements for three days before a sclerotherapy treatment to fight inflammation and swelling. Arnica supplements can help minimize bruising after a treatment.

You should also purchase medical-grade compression stockings (support hose) to wear for the first two weeks after sclerotherapy. Bring the stockings with you to your appointment, along with a pair of shorts to wear during the treatment itself.

What is a sclerotherapy treatment like?

We use a very fine-gauge needle to inject the sclerotherapy solution into your reticular varicose or spider veins. The Asclera^TM solution contains a local anesthetic, which will make your treatment more comfortable.

After your sclerotherapy treatment, we will compress cotton balls, tape them across the injection sites and send you home wearing your compression stockings. You can remove the cotton balls the day after your treatment.

What do I need to do after a sclerotherapy treatment?

We encourage you to walk—you can do that right away. There are also a few precautions you should take after a sclerotherapy treatment:

• Do not take hot baths or showers for two weeks. (The hot water will dilate the treated blood vessels and increase the blood flow.)
• If you have had large veins treated, avoid vigorous exercise for five days after treatment (again, to avoid increased blood flow).
• Do not drink any alcoholic beverages for five days.
• Apply an antibiotic ointment on the treated areas for the first two days.
• After 5-7 days, use lotion to moisturize the treated areas after bathing.
• Do not rub or scratch the treated areas.
• Avoid sun exposure to the treated areas. If sun exposure is expected, use a sun block with SPF 30 or higher. Continue to use sun block for 8-10 weeks.

What should I expect
during the sclerotherapy healing process?

Be patient—healing will take several weeks.

• Expect redness and swelling or welting around the injection sites after treatment.
• As healing progresses, the injection sites will develop thin, “cat scratch” scabs, which will fade in 2-3 weeks.
• The blood vessels can appear dark red or brown, and will continue to fade for up to 10 weeks.
• Sometimes you may experience dark coloration, as trapped blood remains in the treated vessels.

Will my reticular or spider veins come back
after sclerotherapy?

As your most obvious reticular or spider veins are eliminated through sclerotherapy, the smaller remaining veins may seem more noticeable to you. It's virtually impossible to get them all.

In time, you may develop new reticular or spider veins for the same reasons you developed them the first time. Sclerotherapy is like any other kind of maintenance regimen—you may need to come in for touch-ups from time to time.

Is there any way to help prevent
varicose and spider veins?

Avoid crossing your legs, and try to keep your weight in a normal range.