Sclerotherapy
Questions and Answers
What is sclerotherapy?
Sclerotherapy is a technique for the permanent elimination of veins that involves the injection of various fluids directly into veins. This produces injury to the vein with resultant closure and scarring.
This technique has been in use since the mid-1940s. There is also evidence that the Greeks used it over two thousand years ago! It has stood the test of time because it is safe and because it works.
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What kinds of veins can be treated?
Any vein large enough for the insertion of a needle can be treated. This includes huge varicose veins down to tiny spider veins (correctly called telangiectasias). These veins can be anywhere on the body, but are most commonly treated on the legs and face.
Veins too small to inject can be treated with laser.
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Don't I need these veins?
Superficial veins (the ones that become varicose veins) only carry about 10% of the blood out of your legs. Even if all your superficial veins were healthy, you could eliminate all of them without creating a problem with your circulation. The deep veins will easily carry the extra load.
When veins are unhealthy you have already lost them. They are no longer helping to return blood to the heart. The blood in varicose veins is moving back down the legs away from your heart. This is the opposite of the flow in a healthy vein and can only be detrimental to you. Essentially, old tired dirty blood is being returned to the leg instead of being carried back to the lungs, liver, and kidneys for cleaning. See Vein Basics. Back to top
What are the risks of leaving these varicose veins?
Spider veins have only cosmetic significance. They are not a risk to your health.
Varicose veins can hurt and cause leg fatigue and swelling.
Bulging varicose veins are prone to complications. Over years and decades, they may lead to thickening and discoloration of the skin. Eventually, varicose ulcers can develop in the skin. These are extremely difficult to treat and may persist for years.
People with varicose veins are about nine times more likely to develop blood clots in the legs.
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What are the risks of sclerotherapy?
Sclerotherapy is an extremely safe technique. Serious complications are rare.
Bruising around the injection sites is normal following sclerotherapy. These bruises resolve within ten days.
Increased pigmentation along the course of the vein is fairly common. This may take a few months to resolve.
Marked inflammation may occur in the area injected. This may take several weeks to resolve.
Scabs always form in the treated vessels, triggered by the injury to the injured vein lining. When varicose veins are large and close to the surface, these clots may be felt or even seen as lumps under the skin. As these lumps are broken down by your body, they release byproducts that are irritating and pigmented. These byproducts may cause mild tenderness and staining of the skin. Lumps, tenderness, and pigmentation will resolve in weeks to months.
Matting is a phenomenon in which your body builds numerous tiny blood vessels in or near the area injected. These tiny blood vessels have the appearance of a bruise or a flush. They usually resolve over several months, but they are sometimes permanent. They may be treated with further injections or laser.
If the sclerosing agent is injected outside the vein, it can cause damage to the skin and fat beneath the skin. This may lead to break down and ulceration of the skin. This is very rare. The ulcer will eventually heal, but it may take several months and leave a scar. When treating spider veins, ulceration will only occur if the medication used is excessively potent.
Allergic reactions can occur to the injected agents. These reactions are extremely rare. This may simply involve local swelling and itching, but in its worst form allergic reactions can lead to anaphylactic shock. This involves a severe drop in blood pressure that is potentially fatal.
Very rarely, blood clots can form in untreated veins of the legs. Clots of this type area may break loose and travel to the lungs (pulmonary embolism). Small clots would go unnoticed. Larger clots can lead to chest pain and shortness of breath. Even larger clots can be fatal. Blod clots are more likely to occur in people with a genetic predisposition to clotting.
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How many treatments will be required?
There is no simple answer to this. It depends on the extent of the vein problem. Treatment must be carried out from large to small and from high pressure to low pressure. If there is only one small area of leg veins involved, treatment will likely involve one or two sessions. If the vein problem is extensive, treatment may require numerous visits over several months.
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At what intervals can treatments be repeated?
Treatments for large veins are usually done weekly. Spider veins are treated at monthly intervals to give the previously treated spiders a chance to disappear. If treatment sessions are too close, some of the spider veins that have already been treated will still be visible, and further injections will be attempted to eliminate these veins that are already dead but haven't faded yet. This is obviously a waste of your time and money.
What should I do to prepare for treatment?
Do not shave your legs the day of treatment (small risk of infection).
Do not apply lotion or cream to your legs (tape will not stick).
Bring a pair of loose shorts to allow access to your veins and allow you some dignity. Bring long pants or a long skirt to wear afterwards to cover up thre tape and bandages.
Bring support hose to wear after treatment, if so instructed.
Eat well before you come to avoid hypoglycemia and fainting.
Drink lots of fluids before your treatment to fill up your veins and to prevent fainting.
Avoid exercise (even walking) prior to treatment. This may drain your veins and make injections more difficult. It is preferable to stand for a prolonged time to fill your veins.
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What can I expect following treatment?
Treatment of small vessels requires elevation of your legs for 10 or 15 minutes. When large deep veins are treated, you will need to elevate your legs for up to four hours.
When large veins are treated, a compression bandage will be applied that must be left in place for 2-4 days and kept dry. You will also be required to wear support hose over the bandage.
After the injections or the period of leg elevation, you should go for a 15-20 minute walk. For the next few days, you should continue to walk. There is no such thing as too much exercise following sclerotherapy. You are encouraged to be as active as possible, except in the first 24 hours when exercise should be avoided.
For a few days you should avoid hot baths, saunas, hot tubs etc.
You will be advised to wear support hose for a few days up to two weeks.
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Do I really need to wear support hose?
When large veins are treated, support hose is required. It is an important part of the treatment. Use of support hose decreases the rate of complications.
Although the same factors make support hose very beneficial when treating spider veins, it is not required.
Support hose of prescription strength is covered by most insurance companies.
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Does OHIP cover the cost of sclerotherapy?
Treatment of varicose veins that are larger than 5mm and symptomatic is covered by OHIP.
There may be additional charges for materials such as tensor bandages and support hose. Support hose starts at $30 (light compression) and goes up to $179 (strong prescription hose).
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Does extended health insurance cover the cost of sclerotherapy?
Most insurance companies will not cover cosmetic sclerotherapy costs (the treatment of veins that are too small to be covered by OHIP).
Most insurance companies cover the cost of prescription support hose.
Check with your insurer. Receipts will be provided.
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What are the alternatives to sclerotherapy?
You may choose to do nothing with your varicose veins. There is a good chance you will never suffer any complications.
Wearing support hose will reduce symptoms and complications, and slow down progression of the varicose veins.
Surgery can be done to strip large veins.
Spider veins can be eliminated using lasers, but treatments hurt more, cost more, and are less effective than sclerotherapy. We have two lasers for treating veins, but we almost never recommend using them except for facial veins and rosacea.
Laser surgery (endovenous laser ablation of the saphenous vein) can be done. This is a minor surgical procedure requiring local anesthetic only. A fiber optic wire is fed up the vein and a laser beam is applied to the inside of the vein to destroy it. This technique works very well, but it is expensive and limited to large veins.
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What is your cancellation policy?
We require 48 hours notice for cancellation of your consultation or treatment, in order to fill the appointment time. If sufficient notice is not given, the full value of the treatment to be done may be charged. The minimum charge for a missed appointment or late cancellation is $80 (eighty dollars).
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