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Vein Services > Varicose Vein Treatment
To view some photos of varicose vein treatments see the Ultrasound Guided Sclerotherapy page. Questions and AnswersSee the Vein Basics page.
Back to topSclerotherapy is a technique for the permanent elimination of veins that involves the injection of various fluids directly into veins. The injection kills the vein, and your body then breaks it down.
Back to topOne of the substances that can be injected is a synthetic soap. Being a soap, it can be whipped into foam prior to injection.
(Some people think that we are blocking off the vein by injecting stuff like the foam you use for insulation. This is not the case. We inject foam that looks a lot like shaving cream from an aerosol can. It doesn’t solidify. It turns back into liquid and washes away.)
Back to topThe most important difference is potency. Foam is about four times stronger than liquid. This increased potency comes from three factors:
1) Liquid sclerosants are diluted by the blood as they are injected. Foam displaces blood so there is far less dilution.
2) Foam achieves much more complete surface contact. Every square millimeter of the lining of the vein is touched by the foam. Liquid can swirl around and miss parts of the vein.
3) Foam stays put for a while and has more time to do its damage. Liquid is washed away very quickly.
The next advantage of foam is that it is easy to see on ultrasound. While it is being injected, we can watch it with ultrasound to make sure that it is going where we want it to go and staying out of veins we don’t want it in.
The third advantage is that foam can cover large distances. Liquid sclerosants need to be injected every five centimeters or so along a vein. Through a single injection site, foam can be injected to fill a vein as long as 100 centimeters.
Back to topFoam sclerotherapy is used to treat varicose veins. Small spider veins do not require foam; liquid is actually preferable for these little veins.
There is no upper limit in size for the use of foam. Even the largest of veins can be treated. Until about 2002, the only option for treating these veins was surgery. Foam sclerotherapy in combination with ultrasound guidance makes surgery unnecessary in almost all cases.
The most commonly injected vein is the largest superficial vein in the leg (greater saphenous vein). It starts on top of the foot and runs up the inside of the leg to the groin.
Back to topPrior to the introduction of foam sclerotherapy, surgery (ligation and stripping) was the only option for elimination of large veins like the greater saphenous vein. Foam sclerotherapy (with or without ultrasound guidance) eliminates the need for surgery in most cases.
Laser surgery (endovenous laser treatment or EVLT) became available about the same time as foam. This is a minor surgical procedure that is done in the docotor's office. Under local anesthetic a thin fiber optic cable is fed up the vein and a laser beam is applied to the inside of the vein to destroy it. This technique has a high success rate. Like foam sclerotherapy, EVLT makes surgery unnecessary in the vast majority of cases. But it is expensive and its use is limited to large veins. Medium-sized varicose veins are too small for EVLT. Foam Sclerotherapy is used for these veins.
Surgery is still being offered (ligation and stripping) for varicose veins. It requires a general anesthetic, causes considerable pain and work loss, leaves scars, and has a recurrence rate of 20-40%. Surgery is no longer necessary! EVLT and foam sclerotherapy are both much better alternatives.
Back to topBruising around the injection sites is normal following sclerotherapy. These bruises resolve within ten days.
Inflammation around the injection site and along the course of the vein can occur, and it may be extremely tender. This is not very common (less than 5%). Ice, elevation, and ibuprofen may be used. It will resolve in 3 days to 3 weeks.
Scabs form on the inside of the injured veins following every treatment. These scabs may be felt as lumps under the skin. Your body will break them down slowly (weeks to months). As these scabs are broken down by the body, they release byproducts that are irritating and pigmented. These substances may cause mild tenderness and staining of the skin. Large vessels with large scabs in them will cause persistent tenderness and staining for a few months.
Increased pigmentation along the course of the vein is fairly common. This may take a few weeks or even months to resolve.
Allergic reactions can occur to the injected agents. The risk is so small that no one can put a number to it. Severe allergic reactions carry a risk of one in millions (one in five million to twenty million is a good guess).
Extremely rarely, blood clots can form away from the site of injection in the deep vessels of the legs. Clots in this area may break loose and travel to the lungs. Small clots would go unnoticed. Larger clots can lead to chest pain and shortness of breath. Even larger clots can be fatal. The risk is about one in fifteen million.
(Let's put the last two items into perspective. The risk of being struck by lightning is about 1 in 10 million. Your annual risk of dying in a car crash is 1 in 6,500. And that's about the same as your risk of dying in an accident in your own home [1 in 7,000].)
Back to topThere is no simple answer to this. It depends on the extent of the vein problem.
Most people need one to three treatments for each leg that is involved.
Very large veins might require a second treatment several months later. We follow you with ultrasound examinations to see if this becomes necessary.
Back to topTreatments are usually spaced at weekly intervals.
Back to topDo not shave your legs the day of treatment. Tiny nicks will sting when we use antiseptic.
Do not apply lotion or cream to your legs. We put pressure bandages over the treated veins, and the tape will not stick.
Bring a pair of loose shorts to allow us access to your veins and give you some dignity. Bring long pants or a long skirt to wear afterwards to cover the bandages.
Bring your support hose to wear after treatment. In most cases, we will measure you for support hose, and it will be here for you at your first treatment visit.
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.
Back to topA compression bandage will be applied that needs to stay in place for 24 hours. It should be kept dry.
You must elevate your legs above the level of your heart for 4 hours following the injection. You may therefore need time off work or the assistance of a babysitter. You will also need someone to drive you home if you live more than 15 minutes away. You will need to sit in the back seat with your leg up.
Following the period of leg elevation you should go for a 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 vigorous exercise should be avoided.
You will be required to wear support hose for three weeks.
Back to topExcept for the insertion of the needle, this is usually a painless procedure. Occasionally you will feel some discomfort when the vein goes into spasm almost immediately following the injection. This can be quite intense, but it only lasts a few minutes. Vein spasm always happens, but most of the time you don't feel it.
Back to topWhen 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 (lumps and blood clots).
Back to topWe appreciate 48 hours notice for cancellation of your consultation or treatment. If sufficient notice is not received, you may be billed a minimum of $100 up to a maximum of the value of the service that was to be provided.
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