Varicose Vein Sclerotherapy

Questions and Answers

 

What is Sclerotherapy?

Sclerotherapy is a technique for the treatment veins that involves the injection of various chemicals to injure and kill the veins.

It has been in common use for about 80 years. There is evidence that Hippocrates employed sclerotherapy 2,000 years ago.

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What kinds of veins can be treated?

Any vein can be treated from tiny spider veins to large varicose veins. In this section we will discuss the treatment of varicose veins. The treatment of spider veins is covered here.  

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What substances are injected?

Most commonly we are injecting STS foam. STS is a synthetic soap. We mix it with carbon dioxide gas to create foam. 

STS kills cells by disrupting their cell membranes. 

This substance has been used to inject veins in liquid form for many decades. The use of STS in foam form came into common use in about 2000. 

Foam has several advantages over liquid:

1) it is more potent
2) it can spread over about 30 centimeters up and down the treated vein so that only one injection site is most commonly needed.
3) it is visible on ultrasound, so it can be tracked as it is injected. 

Occasionally we use iodine to inject veins.

 

What is the success rate for Sclerotherapy?

The immediate success rate is about 99%. This means that the treated vien is almost always closed at your follow-up visit. But this doesn't mean it is dead. It only shows that it has been injured. 

The recurrence rate is more important to know. This is the number of times that veins survive or new veins develop in the treated area. The average is about 25%. For small veins, it is about 5%. As veins get larger and larger, the recurrence rate increases substantially.

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What are the risks of Sclerotherapy?

Sclerotherapy is a very safe technique. Serious complications are rare.

Bruising can occur, but it is usually very mild. These bruises resolve in ten days or so.

Tenderness along the treated vein can occur and may last a few weeks. Simple pain medication may be required, but most people don't need anything.

Marked tenderness and redness may occur in the treated area (phlebitis). This is very uncommon, perhaps 1%. This may take 3 days to 3 weeks to resolve.

Brown pigmentation along the treated vein is common. It takes a few months to resolve.

Blood clots can form and travel to the lungs (rare).

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How many treatments will be required?

This depends on how many veins you have. Perhaps only one treatment is needed. If you have alot of varicose veins, you might need several sessions. 


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What should I do to prepare for treatment?

Do not shave your legs the day of treatment.

Do not apply lotion or cream to your legs (tape will not stick).

Bring a pair of loose shorts. Bring long pants or a long skirt to wear afterwards.

Bring support hose to wear after treatment.

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 accessing your veins more difficult. It is preferable to stand for a prolonged time to fill your veins.

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What can I expect during treatment?

First, an ultrasound examination is carried out to map the vein to be treated.

Then you lie on the exam bed, and a needle is inserted into the vein. Frequently this is done under under ultrasound guidance.

The injection is carried out. Usually you don't feel this part.

A rope is taped along the vein and support hose is applied to the leg. You stay for ten minutes or so with your feet up.

After this, you get up and go home.

You will be in the office for about thirty minutes, but the treatment portion only takes about ten minutes.

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Is the treatment painful?

There is usually only one needle poke. The injection itself is usually painless.

The vein always goes into spasm as the medication hits it. Usually you will not feel this. If you do, it feels like a burn or a cramp. it will last for five minutes or so.

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What can I expect following treatment?

You will be wearing a compression stocking which must be left in place for 24 hours.

You are encouraged to be as active as possible, except in the first 24 hours when vigorous exercise should be avoided. You should walk every day.

For a few days you should avoid hot baths, saunas, hot tubs etc.

You may be a bit sore for a few days. Most people need no pain meds. Some people use simple analgesics like Tylenol (acetaminophen) or Advil (ibuprofen). Stronger pain medication such as codeine is not needed.

You need to wear support hose for one week.

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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.

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Does OHIP cover the cost of Sclerotherapy?

Sclerotherapy of some veins is covered by OHIP. They have to be big enough. This will be determined at the time of your consultation.

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What are the alternatives to Sclerotherapy?

You may choose to do nothing with your varicose veins, but you risk developing complications such as venous ulcers and blood clots.

Wearing support hose will reduce symptoms, slow down progression of the varicose veins, and reduce complications (ulcers and blood clots).

Surgery can be done to strip large veins. This is a painful procedure that usually results in one to three weeks of time loss. It leaves scars. There is about a 25% chance that you will get new veins in the same area within three years. OHIP stopped covering stripping in 2012 except in patients with complictions like ulcers.

EVLA (endovenous laser ablation) can be performed on some veins. This treatment uses heat to kill veins. 

Clarivein is a modified form of sclerotherapy which can be done on some veins.

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What is your cancellation policy?

We require two business days of notice for cancellations. If this is not received, you may be billed $100.

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