What is Sclerotherapy?

Sclerotherapy is a safe and well established treatment for thread veins on the legs. It has been used for over fifty years. Although there are a number of alternative treatments which are effective for thread veins on the face, it remains the only reliable and successful treatment for leg veins.

Before Sclerothrapy treatment - Click for larger image After Sclerotherapy - click for larger image

What are thread/spider veins?

Thread veins are unsightly very small, abnormally dilated blood vessels. They are red/blue in colour and lie very close to the surface of the skin. Usually they cause no physical problems but occasionally they may cause discomfort and itching.

Why do I get these veins?

The causes are mainly unknown, however:

  • They are usually inherited
  • Hormonal changes for example with pregnancy and HRT may increase their likelihood
  • Trauma/surgery to the legs may cause an eruption of thread veins
  • Standing occupations may increase the incidence of these small veins
  • They become more prominent and numerous with increasing age

Thread veins are not the same as varicose veins, these are much larger and require further investigations and alternative treatments. It is possible to have a combination of both types of veins. Generally it is better to treat the larger veins first. In some cases removal of these veins may improve the cosmetic appearance of the thread veins without requiring any further therapy. If your veins are unsuitable you will be referred back to your GP.

Is there anything I can do to stop these veins appearing?

 Unfortunately if you have this tendency there is very little that can be done to stop them appearing. Compression stockings may slow the progression down, but it will not stop them completely. There is no clinical evidence that any homeopathic remedies will either remove or stop them appearing.

What should I expect from my initial consultation?

A full and thorough assessment by your sclerotherapy practitioner should involve a detailed discussion of the best treatment options for your legs.

During your initial consultation you should be assessed in a standing position, this enables the practitioner to fully assess your legs. This is be done by looking at and feeling the legs.

The practitioner should at this time be able to tell you how many sessions you will need and their cost. This varies according to the quantity and type of veins requiring treatment. Most sessions take approximately 1 hour. You should budget for at least two.

The results after one treatment vary considerably from one client to another, some veins may disappear completely whilst others may only fade and some remain unchanged. On completion you should expect an improvement in the overall appearance of 60 – 80%. Unfortunately, you will never have perfect legs, we hope that you will see enough improvement to increase your confidence in the way your legs look.

Your susceptibility to thread veins does mean that other thread veins may emerge over a period of time. In most cases, further treatments will be necessary. Some clients prefer to return each year whilst others may come back when more veins appear after a few years.

During this initial consultation you should be given a full explanation regarding the side effects of treatments and the follow up care required. Depending on your preference you may continue with treatment at the same time as your initial consultation, if this is the case you are under no obligation to continue with treatment if you do not want to.

 What happens during treatment?

The injections are performed with you lying down. A solution is injected with a very tiny needle, superficially into the veins. This causes the lining of the vein to become sticky and swell. Compression is then applied to close the veins. Over a period of time the vein will heal closed, be absorbed into the body and fade away

injecting pic

Research has shown that ideally there should be some compression of the veins injected. This may be initially with cotton wool and then with a compression stocking. Length of time wearing compression again varies according to the size of veins it usually varies between 24-72 hours continuously and then for a further 2-7 days, daytime only. Research suggests that the longer it is worn the better.

 

Compression assists a better long term appearance and less side effects. If both legs are treated you will be unable to bath during this time, unless you can do so with out making your stockings wet.

Does it hurt?

Sclerotherapy is not painful, it is a tiny prick. Occasionally there may be a feeling of discomfort in some areas of the leg (this varies from person to person).

What drug do you use?

 Sclerovein/aethoxysklerol (polidocanol) is a detergent based drug which is works by destroying the lining of the vein, this is then absorbed into the body over a period of 2-3 months. Sclerovein is very safe and has been in use since the 1950’s. It is not currently licensed for use in the UK (it is licensed in Europe and the USA), It is therefore used as a named patient drug, which means that the pharmacy have records that you have had this drug. It is used in preference to other drugs for reasons of comfort and safety.

What should I expect after treatment?

Once you remove either the bandaging or stockings expect your legs to look worse. There may be marks from the needle, bruising and often the veins may change from their normal red/blue colour to black/brown. All this is normal and may take a week or two to settle, depending on how quickly you normally heal. Some people find the homeopathic remedy arnica helps to improve bruising.

The legs may feel slightly tender for the first few days following treatment. An anti-inflammatory drug such as ibuprofen is often helpful, wearing compression for longer and walking may help.

After about 4 weeks the veins may some signs of improvement, the true effect of treatment is seen between two to three months. Some larger darker flares may continue to fade for up to six months after the procedure.

The true extent of treatment can be seen at two to three months after your first treatment.

Is sclerotherapy permanent?

Small vessels will be absorbed by the body over a three month period and should not reappear. However it is likely that new ones will occur in a similar area. It is possible that larger veins can reopen over time and may need further treatment to close them again.

What are the side effects?

Although very safe, sclerotherapy is not entirely without risk.

Brown staining (haemosiderin stain) is the most common side effect, it may occur in approximately 15% of cases. It happens when the vein is not entirely closed, blood is trapped and clots. In some people iron pigment leaks from the clot and stains the skin over the vessel. It is more likely to occur in slightly larger veins. This mark is not usually permanent, but may take 6 –18 months to fade. When exposed to the sun they may darken and take longer to fade. However, it is usually less unsightly than the original thread veins. In the unlikely event that the stain does not fade (less than 5%) it is possible to have laser treatment to reduce the brown marks.

Immediately after sclerotherapy you may experience some swelling around the ankle or knee joints. This settles spontaneously after the first 24 hours. You may find that raising your legs whilst sitting helps this to settle.

Other less common side effects may be:

Telangiectatic matting, this occurs if the fragile vessel is injured during the injection leaving a mat of tiny vessels that looks like blush or red bruise. It usually disappears without needing further treatment over a period of 6 –12 months. If it persists it may be possible to treat with further sclerotherapy.

Blistering, in rare cases the skin overlying the vein may blister, in extreme cases this may cause small ulcers (feet and ankle areas are most vulnerable), it can potentially lead to a small scar. Occasionally the stocking may rub and cause small blisters these will settle spontaneously if left alone.

In larger veins it is possible for the vein to become lumpy, tender and warm where blood remains in the vessel (thrombophelebitis).  This normally settles without problem over a few weeks, it may resolve more quickly by using anti-inflammatory drugs and wearing the compression hosiery. If you are concerned you should discuss it with your practitioner.

On rare occasions sclerotherapy may precipitate further small thread veins to appear. These often settle over a period of weeks without further treatment. However, if no improvement is seen, their appearance may be improved by further sclerotherapy. Often it is hard to know if these veins would have appeared as part of the normal increase in veins you would get naturally, or if they occurred as a result of your treatment.

Very rarely after about 2-3 weeks a small area of redness and a throbbing sensation may appear with a white or black centre. If this occurs you should seek medical advice with your practitioner, prompt treatment with antibiotics prevents any worsening.

Allergic reaction to the agents used is incredibly rare (less than 1:10.000). Any reaction would occur during the session and your practitioner would cease treating you immediately. Some people feel faint because they do not like needles! Itching and some redness is fairly common during the treatment and is not a cause for concern.

It is possible for the treatment to have little or no effect. Results unfortunately cannot be guaranteed.

The above results are extremely unlikely, and may be more or less of a risk according to your history, vein type and location. A thorough assessment will enable the nurse to discuss any individual risks with you

What happens after the sclerotherapy?

  • Walk immediately after treatment for at least 10 minutes.
  • Wear your support stocking(s) continuously day and night as directed. During this time you will not be able to take a bath or shower.
  • Expect your legs to appear worse on removal of the stocking. At this stage this is normal. They may look worse for up to 2 weeks post treatment.
  • Avoid extremes of temperature for up to 2 weeks i.e. Very hot baths, saunas.
  • Avoid sun exposure for 4 weeks, pigmentation may take longer to fade.
  • Avoid high impact exercise for up to 1 week.
  • Elevate you legs as much as possible for the next 2 weeks (where possible!).
  • Consider delaying long haul travelling for at least 6 weeks post treatment or check with your travel insurance company. Short haul flights should be avoided for 2 weeks.

Are there any other options?

Lasers are by far the most effective way to remove facial veins. However they are much less effective on legs. This is because the pressure of blood in the larger deeper veins cannot be targeted so well. Even fine thread veins on the legs tend to have larger feeding vessels, which will need treatment that is unsuitable for treatment by laser.

 

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