Sclerotherapy eliminates smaller varicose and spider veins through the injection of an FDA-approved drug solution that causes closure of the veins. The solution is injected directly into the affected veins, where it causes the vein walls to seal together. The vein is eventually reabsorbed by the body while blood is rerouted through healthy veins nearby. While Sclerotherapy is covered by some insurance companies for the treatment of varicose veins, it is not covered for the treatment of spider veins by most insurance companies. Therefore, most Sclerotherapy treatments performed on the spider veins are paid by the patients themselves. Spider veins are those small and tiny, “serpentine” veins right on the skin that are 1-2 mm or less in width, and are in shades of blue, purple, or red in color. Although there are alternative treatments for the spider veins such as topical laser treatment, Sclerotherapy is still considered the best treatment for spider veins. No anesthetic is required prior to treatment and patients report little discomfort during and after the procedure. Most return to work and regular activities as soon as the treatment is completed.
Because Sclerotherapy is only “partially successful” among those injected spider veins, multiple sessions of injection maybe needed in some patients. Between 1 to 3 sessions of treatments are usually needed for a given area, separated by weeks to months of interval in between sessions.
In the U.S., there are only two drug solutions that are FDA-approved for sclerotherapy. One is sodium tetradecyl sulfate (Sotradecol®) and the other is polidocanol (Asclera®). Hypertonic solution used to be used widely, but no longer. We use Sotradecol®.
It is important that you have a detailed and open discussion about the true effectiveness of Sclerotherapy, so that you may develop a realistic expectation of the cosmetic outcome from the procedure. Information presented in the following paragraphs should be reviewed in detail during your initial consultation. Sclerotherapy is not magic. It is far from being 100% effective. Any physician who tells you that “Your spider veins will be all gone before the summer” is not telling you the whole truth. If you can imagine, we the clinicians inject a drug solution into these tiny veins, and we depend on a number of factors for a satisfactory outcome. One is your body’s reaction to these sclerosant agents, which is, after all, a chemical irritant. Another is the local micro-anatomy of these tiny veins, and how they are connected with the underlying larger veins. These are just a couple of factors that determine the outcome. As such, the effectiveness of Sclerotherapy to make the veins disappear is widely variable from patient to patient, and even from various parts of the leg. Because of these reasons, studies have shown that Sclerotherapy’s effectiveness ranges from 50% to 80%, and up to 10% of patients do not respond. The further down the leg the spider veins are located, the more difficult it seems to eradicate them, such as around the ankle/foot area.
It is very important that before your commence your Sclerotherapy, that there is no underlying venous insufficiency. If you have an underlying refluxing vein that is feeding the spider veins, the veins will keep coming back. You should see a vein specialist if this occurs.
The main benefit, of course, is to eliminate spider veins with sclerosing injections that will turn ugly red, purple, blue spider veins into less noticeable colors.
There are a number of potential complications with Sclerotherapy. These include skin hyperpigmentation, skin ulcer, micro-thrombus (tiny inconsequential blood clots-trapped inside the spider veins), allergic reaction, etc. During your initial consultation, the whole spectrum of risks will be discussed in detail. A particularly disappointing outcome maybe that of skin hyperpigmentation. Sometimes a segment of spider veins can appear “black” because of a small trapped blood clot inside the vein, and other times, there can be a dark brown line in place of old veins because of deposit of hemosiderin from blood in the skin. Although these complications are not common, it is important that you understand that Sclerotherapy will not magically make your veins disappear. It is very important that you consult a vein specialist who is experienced and upfront about realistic expectations before you commence your treatment.
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