Injection Sclerotherapy for Veins

Principles of Sclerotherapy

Sclerotherapy involves the injection of a "sclerosant" which irritates and damages the internal wall of the vein. This causes clot to form on the inside wall and also encourages the vein to shrink and collapse. Sometimes the sclerosant is mixed with air to create a "foam" which allows effective treatment for larger veins.

The treatment is no more painful than having having blood taken and does not require an anaesthetic. No hospital stay or bed rest is required and normal activity can be resumed immediately.

Sclerotherapy for Surface Vessels

Sclerotherapy can be performed directly to surface veins where it is the treatment of choice and gives very good results. Several treatments may be required and veins may take a few months to gradually fade away. While spider veins respond very well, the treatment does not prevent similar, new veins form appearing in the same area in the future.

Sclerotherapy for Saphenous Veins

Surface Sclerotherapy is often used following a second mode of treatment to the deeper, saphenous veins such as surgical stripping, endovenous laser, or ultrasound-guided injection sclerotherapy of the deeper veins. In comparison to these other treatments, sclerotherapy is more convenient and less invasive, but the known rate of failure over time is greater, and the time required to achieve complete occlusion is longer. Sometimes secondary or "top-up" injections are necessary.

Side-Effects of Sclerotherapy

Initially the irritating action of the sclerosant causes the vein to become red, painful and swollen and this is called "phlebitis". This is expected and can last several weeks before it settles down. Lumps may also develop due to trapped blood within the treated vein. If this is particularly troublesome or painful it can be released by your doctor on subsequent visits.

Mild skin pigmentation (colour change akin to freckling) can occur but often improves over time. Rarely skin ulcers can occur over the site of injection but these usually heal readily. Some patients can develop a fine, mesh-like series of veins which is referred to as "venous matting".

While small amounts of sclerosant (and air, if the mixture is foamed) are known to enter the circulation it is very rare for this to cause major complications. The air will usually dissolve and disappear if the volumes are small, but to reduce the risks it is wise to use the minimum volume of sclerosant necessary, and treatment may be spread out over multiple sessions.

Allergic reactions may occur with the injection of any substance, but these are extremely rare with sclerosant solutions. Rarely, a Deep Vein Thrombosis can occur. This is when a blood clot forms in the deeper veins of the leg and can cause severe swelling and pain in the whole calf or leg with a small risk of migration to the lungs. This is diagnosed with an ultrasound scan and if found will be treated promptly with blood thinning medication.