Sclerotherapy is a treatment to remove the small blood vessels on the thighs and lower legs. The treatment involves the injection of the small reddish/bluish superficial veins of the legs with a solution that is capable of causing the vein to undergo spasm and permanent shutdown. Although the vein may not completely disappear, it certainly becomes less visible or "invisible" due to the decrease or elimination of blood flowing through it. The larger, deep veins, as well as superficial varicose veins respond less well and are usually not treated by this method. The ones that respond the best are the small, purplish, bluish, or red veins that are on the surface of the legs, ankles, or feet. Only those veins large enough to allow injection of the sclerosing solution through a small needle are capable of being improved. Extremely tiny veins are simply not large enough to accept the needle required for this procedure.
The physician will clean the area to be treated with an alcoholic wipe. The solution will then be injected through a very small needle into the appropriate veins. There will be a small amount of discomfort as the solution is injected into the veins. Occasionally, there is a "flushed" feeling or even, rarely, a cramping or "Charlie horse" in the leg.
The solution we routinely use is hypertonic saline- a concentrated form of injectable salt water. The saline solution in non-allergenic (does not cause allergic reactions) but can be irritating and can be associated with local ulceration if the solution leaks around the vessels. If the solution does leak, it is controlled by injecting a diluent to decrease the chance of ulceration. There is some discomfort associated with the injection of the salt solution.
Individuals with a history of active thrombophlebitis or blood clots in the legs, history of pulmonary emboli (blood clots of the lungs), poor circulation in the legs, or a history of swelling of the feet or legs should not be treated. Individuals who are or could be pregnant should not be treated. Individuals who are hypercoaguable or have a history of excessive blood clotting should not be treated.
One of the more common adverse reactions is bruising at the site of the injection along the vessel. The bruising usually lasts one to two weeks, and may resolve completely at that time or may resolve leaving a tan discoloration along the course of the vein. This tan coloration is an unpredictable complication. No treatment is required: quite often, fading will take place over the course of weeks, months, or even up to 2 years.
Some people may develop a fine network of small blood vessels in the vicinity of the treated veins (called telangiectatic matting). Individuals at increased risk of developing these vessels are those on estrogen, either in the form of hormone replacement or oral contraceptive medications. Most of these vessels will ultimately fade, but occasionally the smaller vessels will need to be treated with additional sclerotherapy.
Rarely, following injection of a vein, a clot may occur along the course of a vessel. These clots may also become inflamed or infected. This is a treatable complication: you should inform your doctor if this should occur. Even more uncommonly, a blood clot may form in one of the deeper veins of the leg. This is potentially a serious side effect of treatment and would require medical intervention. Symptoms of this condition are swelling, redness, and pain in the affected leg. If you experience any of these symptoms after treatment you should call your doctor as soon as possible, as well as if you develop cough or shortness of breath.
There is also the possibility that the injection of the solution may cause a small sore, scab, or ulceration at the site of one of the blood vessels. Usually these heal well, but they can heal with a small white scar. This is an extremely uncommon event but when it does occur, is permanent.
Other side effects include stinging and pain at the injection site, swelling of feet or ankles, or muscle cramps. These symptoms are usually temporary and experience during treatment. Tenderness, bruising, or firmness, especially along the larger vessels in the treated areas may last for varying periods of time.
Number of treatments required:
Most patients are pleased with the final results of sclerotherapy which may range from a subtle fading to a complete disappearance of part or all of the tiny blood vessels. The goal is to produce at least 75-80% improvement and it may take several months to see the maximum improvement. It may be impossible to predict how many treatments are required, but usually each network of veins ay require anywhere from one to three treatments in order to achieve improvement. You should not be discouraged that a single treatment does not result in a dramatic change in appearance. You may not experience permanent disappearance of the treated vessels. Some vessels may reopen over time, and new vessels may reform and replace the treated veins. It is impossible to predict which vessels will remain closed, which vessels will reopen, and which vessels will develop new veins adjacent to them. You may discontinue treatment and restart at any time you desire.
Before and after treatment:
Do not shave your legs 24 hours before treatment or apply any moisturizer. Bring a pair of very good support hose (20-30 mm Hg compression) to wear continuously for the next 48 hours after treatment. They should be worn during the day for the next three weeks after these first 48 hours. Please prepare to limit your activity to normal daily activities without strenuous exercise for 48 hours after the procedure. After the first 48 hours, you may exercise, but please plan to wear your compression stocking while you exercise for the next three weeks. Come in with a pair of shorts or a skirt so you can be comfortable during the treatment.
NOTE: Please remember to bring your compression stockings with you for your procedure.
Sclerotherapy is a treatment to improve or eliminate the superficial veins which form on the lower extremities. The risks must always be balanced against the benefits. All aspects of the treatment should be fully discussed with your physician before undergoing the procedure.
Please call our office for scheduling and pricing information: (208) 327-9521
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