Sclerotherapy is a form of treatment for spider veins and varicose veins. Spider veins, or telangiectasias, are small red to blue veins which may appear in up to 50% of women. Varicose veins are larger, blue or purple in color, and may cause pain, throbbing, or burning. The incidence of varicose veins increases as people age. About 41% of women in their 40s have varicose veins, and about 72% of women in their 60s have varicose veins.
Sclerotherapy involves the use of a very fine needle to inject a solution of sclerosing agent directly into the veins to cause damage to the vessel wall. Once the vessel wall is damaged, it will begin to swell and stick together, and the blood in that area will thicken. Over a period of weeks, the damaged vessel and thickened blood are absorbed by the body. Eventually the vein becomes unnoticeable. Repeat treatments may be necessary at 6- to 12-week intervals. There are three kinds of sclerosing agents used: hypertonic (concentrated salt solution), detergent, and chemical irritants. Each class of sclerosing agent destroys the vessel wall in a different way. Selection of a particular sclerosing agent depends on the type and size of vessels being treated. The solution that is injected must make good contact with the vein in order to cause damage. To assist with this process, physicians will encourage the use of support hose or compression bandages for up to two weeks after treatment. Walking is also important because it increases blood flow through the untreated veins. For larger varicose veins, surgical therapy may be required in addition to sclerotherapy.
Sclerotherapy should not be done in someone who is bedridden, since walking following the procedure is necessary. A history of blood clots or previous trauma in the leg should lead to further workup with Doppler ultrasound prior to treatment. A history of suspected allergy to any of the sclerosing agents is a reason to avoid treatment. Treatment of varicose veins during pregnancy should not be done during the first two trimesters and may be considered during the third trimester only if varicose veins are extremely tender or bleeding.