What is sclerotherapy (or varicose veins injections)?
Sclerotherapy is the process by which a substance is injected into a superficial vein allowing them to harden and collapse. It is currently the primary treatment for small varicose veins of the lower extremities. There are three small vein types that can be addressed: telangiectasias (small flat and red), venulectasias (blue, sometimes distended), and reticular ectasias (small, blue). Large veins do not respond as well to sclerotherapy.
How it is done?
A needle is inserted into the vein, much like when you go in for blood-work, but instead of drawing blood, a fluid is injected (i.e. “sclerant”). This sclerant (e.g. saline, glycerin, sodium tetradecyl sulphate, etc.) displaces blood and reacts with the wall of the veins causing them to harden. Each injection is usually very small in volume (0.1-0.4 mL). The number of injections vary on the size of the vein, and are carried out in 2-3 cm intervals covering the entire superficial length of the vessel. The injections are done slowly to prevent pain and/or burning.
Is it painful?
A local anaesthetic and sclerant—polidocanol—is first applied to reduce pain. Application of polidocanol is painless upon injection and has a very low incidence of allergic reactions. On the other hand, glycerin is viscous, and causes pain upon injection (so it is often administered with lidocaine to decrease pain).
Glycerin appears to be more effective than polidocanol in the treatment of spider and reticular veins, but unfortunately, it can be more painful. This, of course, are details that your physician and/or surgeon will discuss with you.
Why it is done?
Sclerotherapy is primarily performed to improve cosmetic appearance, but also to reduce the associated symptoms of venous disease such as pain and burning.
What are the risks?
As with every medical procedure there are associated risks:
- Bruising (transient and clears with time)
- Hyperpigmentation (transient and less common in small vessels)
- Allergic reactions (urticaria and possible anaphylaxis, though very low incidence)
Will it stop the development of other varicose veins?
Unfortunately, the answer is, “no”, and new vessels are likely to develop over time. Treatment sessions are carried out in 2-8 week intervals and repeat treatment may be necessary.
Who should not treat varicose veins with sclerotherapy?
Current literature advices against sclerotherapy during pregnancy, and any other medical condition that may put you at risk such as: thrombophlebitis (due to potential for a pulmonary embolism), hypercoagulable states (blood coagulates fast), and a known allergy to any of the sclerants.
What are other solutions to varicose veins?
Lifestyle modification is usually recommended, and this depends on your symptoms. If there is pain and burning associated with standing for long periods of time, then sitting down and elevating your legs can help.
For those of you engaged in little physical activity, walking 10-30 min a day can help improve circulation. It is important to highlight that there is no correlation between the severity of your varicose veins and the severity of the symptoms. When in doubt, seek medical advice.
Compression stockings may be recommended to you by a physician. If you’re seeking a natural complement, to date, only horse chestnut seed extract (Aesculus hippocastanum) has been properly assessed in scientific studies. For other natural treatments options speak with a licensed naturopathic doctor.