Varicose Veins – Injection Treatment or Sclerotherapy

What does the procedure involve?

Sclerotherapy or injection of varicose veins is a procedure designed to treat varicose veins. The veins are injected with a solution called a sclerosant which damages the internal lining of the vein and causes blood to clot within the vein.

The body will then destroy the vein and it will disappear. The solution normally used for this procedure is called sodium tetradecyl sulphate (STD) or Polidocanol.

What is foam sclerotherapy?

Normally STD is injected as a solution directly into the vein to be treated. Foam sclerotherapy involves making small volumes of the solution into foam by rapid mixing and agitation with a small volume of air. This can then be used to treat some of the larger underlying abnormal veins which would not normally be treated with conventional sclerotherapy.

This is performed under ultrasound control. The foam solution causes an intense spasm of the vein and a greater volume can be injected using lesser amounts of solution.

What Are my veins suitable for foam injection sclerotherapy?

Most major varicose veins are treated by laser or radiofrequency ablation. Sclerotherapy is used as an additional procedure to treat certain specific kinds of veins. It can be used for small to medium-sized veins and spider veins.

If you have very extensive and very large varicose veins, then you may do better with micro-phlebectomy rather than sclerotherapy. If you have any underlying blood clotting tendency it may not be advisable to have sclerotherapy.

What does the procedure involve?

Depending on the number of varicose veins you have, you may need 2 or 3 sessions of treatment, and occasionally more than this. The vein to be treated will be marked on your leg initially using ultrasound scanning. A local anaesthetic will then be injected into a small area of skin, usually in the lower thigh or mid-calf and a needle will be placed into the vein, again using ultrasound scanning.

Two or 3 smaller needles (called butterfly needles) will then be inserted into the visible varicose veins in the leg and these will be similarly flushed. Your leg will then be elevated above the couch and the foam solution will be injected in small volumes at a time into each of the needles. You may experience some slight stinging as the foam is injected but it is usually painless.

Once enough foam has been injected, the needles will be removed and compression dressing applied. This will feel tight but should not be so tight as to make your foot discoloured or painful.

What happens after treatment?

You should keep the compression pads, bandage, and stocking on continuously for 3-5 days. Further compression dressing or stocking will depend on the disease condition.

You can be active as usual after the treatment and do not need to avoid anything in particular.

Will I need further treatment?

It is unlikely that all your varicose veins will improve after one set of injections and you may need several treatments. You will be seen again in a few weeks time and further injections can be performed at that stage. Some of the untreated veins may have shrunk at that stage.

What are the complications?

Superficial thrombophlebitis

Most people will experience some hard lumps which form in the treated veins. These are areas of blood clotting in the treated veins. This is nothing to worry about but may be associated with inflammation and discomfort. If this occurs, anti-inflammatory pain killers may help. These lumps will eventually subside and disappear but this may take several weeks or months.

Brown pigmentation of the skin

This can occur following superficial thrombophlebitis described above and can be permanent. However, it will usually fade over a period of several months and may disappear completely.

Deep venous thrombosis (DVT)

If the solution passes into the deep veins there is a risk of thrombosis. This may be very minor with no symptoms or a major blood clot with a risk of a pulmonary embolus (passage of a blood clot to the lungs). It is for this reason that only small volumes of the foam are injected at a time and the ankle is exercised in order to maintain good flow in the deep veins. Surgery also carries a risk of deep vein thrombosis.

Recurrent and residual varicose veins

If you have any remaining varicose veins, it is usually possible to inject these at your next visit. However, if you have a lot of very small varicose veins it may not be possible to eradicate all of these.

Skin ulceration

If the solution does not go into the vein but goes into the surrounding tissues it can cause a small ulcer of the skin. This will heal up but this may take several weeks and could leave a scar.

Allergic reaction

Allergy to the solution used is rare but can occur. If you have any allergies you should inform your doctor.