Sclerotherapy involves the injection of a fluid (a sclerosant) directly into a diseased vessel in order to cause irreversible damage to the vessel, while avoiding damage to normal collateral vessels and surrounding tissues. After an injection, the damaged vessel becomes non-functional and gradually fades away. Though sclerotherapy has several applications, such as treatment of small hemorrhoids and esophageal varices, the single most widely used application of sclerotherapy is for reticular and spider vein treatment. Reticular veins are superficial veins that have a cyanotic hue and are 2-4 mm in diameter. Spider veins (telangiectasias); on the other hand, are very fine, red, blue or purple superficial veins commonly appearing as thin wiggly lines on the thighs, calves and ankles.
In principal, sclerotherapy can be an effective therapy for veins of any size; however, the larger the vein and closer to the deep venous system, the greater the likelihood of treatment failure or early recurrences. Sclerotherapy of veins larger than 5 mm in diameter often requires special techniques and high potency sclerosants in larger amounts and high concentration, increasing the risk for spasm and many other undesirable adverse effects. The reason is that larger veins contain more blood, dilute the injected sclerosant, and decrease its efficacy.
Currently, the only widespread application of sclerotherapy in the United States and other Developed countries is for reticular and spider vein treatment. Although these small veins may be surgically removed, sclerotherapy presents a rapid, effective, and cosmetically acceptable alternative that is particularly attractive to patients with extensive networks of small abnormal veins. Spider veins respond quickly to this treatment and results can be seen as early as three to six weeks. Larger veins take longer to respond. Contraindications to sclerotherapy are rare and include pregnancy and allergy to the sclerosing agents. The side effects of sclerotherapy are tolerable and temporary. Patients might experience itching, tenderness, skin bruising and redness at the injected area. Sclerotherapy not only offers the possibility of remarkably good cosmetic results, but also has been reported to yield an 85% reduction in symptoms of pain, burning, and fatigue associated with these veins. It should be mentioned that vein size alone does not predict the presence of symptoms. Veins causing symptoms may be as small as 1 mm in diameter, and larger bulging varicose veins may not cause any symptoms whatsoever.
Some patients are highly responsive to sclerotherapy injections and can be treated with weak sclerosants in only a 1-2 sessions, while others are highly resistant, and may require several sessions, stronger sclerosants and/or combination of treatment techniques including laser vein treatment. When a patient has had a poor response to initial series of treatments and the veins recur, or new veins start to appear soon after the treatment, the original diagnosis must always be called into question. Failed treatment often means that a hidden source of reflux was overlooked or the underlying cause for the appearance of the small veins was not identified with Ultrasound Duplex imaging. Reflux vein disease refers to an abnormal communication with the deep vein system allowing reverse flow from the deep vein system into superficial veins. Only when diagnostic tests fail to identify a large vessel as a source of reflux, superficial dilated veins are ascribed to localized valve failure. It should be noted that even the smallest veins have valves. It is only in the latter case that the treatment plan starts with sclerotherapy.
A renowned Los Angeles vein specialist says that he owes his very high sclerotherapy success rate to his treatment plan that starts with the identification of underlying sources of reflux, like the saphenous vein, incompetent perforator veins (veins that allow communication between the superficial venous system and deep venous system of the legs), or reticular vessels. According to the same Los Angeles vein specialist, reticular or spider vein treatment must be directed at the entire system, because if the point source of reflux is not ablated first, the superficial web will rapidly recur, because the larger veins serve as “feeder” veins for the smaller veins. You may read more about sclerotherapy and spider vein treatment by visiting the website of the reputable Los Angeles vein specialist.
