Frequent Asked Questions

Sclerotherapy

What is sclerotherapy?

Sclerotherapy is a nonsurgical treatment for varicose and spider veins which is performed in our clinic. Using a tiny needle, medications are injected. The medication irritates the vein wall so that they stick together and are gradually reabsorbed by the body. Eliminating this disease in veins improves circulation and makes the legs healthier.

What will happen in the first consultation?

You will be asked questions regarding your past health, medication history, and symptoms. The medical staff will examine your legs and a Doppler or ultrasound exam may be performed. You will have an opportunity to discuss your condition, the various legs treatments available, and ask any questions. Frequently, the veins can be treated on the same day as the consultation. 

What causes vein problems?

Veins carry blood from the legs back to the heart through one-way valve systems. When there is a weakness in the vein wall or a faulty valve, the valve stretches and no longer closes properly. The veins become filled with blood that can't flow, causing pain, swelling, discoloration, sores that won't heal, and occasionally phlebitis, leg ulcers, and blood clots. Vein problems are much more common in women, particularly those that stand for a living and/or have had children. Venous disease is also genetically inherited. 

 

What type of vein problems does the clinic treat?

Spider veins and varicose veins are the most common. Other vein problems include chronically swollen legs, recurrent infections, thrombophlebitis, and pregnancy-related problems.

 

How many treatments are required?

Depending on the type and severity of the varicose veins, the average number of treatments is anywhere between 3 and 5, however as many as 10 treatments may be required. The larger vessels only require (3 or 4) well-placed injections with a stronger solution. They must be treated first. The smaller spider veins may require many points of injection using the weaker solution. The injections will be stopped at any time if the patient so requests. The number of injections is less important than the type of sclerosing agent used, its dosage, the site of the injections, and the skill of the medical staff.

Diagnosis and Treatment

Diagnosis starts with a careful history and physical exam. Diagnostic tests are often needed to evaluate the extent of the disease. If treatment is indicated, each one treatment takes about 20 minutes. The number of treatments depends on the severity of the problem. Discomfort after treatment is rare. Most patients leave our office and go directly back home. We recommend that patients walk for 20 minutes after each treatment.

 

Insurance Coverage

The diagnosis and treatment of significant problems due to large diseased veins are sometimes covered by O.H.I.P. Spider veins are considered "cosmetic"   and therefore do not qualify for most insurance plans. The compression stocking that is recommended is often included in private medical insurance plans.

 

What are the most common side effects?

All medical treatments entail a certain degree of risk. This will be discussed during your visit and consent to treatment must be signed before the injections are started. Fortunately, when injections are undertaken by well-trained professionals, complications rarely arise.

 

I have those veins for a reason, right? So, if you just inject them, what will my body do for circulation?

There are hundreds of potential routes back to your heart through other veins. The varicose veins are not doing much good for you - the flow is poor. The blood finds a new route.

Is exercise good or bad for varicose veins?

Great question. The answer is "yes" to both. Blood from the feet begins its journey back to the heart through blood vessels called capillaries,  which flow into progressively larger veins in the "superficial" venous system just under the skin. It then travels through "perforating veins" into the "deep system". When the blood reaches each new level, specialized (but very fragile) valves hold the blood there. On the next contraction of the calf muscles, the blood is propelled up to a new level. As long as the tubes and valves are working properly, all is well. Strong muscles = great circulation.

But, sometimes, through no fault of their own, people have faulty valve systems. This is especially common in the superficial and perforator veins. When the valve allows backflow, suddenly the strong muscle contraction becomes the enemy, propelling blood backward into the superficial veins and making varicose veins worse.

Spider Veins

In the first few days itching, bruising, aching, redness, and swelling are common. Most of these symptoms resolve spontaneously. You may take Tylenol (acetaminophen), but do not take ASA  or related compounds (aspirin, naproxen, and ibuprofen/Advil)  since they may increase bleeding. It may help to elevate the legs and rotate the ankles. Some patients (particularly those with fair skin) notice small red circles or brown lines after treatments. These are due to the pigment of blood or inflammation and usually resolve within 1 month. 90% of the discolorations resolve with 1 year. A superficial blood clot may develop at the injection site which causes a lump. This will disappear in 2-8 weeks. Small superficial ulceration of the skin overlying the injected vessel may occur. It can leave a smaller scar. "Matting" refers to the development of new tiny blood vessels in the treated vessel. This temporary phenomenon occurs 2 to 4 weeks after treatment and usually resolves within 4 to 6 months. It occurs in up to 18% of women receiving estrogen therapy (for menopause) and  2 to 4% of all patients. You will be monitored at the clinic for all allergic reactions (very rare) which can include hives, shortness of breath, and swelling around the airway., If this occurs at home, seek medical attention immediately.

Varicose Veins:

In addition to the side effects listed above, several complications are unique to varicose vein treatment. Phlebitis (inflammation of the vein) may develop at the site of injection as a firm nodule. This resolves with an elevation of the legs, application of a cool pack, rotation of the ankles, tensor bandage, and aspirin 48 hours after treatment. Deep Venous Thrombosis (DVT) is a very rare complication, seen in approximately 1 out of every 30,000 patients treated for varicose veins greater than 3 4 mm in diameter. DVT will be recognized by pain and swelling of the entire foot. The possible dangers of DVT include the possibility of a pulmonary (lung) clot and post-phlebitic syndrome, in which the blood clot is not carried out of the legs, resulting in a permanent swelling of the legs. If the sclerotherapy solution becomes lodged in an artery instead of a vein, its occlusion may cause an interruption of the blood supply to an area outside of the limb.

What should I do before a treatment?

Do not take aspirin, ibuprofen, or other arthritis medicine for 2 days before and after your treatment because these medications can increase bruising. Do not drink alcoholic beverages or smoke for 2 days before and after your treatment. They may impair healing. Shower and wash your legs thoroughly with an antibacterial soap. Do not shave your legs the day of your appointment. Do not apply any cream or lotion to your legs, including tanning cream.  Bring loose-fitting shorts to wear during the treatment. Eat a light meal or snack 1 - 1:30 hours before your appointment. If you sometimes get lightheaded during medical procedures, consider bringing someone to drive you home.

 

What should I do after a treatment?

Spider veins - Your legs will be covered in cotton balls attached with tape, so you are advised to wear dark-colored loose-fitting clothing to the session. Remove the cotton balls after one hour. Resume normal activities. Avoid alcohol, ASA, and hot baths, and exercise for 48 hours.

Varicose Veins - If the veins are large, you may be asked to wear your compression stocking for 48 hours. Walk or keep active for a half-hour after the session to maximize results. Bring comfortable walking shoes. If traveling more than 30 minutes to the office, have someone drive you so that you can move your feet and legs as the passenger. Avoid tanning until the end of the treatment and all the bruises have disappeared, otherwise, your tan colors may be irregular. Do not use self-tanning lotions for at least one month (it can cause unsightly streaking). Maintain normal activities but avoid strenuous physical activities such as running. Ask when you can return to normal activities. Avoid prolonged standing and hot baths for 2 weeks. Cool your legs with cold water after each shower. Most people can return to work immediately after treatment. Do not sit in a "hot tub" for 4 weeks after treatment.

 

What can I do to prevent varicose veins from coming back after treatment?

Varicose veins are a chronic illness and are subject to recurrence. At the clinic, we use the most current methods to effectively treat visible veins and try to prevent future veins from appearing.   In addition, there are several steps that you can take to assist your care"

1 Compression stockings are highly recommended and come in a variety of colors and styles. Use them when your legs ache, for long trips, or prolonged walking or standing. Dr. Martin will prescribe the correct strength and size for you. Wearing stocking increases the effectiveness of treatment by 50% and helps to prevent recurrences.

2. Wear comfortable shoes with a 1 - 2 inch heel (running shoes are best).

3. Avoid wearing girdles and originary knee-high stocking (they impede circulation)

4. Exercise regularly. Avoid standing for long periods and if you do, flex your muscles or sit/lie down with your legs up periodically. We have a handout on exercises.

 

How to get more helpful information?

Please feel free to call our office at any time, or book an appointment to discuss your concerns.