Sclerotherapy
What is sclerotherapy?
Microsclerotherapy (often referred to as sclero) is the most effective way to treat surface veins on the legs. This includes "spider" or "thread" veins, as well as the slightly larger veins called reticular vessels, which may be feeding these smaller ones.
Treatment time
Treatment involves multiple injections of a special solution – the sclerosant – into the vessels. This irritates or damages its lining, which causes the vessel walls to stick together and effectively shut down. This process takes 4 to 6 weeks, so treatments are scheduled at six-weekly intervals.
How many treatments are necessary?
It usually takes 2 to 4 treatments for a satisfactory result. A 100% clearance is unlikely but 85-90% improvement is realistic for most patients.
Cost of treatment
The cost of each session varies depending on the time and solution required. Minimum cost is around NZ$330 and maximum $460 (generally between $360 and $410).
After treatment
Patients should wear support stockings for at least one week following each treatment. These are purchased from the clinic at a cost of around $65 for full length and $45 for knee highs.
Is sclerotherapy painful?
Although there are multiple injections, the needle used is very small so there is generally minimal pain. Which sclerosant is used is at the discretion of the therapist and/or surgeon. At Tristram Clinic, Deborah uses polidocanol, STS (Sodium Tetradecyl Sulphate) or a strong saline solution (hypertonic saline).
Is there a limit to treatment?
With all sclerosants there is a volume limit per session. For patients with large numbers of veins, it may not be possible to inject every vein during the first session. Prior to starting each session, Deborah can usually give patients an idea as to which areas can be treated.
Before treatment
Prior to undergoing treatment, it is important to determine whether the spider or reticular veins are caused by disease of the deeper veins and/or valves. About 25% of those who present with spider veins have them as a result of leaking valves in the underlying veins, or at their origin in the groin or behind the knee. Ideally, these larger vessels should be treated first, to ensure the best outcome from microsclerotherapy.
Do I need to see a vascular surgeon?
All Tristram Clinic patients are assessed by a vascular surgeon prior to sclerotherapy. If a clinical examination by the specialist suggests a problem with an underlying vein, the patient may be advised to have an ultrasound scan. The scan, and any subsequent procedures carried out by the doctor, are considered medical and so are often covered by medical insurance depending on the policy. Sclerotherapy done by the nurse is considered cosmetic and is not covered. This includes sclerotherapy following treatment provided by the surgeon.
The choice as to whether to undergo medical/surgical treatment first is at the discretion of the patient. Our aim is to ensure that each patient makes as informed a decision as possible. Treating only cosmetic superficial veins, which are the result of large vein incompetence, may reduce the chance of a satisfactory immediate result, or its longevity.
Side effects
Side effects from sclerotherapy are common but are generally minor. Staining is the most likely complicaton of treatment. This refers to a brown stain in the place of the vein that has been eradicated. At least 30% of patients will experience this and it will last from a few weeks to several months depending on site and severity. For this reason (and the need to wear stockings) sclerotherapy is best done in the autumn and winter months.
Bruising is likely to occur at each needle site. The bruises resolve in due course in the normal way.
Another common side effect is the formation of clot inside the treated vessel. The clot appears slightly darker than the original vessel (clotted blood is darker than flowing blood), and can be quite tender and firm to touch. Clots do not break off and travel to other vessels, but persist in their site of origin until broken down and re-absorbed by the body. Massage of the clot can sometimes speed up this process. Depending on size, they can last from weeks to months.
There are less common side effects, which will be explained prior to treatment. Make sure you are fully informed about treatment before signing the consent form.
Aftercare
Aftercare is minimal. Walking is encouraged for 20 to 30 minutes a day for at least ten days. Strenuous exercise is not appropriate for the first 4 to 5 days. Time off work is not required and patients can usually drive themselves home after treatment.
For further information regarding microsclerotherapy, or to discuss your individual needs, please contact Deborah on (07) 958 7893.