Sclerotherapy is a very common spider vein treatment and can be used to treat smaller varicose veins. It is generally used to treat spider veins visible to the naked eye (visual sclerotherapy), but can also be used to treat veins just under the surface and out of sight (ultrasound-guided sclerotherapy). Sclerotherapy for varicose veins and spider veins involves the injection of a chemical solution directly into the vein which irritates the vein wall, causing it to spasm and close down permanently. The solution (called a 'sclerosant') can be in liquid form or can be injected as a 'foam' (mixed with a gas such as air). The collapsed veins will be reabsorbed into the body over time. Sclerotherapy does not require anesthesia and is performed in the office.
Visual sclerotherapy is generally used to treat small, red or blue spider veins and reticular veins. It involves directly injecting the sclerosant into the vein using a very small needle. The amount and concentration of solution injected depends on the size and extent of the spider veins. The goal is to cause damage to the visible veins, without damaging surrounding structures. Often, one can visually see the spider veins closing off and disappearing before one's eyes.
Ultrasound-guided sclerotherapy can be used to treat deeper veins (e.g. saphenous veins, perforators) that are not visible to the naked eye. A non-invasive ultrasound probe is used to visualize the needle tip and insure it is within the desired vein prior to injection. Foam sclerotherapy may be used to increase the strength of the treatment. This can be used to treat larger incompetent veins.
Compression stockings may be used after sclerotherapy to aid healing. Multiple sclerotherapy treatments are commonly necessary to eliminate all spider veins. Treatments may occur 4-6 weeks apart, but vary depending on clinician preference.
Potential complications after sclerotherapy include bruising and pigmentation. Bruising usually resolves in 1-2 weeks. Pigmentation may include darker spots (hyperpigmentation) or blush spots (telangiectatic matting). This pigmentation may take months to subside, but almost always fades with time. Patients may also experience a burning, stinging or itchiness at the injection sites after sclerotherapy, but this often fades with the first 30 minutes. Other complications may occur, so consult a trained vein specialist.