While many varicose veins may be treated or removed by sclerotherapy, some will not be suitable and may require surgery. This usually applies to very large varicosities of the main superficial vein. Since surgical treatment leaves scars, usually only the largest veins are treated with surgery. Smaller varicosities can be successfully managed by injections.
How are they treated?
Treatment consists of several small injections in the veins followed by bandaging of the leg. The period of bandaging will be determined by the doctor and is an important part of the treatment.
Why is this method not more popular here?
Vascular disease in Australia and the United States is typically treated by vascular surgeons. In Europe, vascular disorders such as varicose veins, are very effectively treated primarily by doctors who are trained in general medicine. The result of this different orientation has been that compression sclerotherapy has not been able to gain more popularity.
Treatment of varicose veins with injections has been practised since the turn of the century in France. A form of injection therapy was used during the “thirties” in the United States, but surgery pushed the sclerotherapy treatment aside. The present technique has been established since 1950 in Europe. The advent of newer solutions has made sclerotherapy an effective and safe procedure.
Venule flares, or spider veins, are small purple or red veins which can form anywhere on the leg, from thigh to ankle. They can cause discomfort and are unsightly, particularly if widespread, These are also successfully treated by sclerotherapy. However, bandaging is not usually required.
How does sclerotherapy work?
Sclerotherapy is a non-surgical treatment where an irritating solution is injected into the visible leg veins using a very fine needle. The solution causes the vessels to become inflamed, resulting in swelling and eventual closure. Finally the vessels break up and disappear.
Is sclerotherapy painful?
Most patients who have undergone sclerotherapy have reported little discomfort. There may be a slight, to moderate, burning sensation immediately after the injection, but this disappears within seconds. Occasionally the legs are tender for a day or two, but this is unusual.
How quickly will the veins disappear?
It may take up to two weeks for any change to be seen, and some vessels may take up to three months to disappear. Usually vessels have to be injected more than once – an average of four to six times – and therefore have to be checked after four weeks. Usually about 70-80% of all injected vessels will disappear and sometimes all will eventually go. This procedure does not prevent new vessels from occurring.
Are there any side effects?
Most patients experience no adverse effects, however there may occasionally be complications. They are usually minor and temporary and may include one or more of the following:
- small brown spots and crusts which completely disappear within 3 – 6 months
- muscle cramps after treatment lasting only a few minutes
- in rare instances – ulceration which may heal with a small white scar
- tiny red capillaries which occur near the injection site. This occurs in a small number of patients and disappears after 2-6 months, or the vessels may be treated with further injections or laser treatment.
How successful is the treatment?
The treatment is successful in approximately 95% of people. However, some 5% of treated patients will have little, or no response. There is no way of predicting, prior to treatment, those few patients who will have little or no response.
Not all veins are treatable by sclerotherapy. If there is concern regarding the competency of large veins the doctor will order duplex scanning of the legs.