Sclerotherapy and Ultrasound-Guided Sclerotherapy

Sclerotherapy is a technique, which involves the use of a very fine needle to inject a solution called a sclerosant, directly into the veins. The solution causes the lining of the vein wall to swell, which eventually seals off the blood vessel, preventing blood flow.

Prior to treatment, the physician determines if the deep venous system is affected, in which case surgery may be recommended before sclerotherapy is undertaken. Preoperative instructions may include the elimination of certain drugs, in order to minimize the possibility of excess bleeding. Larger veins are usually treated first. After the skin is thoroughly cleansed with alcohol, the physician uses a syringe with a tiny needle to inject a small amount of sclerosing solution directly into a vein.

The solution then causes the vessel to become irritated and swell shut, prohibiting the blood from reentering the vein. When the needle is withdrawn, pressure is immediately applied to the area. The skin may be kneaded to help disperse the solution and reduce bruising. Each vein may require several injections and most disappear in two weeks to two months.

Liquid sclerotherapy is typically utilized to treat very small veins and telangectasias, commonly known as spider veins. This procedure is typically considered to be of a cosmetic nature, even when there may be symptoms associated with the spider veins, and are therefore not covered by most insurance policies,. At Iowa City Thoracic & Vascular, we do very little liquid sclerotherapy for spider veins, but can recommend qualified local professionals
who are skilled at such procedures.

Foam sclerotherapy involves agitating the sclerosant with air to make a foam, and is injected into larger veins to effect closure in a similar manner as with liquid sclerotherapy. At Iowa City Thoracic & Vascular, we perform foam
sclerotherapy as a stand-alone procedure, and as an adjunct to other surgical procedures, in patients with symptomatic venous insufficiency unresponsive to conservative measures alone.

Ultrasound-guided sclerotherapy is another treatment option for some patients with venous disease. This procedure uses ultrasound machines to provide a visual window to structures beneath the surface of the skin. These same machines, used to visualize diseased refluxing veins deep under the surface of the skin, can now enable doctors to safely and effectively treat the actual leaking vein causing varicose veins and spiders seen on the surface of the skin. This procedure involves the injection of liquid or, more commonly, foam sclerosant into precise locations viewed under ultrasound. Ultrasound-guided sclerotherapy gets to the source of the disease - the refluxing or leaking vein - and in doing so treats diseased veins more effectively.

The most common side effect of all forms of sclerotherapy is the appearance of a brown pigment stain where the vein was located. This is a blood pigment which lead into the skin. The stain often is present for many months sometimes a year or longer. On rare incision, an ulcer may form at the site of one of the injections. This is due to some of the sclerosant leaking under the skin. The ulcer is treated with a an antiseptic ointment and bandage and typically heals within a few weeks. Allergic reactions to sclerosants have also been reported, but are extremely rare.

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