Sclerotherapy

Before the procedure, your doctor performs a physical exam and gathers your medical history.

Physical examination

Your doctor will:

• Evaluate the involved veins
• Check for any underlying blood vessel disease

Medical history

Your doctor will want to know your medical history, including asking about any:

• Recent illnesses or existing medical conditions, such as a heart condition or a past history of blood clots
• Medications or supplements you take, especially aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, others), blood thinners, iron supplements or herbal supplements
• Allergies
• Previous treatment for varicose veins and the results of the treatment

If you take aspirin, ibuprofen, naproxen sodium or blood thinners, your doctor may instruct you on how to stop taking the medication for a certain amount of time before the procedure, to reduce the chances of bleeding.

Ultrasound

Depending on which veins are involved, your doctor may request ultrasound imaging on the veins in your legs. Ultrasound is a painless procedure that uses sound waves to produce images of structures inside the body.

The day before

Before the procedure, avoid shaving or applying any lotion to your legs. (Don’t shave or use lotion after the procedure until the injection site is healed either.) Wear loose, comfortable clothing to your appointment. You might even consider wearing a pair of shorts so that your legs are exposed.

What you can expect

Sclerotherapy is typically done in your doctor’s office and doesn’t require anesthesia. It generally takes less than an hour to complete.

During the procedure

For the procedure, you’ll lie on your back with your legs slightly elevated. After cleansing the area to be treated with alcohol, your doctor will use a fine needle to slowly insert a solution into the appropriate vein.

The solution, usually in liquid form, works by irritating the lining of the vein, causing it to swell shut and block the flow of blood. Some solutions contain a local anesthetic called lidocaine.

Eventually, the vein will become scar tissue and disappear. Sometimes a foam version of the solution may be used, particularly when a larger vein is involved. Foam tends to cover more surface area than liquid.

Some people experience minor stinging or cramps when the needle is inserted into the vein. If you have a lot of pain, tell your doctor. Pain may occur if the solution leaks from the vein into surrounding tissue.

Once the needle is withdrawn, your doctor applies compression and massages the area to keep blood out of the injected vessel and disperse the solution. A compression pad may be taped onto the injection site to keep the area compressed while your doctor moves on to the next vein.

The number of injections depends on the number and size of veins being treated.

A. You’ll be able to get up and walk around soon after the procedure. Walking and moving your legs is important to prevent the formation of blood clots.

You’ll be asked to wear compression stockings or bandages — usually for about two weeks — to maintain compression on the treated veins.

Most people return to their normal activities on the same day, but it may be wise to have someone drive you home after the procedure. Your doctor will probably advise you to avoid strenuous exercise for two weeks after the procedure.

You’ll also want to avoid sun exposure to the treated areas during that time. The inflammation caused by the injections combined with sun exposure can lead to dark spots on your skin, especially if you already have a dark skin tone.

A. If you were treated for small varicose veins or spider veins, you can usually expect to see definitive results in three to six weeks. Larger veins may require three to four months. However, multiple treatments may be needed to achieve the results you want.

Veins that respond to treatment generally don’t come back, but new veins may appear.

Your doctor will likely schedule a follow-up visit about a month after the procedure to check the procedure’s success and decide whether further sessions are needed. Generally, you need to wait about six weeks before undergoing another sclerotherapy session.

Studies of sclerotherapy as a treatment for varicose and spider veins indicate that it has an overall success rate of about 60 to 80 percent in eliminating treated veins.

A.Some side effects that may occur at the site of the injection include:

Bruising
Raised red areas
Small skin sores
Darkened skin in the form of lines or spots
Multiple tiny red blood vessels

These side effects usually go away within a few days to several weeks. Some side effects can take months or even years to disappear completely.