What Is Sclerotherapy?

Sclerotherapy is a minimally invasive procedure that’s used to treat:

• Varicose Veins These superficial veins, found close to the surface of the skin, are twisted and enlarged. They’re caused by increased blood pressure within the veins. Varicose veins can be found anywhere on the body but commonly affect the legs.
• Spider Veins These are a milder, smaller type of varicose vein. Spider veins are typically red or blue in color and look like the pattern of a spider web. They’re frequently found on the face and legs.

With sclerotherapy, doctors inject a solution into the vein to close it off, so blood will reroute through healthier, less twisted veins. This treatment can improve the cosmetic appearance of varicose and spider veins while also reducing symptoms such as swelling, aching, cramping, or burning.

While the recovery is generally quick, results from sclerotherapy can take weeks or months. Some people may need several sclerotherapy treatments to achieve their desired outcome.

You might benefit from sclerotherapy if you want to improve the appearance of your varicose veins or spider veins. Or you may consider having the procedure if your problematic veins are causing you pain or discomfort.

However, not everyone is a candidate for the procedure. Sclerotherapy may not be an appropriate treatment if you:

• Are pregnant or breastfeeding
• Have active deep vein thrombosis (DVT, a blood clot in a deep vein) or a superficial blood clot
• Are bedridden

Your doctor might also suggest that you skip having sclerotherapy on a vein that you might need for a surgical bypass procedure in the future. For instance, the saphenous veins, which help send blood in your feet and legs back to your heart, may not be an option as they’re often used for coronary artery bypass graft surgery.

Sclerotherapy works best on smaller varicose veins. If you have very large or severe varicose veins, your doctor might recommend surgery instead.

While sclerotherapy is best known for helping people with varicose and spider veins, it may be used for other purposes, such as:

• Shrinking hemorrhoids
• Treating lymphatic malformations (collections of abnormal vessels that carry lymph fluid around the body)
• Correcting hydrocele (an abnormal amount of fluid that accumulates around a man’s testicle)

Typically, a dermatologist, vascular surgeon, or vein specialist performs sclerotherapy. The procedure is done at your provider’s office and doesn’t require the use of anesthesia.

Your doctor will instruct you to lie on your back or your stomach, depending on the area being treated.

Before the treatment begins, your doctor may perform a test injection to make sure you don’t experience a bad reaction.

Then, your doctor will clean the area with alcohol and stretch your skin at the spot where they will inject the solution. They may use an ultrasound to help locate the affected vein.

Next, the doctor will use very thin needles to inject a liquid or foam solution into your blood vessel. This process will be repeated on other veins if necessary. The solution works by irritating the lining of the vein so that it swells shut and blocks blood flow.

After the needle is removed, your provider will apply compression and massage the area to spread out the solution and keep blood out of the injected vein.

The entire treatment usually takes around 30 to 45 minutes.

Your doctor will give you specific instructions on how to prepare for your procedure.

Tell your provider about all the medications and supplements you take prior to having sclerotherapy. You may have to stop taking certain medicines, such as:

• Antibiotics, including tetracycline or minocycline
• Aspirin or ibuprofen (Advil)
• Blood thinners
• Prednisone (Rayos, Sterapred)
• Iron supplements or vitamins that contain iron

Your provider will tell you how long you should stop taking these medications and when it’s safe to resume using them.

Some other ways to prepare for your procedure include:

• Don’t apply any lotion to your legs before sclerotherapy.
• Bring a pair of shorts to wear during the procedure.
• If you have compression stockings or your doctor requests you wear them after the procedure, bring them with you so you can put them on after the treatment is over.
• If your doctor recommends it, make plans to have someone drive you home after your procedure.

Sclerotherapy is generally considered a safe procedure, but adverse events can occur. Some possible risks include:

• Infection
• Severe inflammation
• A blood clot or DVT
• An allergic reaction to the injected solution

Though extremely rare, there have been a small number of strokes and heart problems reported after sclerotherapy.

You should contact your doctor right away if you experience the following symptoms:

• Sudden swelling in your leg
• Swelling within 5 inches of your groin
• Small ulcers at the site of injection
• Red streaking on your skin, especially near your groin
• Difficulty breathing, chest pain, dizziness, or coughing up blood
• Visual disturbances, headaches, fainting, or nausea

During the procedure, you might feel:

• Mild discomfort
• Cramping
• A burning sensation

Sometimes, doctors use solutions that contain lidocaine to make you more comfortable during the injection.

You may also feel pain if the solution leaks from the vein into your surrounding tissue. If you experience a lot of pain, let your doctor know.

It’s possible that you could have a negative reaction from sclerotherapy. People with underlying medical conditions are more likely to experience complications.

Some possible side effects include the following:

• Injected veins may appear lumpy or hardened. This can last for several months.
• Your skin may be red where the needle punctured it. This should get better within a few days.
• Spots or brown lines may show up on your skin where the solution was injected. These usually go away within a few months, but they can be permanent.
• You may have bruising at the injection site that lasts days or weeks.
• Small blood vessels can develop in the area that was treated. They should fade away within a few months.

Recovery from sclerotherapy is generally very quick. While many people return to their normal activities right away, it’s a good idea to ask someone to drive you home after you receive your treatment.

You’ll be able to walk and move soon after sclerotherapy. Your doctor will suggest that you move often to prevent blood clots from forming. But you should avoid strenuous exercise for about two weeks after the procedure.

For about two days following your treatment, you should:

• Avoid taking aspirin or ibuprofen (Tylenol is okay)
• Keep the injection site clean by washing with mild soap and lukewarm water
• Avoid taking hot baths or applying heat to the affected area
• Keep the affected area out of the sun

As part of your after care, your provider will ask you to wear compression stockings or bandages for about two weeks.

Your doctor will probably want to see you for a follow-up appointment about a month or two after your procedure.

Results from sclerotherapy aren’t immediate. It usually takes about three to six weeks to notice a change. Larger veins may take three to four months or longer.

One session of sclerotherapy may successfully eliminate 50 to 80 percent of the veins that were injected. However, the treatment doesn’t work in about 10 percent of cases. If it’s ineffective, your doctor may recommend a different method, such as surgery or laser therapy.

The treated veins that respond to the procedure won’t reappear, but new veins may crop up over time. If this happens, you may need additional treatments.