Sclerotherapy has been available since the 1930s and remains the treatment of choice for superficial leg veins and the deeper blue and green reticular veins that feed them.
Saline sclerotherapy uses a strong salt water solution to shrink and fade these veins. Salt has the advantage of being a naturally occurring bodily material with no molecular toxicity or allergic potential.
What does treatment involve?
- Sclerotherapy is an office procedure that takes about 45 minutes.
- Your doctor will review your medical history and perform a clinical examination of your legs.
- During treatment, each of your veins is injected with a salt water solution, using an ultra fine disposable needle. This solution irritates the lining of the veins, causing them to shrink and fade.
- Cotton balls and tape will be applied immediately after injection, but can be removed at the completion of your treatment.
- Some stinging may be experienced. Most patients equate this to being roughly equivalent to leg waxing on a scale of pain. Laughing gas is available if needed.
- Most patients need two treatments spaced 6 weeks apart.
- Most veins and both legs will be treated at each session.
- Light compression hose must be worn for 11 days after your treatment. These are available at the practice and can be purchased on the day.
- You can expect to achieve a very significant improvement in the appearance of your legs.
- Maintenance treatments may be needed over the years to keep your legs in their improved condition.
What to do on the day of treatment?
- Continue all your usual medications
- Do not apply moisturiser to your legs.
- Wear loose trousers or a long skirt with sandals or loose shoes. Do not wear thongs.
- Take two Panadol tablets about one hour before your appointment
Why do we get leg veins?
Leg veins are usually inherited, but can worsen following pregnancy or weight gain, standing for long periods or taking hormonal medication. Sometimes there is no predisposing factor for their development. Women and very much more prone than men.
Does saline sclerotherapy always work?
Sclerotherapy is a highly successful treatment that delivers impressive and relatively long lasting results for most people, especially if the reticular/ feeder veins that supply the superficial system are treated together with the smaller vessels. Improvements occur over 4-6 weeks following each treatment. Large veins may take some months to disappear completely. Some veins may need several treatments.
Veins treated adequately by sclerotherapy will not recur. However, the underlying predisposition to develop leg veins, which are often inherited and therefore genetic, remains Repeat treatment may be needed over the years.
What can I do to prevent new veins appearing?
It is important to maintain normal body weight and to exercise regularly to minimise the development of new veins. there is some evidence that supplements can strengthen vein walls and delay or prevent recurrence. Read More.
How many sclerotherapy treatments will I need?
Most patients complete their treatment within 1-2 visits six weeks apart.
What happens after treatment?
You will be asked to wear your support stockings immediately after treatment. You will be able to drive yourself home because no sedation is needed for this treatment. See further Aftercare information.
What are the side effects of sclerotherapy?
There is a stinging sensation as the saline enters the veins. Temporary aching or cramping can occur as larger veins are injected. Small bruises will develop at the injection sites. These usually resolve over a week or two.
What are the risks of sclerotherapy?
- A blush, made up of tiny veins, can develop around injection sites and make the skin look redder than before treatment. This reaction usually settles within six months but may be long lasting. Blushing occurs in about 5% of patients and of these is more common in women taking oestrogen. (I.e. The contraceptive pill or post-menopausal hormone replacement therapy).
- Brown staining of the skin can develop in treated areas due to leakage of iron pigment from dying veins. Such staining usually fades slowly and does not require treatment. Such staining rarely results from saline injections.
- Lumps, which may be tender, can develop if larger veins are treated. This is due to trapped blood within the vein. It is a good sign that the treatment has worked well and the trapped blood can be easily released at your next visit if necessary.
- Phlebitis. 1 in several hundred treatments will produce a length of tender, inflamed vein which usually lasts 10-14 days. An anti inflammatory medication may be used along with the compression stockings, to relieve pain. Appropriate use of compression stockings as suggested in the aftercare instructions will reduce the risk of this complication.
- Ulcers can form at treatment sites. Sometimes they occur due to salt leaking into the surrounding skin. Generally they occur due to sensitivity of the tissues to the concentration of the solution injected. Backflow of salt into small arterioles can also cause ulcers. Ulcers appear to occur more frequently in patients who smoke or are overweight, those who have frail skin or are on prednisone or methotrexate tablets. They are tender, will heal slowly and may leave a small, pigmented scar.
- Deep venous thrombosis, or clotting in the deep veins of the leg. . The risk is approximately 1 in 5000 patients for superficial sclerotherapy, Movement of such clots to the lungs may result in a life-threatening condition called pulmonary embolism. PLEASE INFORM YOUR DOCTOR IF YOU HAVE A PERSONAL OR FAMILY HISTORY OF CLOTTING.
- Patients prone to migraine may sometimes experience symptoms of impending migraine. Such symptoms usually settle over 20-30 minutes and full blown migraine rarely develops.
Sclerotherapy is not recommended for pregnant women, or within one month of long haul air travel (i.e. more than 5 hours)
Are there other treatments for spider veins?
No. Spider veins and their underlying feeder veins are not suitable either for surgery or laser treatment. Laser treatments currently available are ineffective and potentially dangerous.
Will I receive a Medicare rebate?
Medicare rebates apply to veins greater than 2.5mm in diameter.
Some Health Funds offer rebates on the cost of purchasing your stockings. The level of this rebate will depend on your fund’s policy.