What is Sclerotherapy?
Sclerotherapy is a treatment that involves the use of a very fine needle to inject a solution that can sclerose (i.e. seal off) unwanted veins. The body then naturally breaks these veins down in the same way that it removes bruises and blood circulation is restored through normal veins. Sclerotherapy can be used to directly inject veins visible on the surface of the skin in which case it is called Surface Sclerotherapy. The term Micro Sclerotherapy is sometimes used for this treatment because of the very tiny gauge needles that are used.
Sclerotherapy can also be used to inject veins that are situated below the surface of the skin. To accurately visualise the position of these deeper veins a special Ultrasound is needed and this method of Sclerotherapy is hence called Ultrasound Guided Sclerotherapy (UGS). UGS is a minimally invasive procedure which can target very large Varicose Veins and underlying blood flow problems without surgery.
What are the advantages of Surface Sclerotherapy?
Surface Sclerotherapy is very effective and for the majority of Spider Veins and surface Varicose Veins it is the best treatment. Importantly, Surface Sclerotherapy is a straightforward treatment that doesn’t require expensive equipment and is a walk in, walk out procedure that does not require hospitalisation, no anaesthetic, no cutting of the skin and with patients being able to resume normal activity and work immediately afterwards.
Is Surface Sclerotherapy painful?
The vast majority of patients do not regard Surface Sclerotherapy as painful because the needle used is very, very fine. However some patients with sensitive skin do feel a stinging sensation as the solution used contains saline. If patients have very sensitive skin it is best not to schedule a treatment in the premenstrual time and taking an anti-inflammatory like Nurofen before treatment can be beneficial.
Are there any side effects?
Surface Sclerotherapy has been found to be a remarkably safe method of Leg Vein treatment in many clinical studies both in Australia and overseas. All needles are single use and disposable and the solution used is very well tolerated with a remarkably low incidence of allergic reactions.
Minor side effects such as surface bruising may occur but usually disappears quickly. Tender cords can occasionally develop when larger veins are treated by Surface Sclerotherapy but these disappear over several weeks as the body breaks down these ‘sealed’ veins. Uncommonly after treatment the vein may develop a brownish colour (hyper pigmentation). This is similar to how an area of skin can go a brown colour after bruising. It mainly occurs with very large or thick patches of veins and individuals with darker skin, and usually resolves over several weeks although rarely it may be long lasting. In cases where pigmentation is persistent laser treatment has been found to be effective in removing this pigment.
Whilst serious side effects are very rare with Surface Sclerotherapy it needs to be remembered that unknown or unpredictable problems can occur with any form of medical treatment. Fortunately Deep Vein Thrombosis is a very rare complication with Surface Sclerotherapy as the veins being treated by Surface Sclerotherapy are so superficial and normal activity and walking can be resumed immediately after treatment. Another possible rare complication is the development of a small skin ulcer. If this occurs it is mainly in the elderly and typically heals very quickly.
Who does the treatment?
All Surface Sclerotherapy treatments are performed by experienced medical practitioners who have been fully trained in the latest leg vein treatment methods. Doctors at our clinic have been successfully treating Spider Vein and Varicose Vein problems with Surface Sclerotherapy for over twenty years.
Are there any requirements before Surface Sclerotherapy?
All treatments are performed on an outpatient basis in our Leg Vein Clinic. No anaesthetic is necessary and there is no specific preparation required before treatment. We do recommend not shaving or waxing the legs in the 24 hours before any Leg Vein treatment including Surface Sclerotherapy. We do recommend wearing loose fitting clothing and comfortable footwear as patients need to be able to wear compression stockings after treatment and be ready to walk for at least 30 minutes after treatment. We advise not applying any leg moisturiser on the day of treatment as some small dressings may need to be applied to the skin. Patients can elect to bring shorts to wear during the procedure.
Can Sclerotherapy be used during pregnancy?
All elective medical procedures including all leg vein treatments are generally avoided during pregnancy. The main solutions used in Surface Sclerotherapy are classed as B3 which means whilst there is no evidence of problems being caused during pregnancy there are no large clinical studies to prove they are definitely safe. In addition the results from Surface Sclerotherapy during pregnancy are likely to be less effective due to the increased blood flow, hormonal changes and pressure in the Leg Veins during pregnancy. If because of severe symptoms, Leg Veins need to be treated during pregnancy, the best management is with the use of compression stockings. Surface Sclerotherapy is usually recommenced after weaning.
What needs to be done after Surface Sclerotherapy?
Normal work and activity can be recommenced immediately after Surface Sclerotherapy. Walking is encouraged for 30 minutes immediately after treatment, and 30 minutes daily for 2 weeks after Surface Sclerotherapy. Walking is very important to stimulate blood flow through the deep veins and reduce any risk of Deep Vein Thrombosis. Any small tape dressings can be removed anytime from 2 hours after treatment but should not be left overnight as they may start to irritate the skin. A compression bandage or stocking may be needed to be worn for several days after Surface Sclerotherapy especially if larger veins have been treated. The medical grade compression stockings we recommend are 20-30 mmHg level of compression.
After 1 week, massage to the treated area is recommended if there are any small lumps indicating trapped blood. Any moisturiser or hand cream can be used for massage and we would recommend 5-10 minutes twice a day if necessary.
If a further treatment session of Surface Sclerotherapy is required it is usually scheduled after 4 weeks. Maintenance treatments may be needed but it can be quite variable with some patients having a yearly follow up whereas other patients might not need to have further new Leg Veins treated for many years.
Are there any restrictions after Surface Sclerotherapy?
It is advisable to avoid prolonged periods of standing still or sitting in the first week after Surface Sclerotherapy. It is preferable to avoid vigorous exercise (eg aerobics, running, leg weights) for 48 hours after Surface Sclerotherapy to minimise bruising. It is also advisable to avoid long hot baths, spas or saunas for one week after Surface Sclerotherapy. There is no restriction on sun exposure after Surface Sclerotherapy.
Any planned air travel should be discussed regarding the timing of any Leg Vein treatment, including Surface Sclerotherapy, because of the potential for an increased risk of flight related Deep Vein Thrombosis. It is the general recommendation that any long haul (over 4 hours) air travel should be avoided for 2 weeks after Surface Sclerotherapy but the precise advice for airplane travel after Surface Sclerotherapy does vary depending on the severity of the Surface Veins being treated and if there are any other risk factors for Deep Vein Thrombosis. If a plane flight is unavoidable after Surface Sclerotherapy in a patient at higher risk of Deep Vein Thrombosis then cover with a blood thinning injection (eg Clexane) may be advised.
How many treatments are necessary?
The number of Surface Sclerotherapy treatments will depend on the number of Leg Veins that are treated and the level of improvement sought. Minor surface veins respond very quickly and may only require one or two treatments. Larger areas may require several treatments. Management of Leg Veins typically requires follow up maintenance treatments, as if there is a tendency to develop leg veins in the first instance, there will be a tendency to develop more in the future.
What are the costs likely to be?
Surface Sclerotherapy treatments can qualify for a Medicare rebate if the Leg Veins are over a certain size (2.5 mm in diameter). The out of pocket expenses if the treatment qualifies for a Medicare rebate is around $200 per treatment. There is a maximum of 6 Sclerotherapy treatments that can qualify for a Medicare rebate in any 12 month period, which includes both Ultrasound Guided Sclerotherapy and Surface Sclerotherapy.
Small surface Leg Veins are regarded as cosmetic and there is no Medicare rebate irrespective of how the Leg Veins are treated. On any procedure without a Medicare rebate GST of 10% is applicable. Expect to pay around $300 + $350 per treatment for Surface Sclerotherapy of small Spider Veins.