Sclerotherapy Injections for Veins
Injections of sclerosing agents (substances that cause the vein walls to collapse and scar together) are the most common injection treatment for veins offered at The Vein Clinic. Liquid sclerotherapy is used for treating smaller varicose veins and spider veins and is typically done as a cosmetic only treatment.
Foam sclerotherapy is a modification of this technique whereby air or physiological gases (oxygen/carbon dioxide) are mixed with the sclerosant agent to form a “foam”. Foam sclerotherapy has been proven to be more effective over liquid in treating larger incompetent veins. Foam sclerotherapy injections for larger veins are usually guided by ultrasound, to ensure accurate placement within the target vein, maximising efficacy and minimising the risk of complications.Read More
What is Cosmetic Microsclerotherapy?
Microsclerotherapy is the gold standard for the treatment of telangiectasia or “spider veins”.
Spider veins are very fine and red in colour and are caused by back pressure from reticular veins. Reticular veins are slightly larger veins that lie just beneath the skin and are distinguishable by their slightly blue-green colour and tendency to form a central network “feeding” into or around an area of spider veins. Reticular veins require treatment when they have become inefficient in directing blood back to your heart and lead to back pressure, causing spider veins. Poor results and complications of treatment such as “matting” are often the result of failing to identify and properly treat these reticular veins.
How Cosmetic Microsclerotherapy For Veins Works
Microsclerotherapy involves meticulous injection (often with the aid of magnification, transillumination, or augmented reality) of a sclerosant solution using very fine needles. A transient burning discomfort from sclerosant entering larger veins may occur, but this usually lasts less than a minute. Sclerosants cause irreversible damage to the inner wall of the vein, resulting in a scarring reaction called ‘sclerosis’. This leads to permanent closure of the vein. The sclerosed vein undergoes a slow transition over time to become a fibrous cord and eventually disappears completely as the redundant scar tissue is removed by a process called ‘apoptosis’. The sclerosants are used at The Vein Clinic are sodium tetradecyl sulphate (STS) and polidocanol.Read More
Most patients will require more than one course of microsclerotherapy to remove spider veins. One course of treatment usually gives 70-80% improvement. If there are extensive spider veins, then 3 treatment sessions over 3 months is usually required, with one further retreatment a year later. The process that causes spider veins is chronic and related to aging. There is a marked tendency for new spider veins to develop over time. Despite optimal treatment, >50% of patients will develop new spider veins within 3 years.
Stages of Vein Treatment
Treatment of large malfunctioning veins (trunk)
Endovenous Laser Treatment (EVLA) to great, small, and/or anterior accessory saphenous veins. 60 minutes
Treatment of large varicose veins (branches)
Phlebectomy removal of larger bulging varicose veins 90-120 minutescombined with
Ultrasound-Guided Foam Sclerotherapy (UGFS) on smaller veins. 30 minutes
Treatment of small varicose veins (branches) if required
Extra sessions of UGFS to close smaller veins if identified as required at post-treatment follow-up scan 30 minutes
You may not require this stage.
Optional treatment surface veins (leaves)
Usually done by Microsclerotherapy 30 minutes
Most patients require multiple treatment sessions to remove spider veins.
Follow up and maintenance to ensure best results
What To Expect?
Discomfort: Microsclerotherapy injections for spider veins involves a finer needle and the experience is much like a mosquito bite. The number of injections required is usually far more than that for varicose veins and may be between 10-100 per treatment session. Many patients are surprised to learn that spider vein treatments are generally more difficult and painful than the larger varicose vein treatments.Read More
Walking: It is a requirement that patients walk for 20-30 minutes immediately following treatment and for 20-30 minutes each day for the next 2 weeks. This helps prevent complications such as DVT (deep vein thrombosis) and promotes the opening of collateral pathways for blood to return to the heart in healthy veins.
Sports, gym & other physical activity: Walking and gentle exercise only is advised in the first week following treatment. In the second week other exercise may be gradually introduced “as tolerated”. In general terms after 2 weeks most people can return to normal activity. Recovery, like most things in medicine, is individual and depends on the extent of treatment, type of treatment performed, patient pain threshold, extent of inflammation after treatment, compliance with stockings, other medications prescribed after treatment, general health and healing capacity. If you’re unable or unwilling to take anti-inflammatory tablets after treatment your recovery may be more prolonged.
Results: Several treatment sessions may be required and gradual improvement will usually be seen after each treatment. With spider vein treatment, results take time and cosmetic appearances may in fact be worse for up to 3 months following treatment and the full effect of treatment may not be shown for up to 12 months.
Potential Complications of Microsclerotherapy
Pre-treatment and 6 months post
Staining or pigmentation can occur in up to 20% of patients and is due to the breakdown of red blood cells depositing iron containing the pigment haemosiderin. Melanin is also associated with post-sclerotic pigmentation and is more common in patients with darker complexions. Trapped blood predisposes patients to more pigmentation, as does incomplete treatment of underlying reticular veins. Most pigmentation usually disappears within 3-6 months. A small percentage of patients will have pigmentation persisting for up to 12 months. It may be permanent in about 1% of patients.
Pre-treatment and 5 months post
Matting is the development of new, very fine red networks of spider veins. Mostly seen around the lateral thighs and medial knee areas, they differ in appearance to the original spider veins that prompted the treatment. They can arise a few months after treatment, with a reported incidence of 7-10%. There is an increased risk of developing this complication if the primary treatment of sclerosing regional reticular veins in the dependent area has been inadequate. Fortunately, matting often disappears over time without the need for further treatment.
Ulceration of the skin is a rare complication and arises if the arterial circulation of the skin has been compromised. Occasionally the sclerosant triggers arterial spasm from an effect on the venous side of the circulation. Extensive ulceration of the skin due to direct injection of sclerosant into an arterial vessel is a very rare but serious complication.
Word of Caution
It is not uncommon that patients presenting to The Vein Clinic may have had less than pleasing long-term results from previous sclerotherapy treatment. The usual reason is that they have only had the visible surface veins treated. In many cases, underlying “feeder” veins that may only be visible on ultrasound have not been treated. This can result in the body producing even more abnormal veins once the surface veins have been treated.Read More
In many cases, patients presenting with spider veins are usually only seeing the “tip of the iceberg”. A high percentage of patients will have hidden varicose veins. If the underlying abnormal veins are not treated first, results from surface sclerotherapy will not be satisfactory. It is for this very reason that The Vein Clinic will not undertake microsclerotherapy without first investigating the status of your underlying veins using high frequency ultrasound evaluation.
Once all “feeder” veins have been eliminated and the medical stages of treatment are complete, we can move on to the cosmetic stage of treatment with surface microsclerotherapy. In order to improve the success of sclerotherapy, we use specialised magnifying and cross polarisation technology (Syris V600 ™) to literally see 1mm below the surface of the skin, improving the targeting of spider veins.
Patients need to understand that due to the fact surface veins are often numerous, have multiple feeders and are extremely small, complete elimination and a perfect cosmetic result is rarely achieved. Realistically a 50-90% improvement in appearance can be anticipated following a series of multiple treatments. Whilst multiple veins are treated in one session, usually several (average three) treatment sessions will be required to obtain optimal results. These sessions are performed at approximately 4 weekly intervals, so this is not a treatment to have a week before you are going to Bali!
About The Vein Clinic
The Vein Clinic is a specialist medical clinic dedicated to excellence in the treatment of superficial venous disease. We are NOT a cosmetic clinic so we do things very differently from such clinics that treat veins according to what they see on the surface. We look deeper to get to the underlying source of your surface vein problems and will not treat you based just on what is seen to the naked eye. We DO NOT use surface laser to treat surface veins as this does not treat the underlying abnormality and may result in poor cosmetic results such as matting.Read More
Dr Luke Matar and The Vein Clinic specialise in minimally invasive and non-surgical treatments for varicose veins, spider veins and venous reflux. Vein experts around the world now recognise these treatments as the new standard of care for the removal of varicose veins. Unlike with vein surgery, your everyday life will not be affected by your treatment.
The Vein Clinic offers a large variety of treatments for varicose veins, and Dr Luke Matar will always provide a through ultrasound and clinical assessment, to help you fully understand the underlying causes of your vein problem. Varicose veins are caused by venous reflux, and it’s important to address the underlying cause to avoid recurrence of your symptoms.
Once you have received a clear diagnosis, Dr Matar will assist you to to make a well informed decision about your treatment.
85% of patients are happy with results after microsclerotherapy treatment. Paradoxically, the more extensive and numerous the spider veins, the more likely you will be pleased with the outcome of treatment. Generally speaking, patient satisfaction with treatment outcome is age-related and greatest in patients older than 40 and lowest in those in their 20’s or 30’s.
10% of patients are unsatisfied following treatment and this is typically due to unrealistic expectations of what treatment can reasonably achieve. Those with pain, ache, itch, and discomfort related to spider veins will be usually experience symptom relief and be happy with the results of treatment.
Patients with very small localised patches of spider veins and no underlying feeder veins are often not good candidates for treatment as these smaller veins are more difficult to treat and the risks of treatment may outweigh the benefits. Even under ideal conditions, a favourable cosmetic result is not guaranteed, and 5% of patients may be unhappy with the results of treatment.