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What is the difference between ultrasound guided sclerotherapy and visual sclerotherapy?


Images courtesy of
Steven E. Zimmet, MD

What is Sclerotherapy?

Sclerotherapy is the most common method of varicose vein treatment. Visual sclerotherapy is used to treat veins visible on the surface of the skin. Ultrasound-guided sclerotherapy is used to treat certain veins below the skin surface.  Spider veins and varicose veins have poorly functioning valves such that pooling of blood occurs in those veins.

Sclerotherapy procedures require an injection of a chemical solution directly into an unwanted vein. The chemical solution is designed to irritate the lining of the vein wall, causing the varicose vein to collapse and disintegrate. A variety of medications, called sclerosants, are used in their liquid form to treat veins. Some physicians create foam with certain sclerosants, such as Sotradecol and Asclera, which can improve success of treatment in larger varicose veins during a procedure called foam sclerotherapy.

After an enlarged vein has been eliminated, blood that would normally flow through that vein redirects its path toward remaining properly functioning veins. Typically blood flow is improved and more efficient since dysfunctional veins have been eliminated.

Because some insurance companies consider sclerotherapy a cosmetic procedure, patients may be led to believe that varicose veins are not significant medical problems. Recent trends in the medical community call for greater diligence in treating varicose veins because they commonly cause significant symptoms, and because their presence increases the risk of problems such as chronic venous insufficiency (CVI), or venous reflux. Many patients diagnosed with varicose veins typically seek treatment to relieve themselves of leg pain, aching, intense feelings of heaviness, or itching. Other problems caused by these varicose veins including leg swelling, eczema, skin discoloration and inflammation, bleeding, phlebitis or deep vein thrombosis, and open sores called leg ulcers.

Sclerotherapy is a minimally invasive technique that can be used to treat varicose veins and spider veins for medical and/or cosmetic reasons. It takes approximately 4 weeks to see the benefits of this kind of varicose vein treatment. Several sclerotherapy treatment sessions are often required to obtain the best results.

Bruising is common after sclerotherapy, but usually clears within 1-2 weeks. The most common side effect of sclerotherapy is a brownish discoloration that develops at the site of a treated vein. This usually goes away over time. Matting, a group of tiny red veins, may appear at a treatment site. These may clear with time, or may need to be treated. Serious side effects of sclerotherapy are very rare, and can include blood clots or allergic reaction to the medication. Neurological side effects such as visual disturbance, headache and stroke-like symptoms occur rarely. Typically these fully resolve over time. You should always seek immediate professional medical attention if you have any concerns.

Sclerotherapy is generally very effective and very well tolerated as a varicose vein treatment and spider vein treatment. The procedure is simple, requiring the patient to only avoid lotions and shaving during the 24 hours leading up to his or her appointment. Sclerotherapy does not require sedation and discomfort is usually mild. Post-treatment instructions usually include being active aerobically (walking, biking, using a treadmill), avoiding hot baths, and wearing compression stockings for several days to a week or two.

If you are exploring sclerotherapy as a way to treat varicose or spider veins, contact a DoctorQA physician to go over your options.


Reviewed by Steven E. Zimmet, MD, RVT, FACPh
Editor of Phlebology
President, Zimmet Vein & Dermatology
Past-President, American College of Phlebology

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