Sclerotherapy is a tried and true method of dealing with smaller bluish veins under the skin called reticular veins and tiny telangectasias commonly known as spider veins. Many chemicals, called sclerosants, have been used and they all work by causing irritation of the inner lining of the vein. This causes the vein to close and, over time, the destroyed vein is eliminated by the body. For many years, "saline injections" were the standard sclerosant and used virtually everywhere. Unfortunately, saline injections had significant drawbacks. They were painful and could damage the skin and even cause an ulcer to develop. At The Vein and Laser Center, we have never used saline for these reasons. Instead, we use two widely used sclerosants which have become the industry standard for sclerotherapy. These are Sodium Tetradecyl Sulfate, STS for short, and Polidocenol, or Pol. These agents are extremely safe with allergic reactions very rare. They are used in various concentrations and are injected directly into the vein with a tiny needle about the size of a hair. This feels like a mosquito bite and most patients find this relatively painless. Compression is used immediately after the treatment and the compression stocking should be worn for several days but as a general rule the longer they are used, the better the result. Forty-eight hours is best but certainly not more than a week. It commonly takes several weeks for the spider veins to start to disappear. For this reason we do not retreat the same area sooner than four to six weeks.

For those rare patients who are phobic to needles or feel they cannot tolerate sclerotherapy, we have successfully used the Lyra laser to eliminate these surface veins. It is also safe and effective for veins up to 4 millimeters in diameter.

Foam Sclerotherapy is a technique gaining increased acceptance as an adjunct to standard sclerotherapy. This technique has actually been around for many decades but has only recently been found to increase the effectiveness of sclerotherapy in closing larger veins. Sclerosant is simply mixed with air and injected into a vein. The microscopic bubbles thus formed allows increased contact between the chemical and the vein wall without being washed away and diluted by the blood inside the vein. We have used foam sclerotherapy with great success, closing even large, bulging varices.

In addition, sclerotherapy can be used to treat more deeply situated veins not visible from the surface that are not amenable to ambulatory phlebectomy. Ultrasound can be used to guide the injections into the underlying diseased vessels. This procedure, known as Ultrasound-Guided Sclerotherapy, or USG, allows sclerosant to be administered safely and accurately to the problem veins hidden from view.

A few comments about sclerotherapy: The first principle is that the smaller the vein to be eliminated, the greater the success. Secondly, varicose veins treated by sclerotherapy will recur if venous reflux through the greater or lesser saphenous vein is not controlled first. Most importantly, disappearance of the veins takes time and is rarely 100%. The majority of patients undergoing sclerotherapy will see their veins cleared or at least significantly improved (85% improvement is generally accepted as the "industry standard"). The number of treatments required is quite variable and cannot be predicted at the beginning of treatment although an estimate can be made. Unfortunately, there is no guarantee that sclerotherapy will be effective for you. About 10% of patients undergoing sclerotherapy will have fair to poor results. In very rare cases they may actually be worse. Once reflux, if present, has been treated, there is no way to predict who will have less than satisfactory results. Lastly, they may come back in new locations. This cannot be prevented because any treatment for varicose vein disease is treating the outward manifestation of an underlying abnormality of the veins for which there is no cure. All of this having been said, the vast majority of our sclerotherapy patients have seen excellent results.