Sclerotherapy for Varicose Veins: An Expert Guide from Ontario Vascular

Varicose veins affect nearly one in four adults. They can cause aching, swelling, and visible vein patterns that may affect quality of life. Sclerotherapy is a minimally invasive treatment that helps close and fade these veins, restoring smoother circulation.

This guide, brought to you by the specialists at Ontario Vascular, covers:

• What sclerotherapy is

• How it works

• What to expect before, during, and after the procedure

• Common side effects and safety

• How it compares to other vein treatments

• Cost and insurance basics

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⚠️ Always consult a licensed healthcare provider before making medical decisions. This content is for informational purposes only and does not constitute medical advice.

Our Commitment to Your Vein Health

At Ontario Vascular, our team of board-certified specialists is dedicated to providing advanced, patient-centred care for vein conditions. With years of experience and access to the latest diagnostic and treatment technologies, we ensure every patient receives a personalized and effective treatment plan. Our expertise in sclerotherapy and other vascular interventions means you are in trusted hands for optimal outcomes and lasting relief.

What Is Sclerotherapy?

Sclerotherapy is a medical procedure where a solution—called a sclerosant—is injected into abnormal veins. The solution irritates the inner lining of the vein (the endothelium), causing it to swell, collapse, and seal shut. This process, known as sclerosis, effectively closes off the problematic vein. The body gradually absorbs the closed vein, and blood is naturally rerouted through healthier vessels, improving circulation and reducing symptoms.

What Types of Sclerotherapy Exist?

Type	Description	Best For	Additional Details
Liquid Sclerotherapy	Clear solution injected into the vein	Small to medium veins (spider veins, reticular veins)	The sclerosant is injected directly as a liquid. It's precise for superficial veins and allows for clear visualization of the solution's spread.
Foam Sclerotherapy	Sclerosant mixed with air to form a thick, stable foam	Larger or more tortuous veins, saphenous veins	The foam displaces blood more effectively, allowing for better contact with the vein wall and requiring less sclerosant. It's often preferred for larger veins due to its increased potency and visibility under ultrasound.
Ultrasound-Guided Sclerotherapy	Uses real-time imaging for precision, especially for deeper veins	Deeper veins not visible on skin, incompetent saphenous veins, recurrent varicose veins	Ultrasound guidance ensures accurate placement of the needle and sclerosant, minimizing risks and maximizing efficacy for veins that cannot be seen or felt. Essential for treating source veins.

The choice of sclerotherapy type depends on the size, location, and type of vein being treated, as well as the physician's expertise and patient-specific factors. A thorough evaluation by a vein specialist is crucial to determine the most appropriate approach.

Patient Selection: Who is a Candidate?

Sclerotherapy is a versatile treatment, but it's not suitable for everyone. A comprehensive medical history and physical examination are essential to determine if you are an ideal candidate.

Ideal Candidates for Sclerotherapy:

• Individuals with symptomatic spider veins, reticular veins, or small to medium varicose veins.

• Patients experiencing symptoms such as aching, throbbing, swelling, or itching related to their veins.

• Those seeking cosmetic improvement for visible veins.

• Individuals who are generally healthy and have realistic expectations about the outcomes.

Contraindications (When Sclerotherapy is Not Recommended):

• Pregnancy or Breastfeeding: Sclerosants can potentially cross the placenta or enter breast milk, posing risks to the fetus or infant.

• Deep Vein Thrombosis (DVT): A history of DVT, especially recent, requires careful consideration and often precludes sclerotherapy until the DVT is fully resolved and assessed.

• Severe Arterial Disease: Patients with compromised arterial circulation may not be suitable candidates due to potential complications.

• Allergy to Sclerosant: Known allergies to any of the sclerosant agents.

• Acute Infection: Active skin infection at the treatment site.

• Immobility: Patients who are unable to walk or move adequately after the procedure may be at higher risk for complications.

Preparing for Your Sclerotherapy Session

Proper preparation can significantly contribute to the success and comfort of your sclerotherapy treatment. Your vein specialist will provide specific instructions, but general guidelines often include:

• Avoid Lotions and Oils: Do not apply any lotions, oils, or creams to your legs on the day of your procedure, as these can interfere with the antiseptic solution and marking of veins.

• Wear Loose Clothing: Opt for comfortable, loose-fitting clothing. You will likely need to wear compression stockings immediately after the procedure, so ensure your clothing can accommodate them.

• Stay Hydrated: Drink plenty of water in the days leading up to your appointment.

• Discuss Medications: Inform your doctor about all medications, supplements, and herbal remedies you are taking. You may be advised to temporarily stop certain medications, such as blood thinners or anti-inflammatory drugs, though this is not always necessary.

• Arrange for Transportation: While most people can drive themselves home, if you anticipate any discomfort or are undergoing extensive treatment, having someone drive you might be beneficial.

• Eat a Light Meal: A light meal before your appointment is usually recommended to prevent lightheadedness.

What Veins Can Be Treated?

Sclerotherapy is primarily used for superficial vein issues, targeting veins close to the skin's surface. Understanding the types of veins treated helps clarify their application:

• Spider veins (telangiectasia): These are very thin red, blue, or purple veins that resemble a spiderweb or tree branches. They are typically cosmetic concerns, but can sometimes cause mild itching or burning. Sclerotherapy is highly effective for these small, superficial vessels.

• Reticular veins: These are mid-sized, often blue or green veins that lie just beneath the skin's surface. They are larger than spider veins but smaller than varicose veins and can sometimes "feed" spider veins. Treating reticular veins can prevent the recurrence of spider veins.

• Varicose veins: These are enlarged, twisted, and often bulging veins that can cause significant symptoms like aching, heaviness, swelling, and skin changes. Sclerotherapy is suitable for small to medium-sized varicose veins. For larger or more complex varicose veins, especially those originating from incompetent saphenous veins, foam sclerotherapy or ultrasound-guided sclerotherapy is often employed, sometimes in conjunction with other treatments.

It's important to note that sclerotherapy is generally not used for deep vein issues, which require different treatment approaches.

What Happens During the Procedure?

• It’s done in an outpatient clinic setting, meaning you can go home the same day.

• The provider will clean the skin over the targeted veins with an antiseptic solution.

• Using a very fine needle, the sclerosant is injected directly into each targeted vein. Patients may feel a slight prick or mild stinging sensation.

• For deeper or larger veins, the procedure may use ultrasound guidance. This real-time imaging allows the physician to precisely visualize the vein and ensure accurate placement of the needle and sclerosant, enhancing safety and effectiveness.

• After the injection, the treated area may be gently massaged to help disperse the solution and ensure optimal contact with the vein wall.

• Each session typically lasts about 15 to 45 minutes, depending on the number and size of veins being treated. Multiple injections may be administered during a single session.

• Immediately after the injections, compression is applied, usually in the form of cotton balls taped over the injection sites and then a compression stocking or bandage.

How Effective Is Sclerotherapy?

Measure	Outcome	Details and Factors Influencing Success
Success Rate	50–80% of treated veins improve per session	Success rates vary based on vein size, type, and location, as well as the sclerosant used and the physician's expertise. Smaller veins generally respond better and faster.
Visible Results	3–6 weeks for spider veins, 3–4 months for varicose veins	Spider veins fade relatively quickly. Larger varicose veins take longer to be absorbed by the body, and their disappearance is more gradual. Patience is key.
Multiple Sessions?	Yes, usually 2–4 treatments spaced 4–6 weeks apart	It's rare for all problematic veins to resolve in a single session. Multiple treatments are often necessary to achieve optimal cosmetic and symptomatic results, allowing time for the body to heal between sessions.

Factors Influencing Long-Term Efficacy

The long-term success of sclerotherapy is excellent for the veins treated. However, it's important to understand that sclerotherapy does not prevent new veins from forming in the future. Factors such as genetics, prolonged standing, obesity, and hormonal changes can contribute to the development of new spider or varicose veins over time. Regular follow-up appointments and adherence to lifestyle recommendations can help maintain results and address any new veins promptly.

What Are Common Side Effects?

Most side effects are mild, temporary, and resolve within a few days to weeks:

• Bruising or redness at the injection site: This is very common and typically fades within a week or two.

• Itching or swelling: Mild itching or swelling around the treated area is normal and usually subsides within a few days.

• Temporary brown discoloration (hyperpigmentation): This occurs in a small percentage of patients, especially with larger veins. It's caused by hemosiderin (iron from red blood cells) leaking into the skin. It usually fades over several months but can occasionally be persistent.

• Mild aching or cramping: Especially in the first few days after treatment, particularly with larger veins.

• Small skin sores or blisters: Rare, but can occur if some sclerosant leaks out of the vein. These usually heal on their own.

Rare but serious complications include:

• Deep vein thrombosis (DVT): A blood clot in a deep vein. While rare, it's a serious complication. Symptoms include severe leg pain, swelling, and redness.

• Allergic reaction: Ranging from mild rash to severe anaphylaxis. This is why a thorough medical history is taken before treatment.

• Skin ulceration: Tissue damage that can lead to an open sore, usually due to inadvertent injection into an artery or leakage of sclerosant.

• Temporary visual disturbances or headaches: Very rare, usually transient, and associated with foam sclerotherapy.

Seek immediate medical care if you experience chest pain, shortness of breath, severe leg pain or swelling, signs of infection (fever, increasing redness, pus), or any other concerning symptoms.

Aftercare: What Should You Do?

Proper aftercare is crucial for optimal results and to minimize side effects. Adhering to your specialist's instructions will significantly impact your recovery and the success of the treatment.

Compression Stockings: Your Best Ally

• Wear them day and night for at least one week: Your doctor will specify the duration and compression level.

• Help prevent blood pooling and improve healing: Compression stockings apply gentle pressure, keeping the treated veins closed, reducing swelling, and promoting blood flow through healthier veins. This is vital for preventing complications and ensuring the vein scars down effectively.

Activity Tips: Stay Active, But Smart

• Walk regularly: Immediately after the procedure, walking for 20-30 minutes is highly recommended. Continue daily walks to encourage circulation and prevent blood clots.

• Avoid strenuous activity for 48 hours: This includes heavy lifting, intense exercise, and prolonged standing or sitting. These activities can increase pressure in the veins and potentially compromise the treatment.

• Elevate legs when resting: Raising your legs above heart level helps reduce swelling and discomfort.

• Avoid hot baths, saunas, and whirlpools: For at least a week, as heat can dilate veins and interfere with the healing process. Showers are fine.

• Avoid direct sun exposure: On treated areas for several weeks, as this can worsen hyperpigmentation.

At-Home Comfort Measures: Managing Mild Symptoms

• Cold compresses: Apply to injection sites for brief periods to reduce swelling and discomfort.

• Pain relievers, if needed: Over-the-counter medications like acetaminophen or ibuprofen can manage mild pain or aching.

• Keep injection sites clean and dry: Follow any specific wound care instructions provided by your clinic.

Cost and Insurance

Understanding the financial aspects of sclerotherapy is an important part of your treatment journey.

Cost Factors:

• Number of sessions: Most patients require multiple sessions, which will impact the total cost.

• Size and number of veins treated: Extensive treatment for larger or numerous veins will naturally incur higher costs.

• Type of sclerosant used: Different agents may have varying costs.

• Geographic location and clinic policies: Prices can differ significantly between regions and individual clinics.

• Use of ultrasound guidance: If ultrasound is required for deeper veins, it may add to the cost.

Insurance Coverage: Navigating the System

• Often covered if medically necessary: If your varicose veins cause symptoms such as pain, aching, swelling, heaviness, skin changes (e.g., dermatitis, ulceration), or bleeding, sclerotherapy may be considered medically necessary. In such cases, many insurance providers will cover a portion or all of the treatment cost. Documentation of symptoms and a trial of conservative measures (like compression stockings) are often required.

• Cosmetic treatments for spider veins are usually not covered. If the primary reason for treatment is aesthetic improvement without significant medical symptoms, insurance typically classifies it as cosmetic and will not cover the expense.

• Pre-authorization: It is crucial to contact your insurance provider before starting treatment to understand your specific policy, coverage limits, deductibles, and co-pays. Your clinic can often assist with the pre-authorization process.

Payment Options May Include:

• Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA): These tax-advantaged accounts can be used to pay for qualified medical expenses, including medically necessary sclerotherapy.

• Financing plans or treatment packages: Many clinics offer payment plans or discounted packages for multiple sessions, making treatment more accessible. Discuss these options with your provider's administrative staff.

Sclerotherapy vs. Other Treatments

Sclerotherapy is one of several effective treatments for vein disease. Understanding how it compares to other options can help you and your specialist choose the best path.

Treatment	How It Works	Pros	Cons	Best Suited For
Sclerotherapy	The injection causes the vein to close and fade.	Minimally invasive, cost-effective, no downtime, effective for various vein sizes.	May require repeat sessions, temporary discoloration, not ideal for very large or tortuous veins as a sole treatment.	Spider veins, reticular veins, small to medium varicose veins, and residual veins after other treatments.
Endovenous Laser Ablation (EVLA)	A laser fibre inserted into the vein heats and closes it from within.	Highly effective for larger saphenous veins, minimally invasive, high success rates, and quick recovery.	Heat-related discomfort requires local anesthesia, higher cost than sclerotherapy.	Larger, straight varicose veins, especially incompetent saphenous veins.
Radiofrequency Ablation (RFA)	Similar to EVLA, but uses radiofrequency energy to heat and close the vein.	Permanent for larger veins, less post-procedure pain than laser for some, and minimally invasive.	More invasive than sclerotherapy, higher cost, requires local anesthesia.	Larger, straight varicose veins, similar to EVLA.
Ambulatory Phlebectomy	Small incisions are made to physically remove varicose veins.	Immediate removal of bulging veins, good for superficial, tortuous veins.	More invasive than sclerotherapy, small incisions, and potential for bruising and swelling.	Large, bulging superficial varicose veins that are close to the skin surface.
Vein Stripping (Surgery)	Surgical removal of the entire saphenous vein through incisions.	Long-term solution for severe varicose veins.	Most invasive option, longer recovery time, general anesthesia, and higher surgical risks (infection, scarring).	Historically used for very large, symptomatic saphenous veins; now largely replaced by less invasive methods.

The choice of treatment depends on the specific characteristics of your veins, the severity of your symptoms, your overall health, and your personal preferences. A thorough consultation with a qualified vein specialist will help determine the most appropriate and effective treatment plan for your individual needs.

Our commitment is to empower you with knowledge and provide the highest standard of care. Understanding sclerotherapy, how it works, and what to expect ensures you feel confident in discussing your options with our specialized vein team. It’s a safe, effective method when performed under our expert vascular care, offering significant relief from symptoms and cosmetic improvement for many individuals. Trust our specialists to guide you in making the best decisions for your vein health and achieving lasting results.

Ready to Discuss Your Vein Treatment Options?

If you're experiencing symptoms of varicose or spider veins, or simply wish to improve their appearance, a consultation with our specialized vein clinic is your next step. Our experts can assess your condition and recommend a personalized treatment plan tailored to your needs.

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