Submitted by: Sue Jerdak
Sclerotherapy, a treatment method in which a fluid (a sclerosant) is directly injected into a vessel, is used for treating blood vessel and lymphatic system malformations. The injected sclerosant causes a reaction in the walls of the vessel which in turn causes the vessel to become non-functional and to gradually fade away. In children and young adults, sclerotherapy is used to treat vascular or lymphatic malformations. In adults, it is used for treating veins, small hemorrhoids and esophageal varices; however, the single most widely used application of sclerotherapy is for small vein treatment. The principle goal in the technique is to cause irreversible damage to diseased vessels while avoiding damage to normal collateral vessels and surrounding tissues.
Although there are more than 30 different medications that are being used in different parts of the world for sclerotherapy purposes, only a few are considered truly safe and effective for vein treatment in the United States today. Polidocanol and Sotradecol (Sodium Tetradecyl Sulfate or STS) are both FDA approved widely used sclerosants. Chromated Glycerin (Sclermo), regularly used for sclerotherapy by many vein specialists in the United States is not yet FDA-approved, despite being a very popular sclerosant throughout the world with a long track record of safety. Hypertonic saline (salt solution) on the other hand, is FDA approved, but not for sclerotherapy.
In principal, sclerotherapy can be an effective therapy for veins of any caliber; however, the larger the vein and closer to the deep vein system, the greater the likelihood of treatment failure or early recurrences. Sclerotherapy of veins larger than 5 mm in diameter often requires special techniques and high potency sclerosants in large doses, increasing the risk for spasm and many other undesirable adverse effects. This is because larger veins contain more blood to dilute the injected sclerosant. For medium-sized veins, a sclerosant, such as Polidocanol or Sotradecol, classified as detergents, can be mixed with air or carbon dioxide gas to form a foam. Compared to traditional liquid sclerotherapy, foam sclerotherapy has certain advantages including a smaller volume of the sclerosing agent needed for injection, lack of dilution with blood (dilution decreases efficacy), and homogeneous effect along the injected veins. In the United States and many other developed countries, the VNUS closure and EVLT procedures have become the gold standard for the treatment of the largest superficial veins, like the saphenous vein, because they are both minimally invasive, safer, less painful and more effective than sclerotherapy or surgical removal.
Currently, the only widespread application of sclerotherapy in vein treatment is for small-vessel varicose vein disease of the lower extremities, such as spider veins, and reticular veins. The latter are superficial veins that have a cyanotic hue and are 2-4 mm in diameter. Although these small veins may be surgically removed, sclerotherapy presents a rapid, effective, and cosmetically acceptable alternative that is particularly attractive to patients with extensive networks of small abnormal veins. Spider veins respond quickly to this treatment and results can be seen as early as three to six weeks. Larger veins take longer to respond. Spider and reticular veins are present in up to 80% of women at some point in life. Sclerotherapy not only offers the possibility of remarkably good cosmetic results, but also has been reported to yield an 85% reduction in symptoms of pain, burning, and fatigue associated with these veins. It should be mentioned that vein size alone does not predict the presence of symptoms. Veins causing symptoms may be as small as 1 mm in diameter, and larger bulging varicose veins may not cause any symptoms whatsoever.
The side effects of Sclerotherapy are tolerable and temporary. Patient might experience itching, tenderness, skin bruising, and redness at the injected area. Contraindications to sclerotherapy are rare and include pregnancy and allergy to the sclerosing agents. A bedridden patient is not a good candidate for sclerotherapy because ambulation is necessary following treatment to clear the sclerosant from the body, and thus to decrease the possibility of complications, such as deep vein thrombosis. Moreover, patients with severe arterial obstruction to the legs are very poor candidates for venous sclerotherapy, because they cannot tolerate compression needed after the treatment and cannot ambulate freely. On the other hand, diabetic patients with good blood sugar control may be treated, but with caution. It should also be mentioned that some patients cannot tolerate heavy compression hose during hot summer months. These patients should postpone treatment to winter months, when the warming effect of compression hose can be appreciated.
The number of sclerotherapy sessions needed for optimal results depends on the extent of the problem. Some patients are highly responsive to treatment, and can be treated with weak sclerosants in only a 1-2 sessions, while others are highly resistant, and may require more sessions, stronger sclerosants and/or combination of treatment techniques including laser vein treatments. When a patient has had a poor response to initial series of treatments, the original diagnosis must always be called into question. Failed treatment often means that a hidden source of reflux was overlooked or Ultrasound Duplex imaging was not initially performed to identify the underlying cause for the appearance of the small veins. Reflux vein disease refers to an abnormal communication with the deep vein system allowing reverse flow from the deep vein system into superficial veins. Only when diagnostic tests fail to identify a large vessel as a source of reflux, superficial dilated veins are ascribed to localized valve failure. Even the smallest veins have valves. In the latter case only, the treatment plan is restricted to sclerotherapy or occasionally, a combination of treatments including sclerotherapy and topical laser.
A renowned vein specialist, Dr. R. Dishakjian of Nu Vela Esthetica, a Los Angeles Vein Clinic, says that he owes his very high sclerotherapy success rate to his treatment plan that starts with the identification of underlying sources of reflux, like the saphenous vein, incompetent perforator veins (veins that allow communication between the superficial venous system and deep venous system of the legs), or reticular vessels. According to the same Los Angeles vein specialist, treatment must be directed at the entire system, because if the point source of reflux is not ablated first, the superficial web will rapidly recur, because the large veins serve as “feeder” veins for the small veins, such as spider veins. Find out more about various vein treatment procedures by browsing through the website of Nu Vela Esthetica, a premiere Los Angeles Vein Clinic that offers comprehensive set of varicose vein treatment options.
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