A Closer Look At Sclerotherapy

Varicose veins can impact your appearance and cause you discomfort. Are you looking into ways to treat your varicose veins in Houston? If so, then your vein specialist may recommend an option called sclerotherapy. Continue reading to learn about this treatment option for varicose veins.

How It Works

Sclerotherapy is a proven medical procedure for treating varicose and spider veins that has been practiced since the 1930s. During this procedure, a solution is injected into the vein and irritates the blood vessel’s lining. The irritation causes the vein to collapse and, over time, the blood clots and the varicose vein fades from view as it turns into scar tissue.

What to Expect

Your sclerotherapy procedure will be performed at a doctor’s office by a surgeon or dermatologist and should take about 60 minutes or less. The solution is usually injected through a fine needle, and you may experience some mild discomfort for a couple of minutes after. Depending on your state of health and the size, number, and location of your varicose veins, more than one session may be required.

How to Prepare

There are some medications that you will need to avoid before your sclerotherapy appointment, so be sure to inform your doctor about every medication and dietary supplement that you are taking. Finally, do not apply any lotion to your legs on the day of your appointment.

What to Know

There are some mild side effects associated with sclerotherapy, such as itching, bruising, and raised, reddened areas at the injection site. Larger veins can become hard and lumpy and take several months to fade, and brown spots or lines may be left at the vein’s location. Also, new blood vessels may appear at the treatment site that typically fade over time without additional treatment. Ask your vein specialist about any other possible side effects before your sclerotherapy procedure.

What Is Sclerotherapy and Who Is It For?

Sclerotherapy is one of the oldest and most reliable treatments in vein care, and it remains the first choice for spider veins and small varicose veins on the legs. The name comes from the medication used, called a sclerosant, which causes the inner lining of the vein to become inflamed and stick together. Once the vein is closed, blood simply takes another route through healthy veins, and the treated vein is gradually reabsorbed.

In our practice, sclerotherapy is usually a good fit for people who have:

• Red, blue or purple spider veins on the thighs, knees, calves or ankles
• Small reticular veins, the greenish-blue feeder veins that often sit near spider vein clusters
• Small varicose veins left over after a larger vein has been treated with ablation
• Aching, burning or itching over a group of small veins

It is not the right first step for large, bulging varicose veins caused by a leaking main vein. Treating only the branches in that situation tends to give short-lived results, because the pressure that created them is still there.

Types of Sclerotherapy: Liquid, Foam and Ultrasound-Guided

Sclerotherapy is not one single technique. The form of the medication and the way it is delivered are chosen to match the size and depth of the vein.

Liquid sclerotherapy

The classic approach. A very fine needle places a small amount of liquid sclerosant into a spider vein or small reticular vein that can be seen on the skin. This is what most people picture when they hear the word sclerotherapy.

Foam sclerotherapy

For slightly larger veins, the sclerosant is mixed with air or a gas to form a fine foam. Foam pushes blood out of the way and stays in contact with the vein wall longer, so it works better in wider veins than liquid does.

Ultrasound-guided foam sclerotherapy

Some faulty veins sit too deep to see or feel. With ultrasound-guided foam sclerotherapy, we watch the needle and the foam on an ultrasound screen as it fills the target vein. This lets us treat deeper tributaries, recurrent veins after earlier surgery and veins near wounds. A commercially prepared foam, Varithena, is another option for certain larger veins.

Sclerotherapy vs. Other Vein Treatments

Patients often come in having read about lasers, ablation and phlebectomy and want to know where sclerotherapy fits. The short answer is that each tool suits a particular kind of vein, and many patients end up with a combination.

For leg spider veins, sclerotherapy usually gives more reliable results than surface laser, because leg veins tend to be deeper and connected to feeder veins that laser light does not reach well.

Am I a Good Candidate for Sclerotherapy?

Most healthy adults with spider veins or small varicose veins are candidates. We are more cautious, or may recommend waiting, in a few situations:

• Pregnancy and breastfeeding. We generally postpone treatment until after delivery and nursing, partly because many pregnancy-related veins improve on their own.
• A history of deep vein thrombosis or a clotting disorder. Treatment may still be possible, but it needs careful planning.
• Known allergy to a sclerosant. A different medication may be used.
• Being bedbound or unable to walk. Walking after treatment is an important part of recovery.
• Poorly controlled arterial disease in the legs. Circulation should be checked first.
• Untreated reflux in a larger vein. We usually treat the source first, then the smaller veins.

How We Evaluate Patients Before Sclerotherapy

A good result depends on treating the right veins in the right order. Before any injection, our evaluation includes:

1. Focused history. We review symptoms, prior vein treatments, pregnancies, clot history, medications and any allergies.
2. Standing examination. We map the visible veins with you standing, when they are fullest, and look for feeder veins and signs of a deeper problem such as ankle swelling or skin staining.
3. Venous duplex ultrasound when needed. If there are symptoms, larger varicose veins, ankle clusters or recurrence after past treatment, we scan the leg in our IAC-accredited vascular lab to check for reflux in the main veins.
4. A clear plan. We explain which veins will be treated, in what order, roughly how many sessions to expect and whether treatment is cosmetic or medical.

Sclerotherapy Recovery: A Practical Timeline

Recovery is easy for most people, but knowing what is normal helps. Here is what patients typically notice:

• Right after the session: small raised bumps or redness at the injection points, which settle within hours. We ask you to walk for 10 to 20 minutes before driving home.
• First few days: compression stockings are usually worn as directed. Daily walking is encouraged. Avoid hot tubs, saunas, heavy leg workouts and long hot baths.
• First two weeks: bruising and darker lines along the treated veins are common. Larger veins may feel firm or lumpy as they close; this is trapped blood, not a problem, and it can sometimes be released at a follow-up visit to speed healing.
• Three to six weeks: spider veins usually look clearly lighter. This is a good time to judge results and plan any further sessions.
• Three to four months: larger veins and any brown staining continue to fade. Some staining can take longer, especially in people who tan easily.

Protect treated skin from strong sun for several weeks, since tanning can make temporary discoloration more noticeable. Houston sun is strong for much of the year, so sunscreen or covering up is worth the effort.

How many sessions will I need?

This depends on how many veins there are, how large they are and how your body responds. A small cluster may clear in one or two sessions. More extensive spider veins often take three or more, spaced several weeks apart to let the treated veins fade and to see which ones need another pass.

Sclerotherapy closes the veins that exist today, but it does not change the tendency that created them. New veins can appear over the years, especially with family history, pregnancy or long hours on your feet. Many patients return for a short maintenance session every year or two.

Less Common Side Effects and Risks

Serious complications from sclerotherapy are uncommon when it is performed by an experienced vein specialist, but you should know what to watch for. Beyond the mild effects most people have, rarer problems include:

• Superficial phlebitis: a tender, warm, firm cord along a treated vein, usually managed with walking, compression and anti-inflammatory medication if appropriate
• Small skin ulcers: a tiny sore at an injection site that heals with wound care
• Allergic reaction: rare, and treated promptly in the office
• Visual disturbance or migraine-like symptoms: occasionally reported shortly after foam treatment and usually brief
• Deep vein thrombosis: rare, but important to recognize early

Questions to Ask Before Your Sclerotherapy Appointment

A good consultation should leave you clear on what is being treated and why. These are the questions we encourage patients to ask, whether they see us or another vein provider:

• Have my legs been checked with an ultrasound, or is one needed before treating the surface veins?
• Are these veins purely cosmetic, or is there an underlying reflux problem?
• Which sclerosant and which technique, liquid or foam, do you plan to use, and why?
• How many sessions do you expect, and how far apart?
• How long should I wear compression stockings afterward?
• Which of my medications or supplements should I discuss before the session?
• What should I do if I notice a lump, a dark line or a sore spot afterward?

It also helps to plan the timing. Many patients prefer to start in the fall or winter, when wearing compression stockings is more comfortable and there is time for bruising and staining to fade before shorts season. If you have an event coming up, such as a wedding or beach trip, allow at least six to eight weeks between your last session and the date.

On the day itself, wear loose, comfortable clothing, bring your compression stockings if you already have them, and skip lotion or oil on your legs. Plan a short walk afterward, and avoid booking a long flight or car trip for the first few days.

Is sclerotherapy covered by insurance?

Coverage depends on why the treatment is being done. Sclerotherapy for spider veins treated only for appearance is generally considered cosmetic. When sclerotherapy is part of treating symptomatic venous insufficiency, for example foam treatment of leaking varicose veins after ablation, most insurance plans, including Medicare, may cover it when their criteria are met. We review the medical and cosmetic parts of your plan with you before treatment begins.

Sclerotherapy With a Vein Specialist in Houston

Spider veins are common, but the best results come from understanding why they are there before treating them. As a vein clinic in Houston, our team performs the ultrasound evaluation, treats any underlying reflux and then carries out sclerotherapy in the office, so the whole plan stays in one place. Dr. Syed Raza is a fellowship-trained interventional radiologist with more than 15 years of experience treating vein disease. We serve Houston, Katy and nearby communities and usually offer same-week appointments. To learn more, see our sclerotherapy treatment page or call (832) 321-5355.

Frequently Asked Questions

Does sclerotherapy hurt?

Most people feel a series of quick pinpricks and sometimes a brief stinging or cramping sensation as the medication enters the vein. No anesthesia is needed, and the discomfort usually passes within a minute or two.

How long after sclerotherapy will I see results?

Spider veins typically look lighter within three to six weeks. Larger veins can take three to four months to fade fully, and any brown staining may take longer.

Can I exercise after sclerotherapy?

Walking is encouraged right away and every day after treatment. Most people can return to normal workouts within a few days, but it is best to avoid heavy leg exercise, running and weightlifting for about a week or as your specialist advises.

Why do I need to wear compression stockings after sclerotherapy?

Compression helps keep the treated veins closed, reduces trapped blood and bruising, and lowers the chance of inflammation. Wearing them as directed generally gives a cleaner, faster result.

Can treated veins come back after sclerotherapy?

A vein that has fully closed and been absorbed does not usually return, but new spider veins can form nearby over time. Treating any underlying reflux first and following up with maintenance sessions helps keep results lasting.

Is sclerotherapy safe for spider veins on the face?

Facial spider veins are generally treated with surface laser or light-based therapy rather than injections. Sclerotherapy is mainly used for veins on the legs.

How should I prepare for sclerotherapy?

Tell your vein specialist about every medication and supplement you take, avoid lotion on your legs that day and wear loose clothing. Bring or plan to buy compression stockings, and arrange to walk for a short while after the session.

Trusted Health Resources

1. Chronic Venous Insufficiency, Society for Vascular Surgery
2. Venous Insufficiency, MedlinePlus Medical Encyclopedia (NIH)
3. Varicose Veins and Spider Veins, MedlinePlus (NIH)