Is Sclerotherapy safe ?

Published: 21 November 2016

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Understandably this is one of most frequently asked questions that I get asked!

General

Sclerotherapy remains the gold standard for treating the venous disease of small to moderate size. This includes small varicose veins and spider veins. Sclerotherapy involves an injection of a solution directly into the vein. There are three major solutions that are used in Australia in the treatment of venous disease. These include hypertonic saline, aethoxysklerol and sodium tetradecyl sulphate. Which one is used depends on a particular practitioner’s preference as well as the size of the veins.The solutions work by the solution irritating the lining of the blood vessel, causing it to collapse down and stick together, effectively turning the vein into a “bruise” that one’s body slowly resorbs over time.

Sclerotherapy has a long history dating back to the 1930s. The methods of treatment therefore have a long history with respect to best practice, outcomes and known complications.

Importantly, there are no known long term side effects of sclerotherapy.

For the vast majority of patients this treatment is generally extremely well tolerated and safe with minimal side effects or complications.Like any treatment available sclerotherapy is not without potential complications.

uation and Experience

For the best outcomes and to limit complications as much as possible, prior to any therapy one should be properly assessed by the treating practitioner.

This typically involves a consultation as well as an ultrasound to uate and map the varicose vein disease. Even if one has spider veins. It is most useful to perform an ultrasound to exclude and characterise any underlying and contributing venous vein disease.From this, a personalised treatment plan can be discussed and planned.

Probably the biggest “complication” of therapy is the failure to achieve the desired clinical outcome and adequately removing the spider veins or much less commonly the larger reticular and varicose veins. About 10% of patients who have their spider veins treated fail to get the result they desire. We do not yet understand why some patients are more resistant to treatment than others and it is not possible to predict this prior to commencing therapy.

Usually if I treat a patient with a particular solution and fail to get a great response I would switch to another solution. Why in a particular person one type of solution would work better than another is not known and again cannot be determined prior to starting any given treatment.

As there are complications even in the best most experienced hands, it is important that this treatment is performed by someone trained and experienced in vein therapy. Someone who knows what treatment is best in your particular case and is best able to limit the risk of complications and is able to recognise them and know how to manage them if they occur.

Temporary Side Effects of Sclerotherapy – these can be expected during /post treatment.

These are minor and well-tolerated and do not occur in every patient.

• Mild itching at the injection site which can last for one or two days after the procedure.
• Bruising may also occur around the injection site and can last from several days to a couple of weeks.
• Mild discomfort during the injection which last for a few seconds. Larger veins this can last up to a minute or two.
• Red, raised areas at the injection sites. These are similar to hives, and should disappear within a day or so.
• “Trapped blood” – Larger veins that have been injected may become lumpy and hard and may require several months to dissolve and fade. If these are present and annoying the patient, the treating practitioner will often drain these using a small needle. This is not dangerous and will resolve.

Other side-effects / complications of therapy include:

• Brown lines or spots may appear along a treated vein. On average this occurs in about 10% of patients with varicose veins. This usually settles over three to six months, but they may also last indefinitely. This occurs with all forms of therapy.
• Matting. This is the development of new, tiny blood vessels which may occur at the site of sclerotherapy treatment. This is thought to be an inflammatory response. This occurs not just with venous therapy but can occur with any kind of trauma to the skin. These tiny veins can appear days or weeks after the procedure, but often fade within three to twelve months without further treatment. This can even look like a small bruise.
• Inflammation. This is usually mild but may cause swelling, warmth and discomfort around the injection site. This is usually self-limiting but may require treatment such as anti inflammatories, ice and compression.
• Deep vein thrombosis. This is extremely uncommon.
• Allergic reaction. It’s possible that you may have an allergic reaction to the solution injected, however this is rare
• Skin ulcers. These are very small and fortunately are rare. Most occur within 2 weeks of injection. They heal slowly and may leave a small pale scar.
• Visual disturbance – this is a rare complication (about 1%) for patients undergoing foam sclerotherapy. Patients experience a sparkling appearance in their vision which resolves spontaneously after about 15 minutes.
• Transient stroke has been reported. This is very rare.
• Intra-arterial injection. This is an extremely uncommon complication, which may result in muscle and skin damage.

If you have venous disease but are unsure whether these are of any clinical significance or if you have spider vein disease that worry you, please give us a call and organise an appointment.

We can discuss your particular venous issue, discuss options and create an individualised treatment plan if required. The venous disease that you have may well require reassurance only with no treatment required.

To make an appointment today to have your venous disease assessed by Dr Berman, please phone 9561 5155