MICROSCLEROTHERAPY

Treatment for the small surface spider veins

Microsclerotherapy involves injecting a “sclerosant” directly into each vein with very fine needles. It was introduced in the 1920s and made popular in the 1960s. Less painful solutions for removal of surface veins were introduced into Australia several years ago and have been extensively investigated in many thousands of patients. The products that we use for spider vein removal at our Melbourne clinic are Polidocanol (Aethoxysclerol), Fibrovein (Sodium tetradecyl sulphate) and 20% Normal Saline.

Microsclerotherapy is used to treat small to very small veins.

Multiple treatment sessions may be required for complete removal and most patients can expect at least a 70% improvement in the appearance of their legs. Maximum benefit may not be seen for 3 months and perfection cannot be guaranteed.

What should you do before microsclerotherapy?

• If possible, do not take aspirin for 7 days before treatment. Use can be resumed the day following treatment.
• Avoid sun exposure and tanning for 1-2 weeks before and after treatment to avoid pigmentation problems
• Do not apply moisturiser or shave or wax your legs on the day of treatment
• Wear loose fitting clothing and sandals or loose shoes to allow for the thickness of the stockings applied after treatment.
• Treatment should not be considered if you intend to fly overseas within the following two weeks.

What happens during microsclerotherapy?

A sclerotherapy session at our Melbourne clinic takes between 15 and 45 minutes.

While you are lying down on a treatment couch, very fine needles are used to inject a solution into the spider veins. This irritates the lining of the vein, causing the two opposing sides to stick together. The number of injections varies from 1-2 to 30 depending on the response of the veins to the therapy and the number of veins requiring treatment.

During this procedure you may listen to music, read, or talk to the practitioner. While compression is used to try and keep the vein empty of blood, a small amount of clot can develop in the vein. This clot will be slowly absorbed by the body.

Tender lumpy swelling of the vein can persist for several weeks and it may be necessary to prick these veins to squeeze out “trapped blood”.

You will rest for several minutes after the injections with your leg elevated and you should continue to keep the leg elevated as much as possible for the first 24 hours.

If possible, do not drive yourself home. You will be asked to go for a 20-30 minute walk immediately after treatment and then daily for 1 week.

Maintain normal daily activities, but avoid standing still for long periods.

Avoid strenuous physical activity, such as running, for a week after treatment since this increases the risk of blood flow returning into the treated veins.

You are required to avoid any flights of longer than 2-4 hours duration for 2 weeks and any flights of greater than 4 hours duration for 4 weeks after treatment.

If travel is unavoidable, then an anticoagulant should be administered prior to the flight.

If only surface spider veins are treated, then Hostess type stockings will suffice. If larger veins are treated at the same time, then tighter stockings may have to be worn. We have a range of graduated compression stockings available and these are expertly fitted at the time of treatment.

Depending on the treatment performed, the length of time you will need to wear the stockings will vary and you will be advised at the time of treatment. If larger veins are treated at the same sitting, stockings would typically be worn continuously for 3-7 days. Then they would be worn through the day, removing them at night and replacing them in the morning after the shower for the next 7 days (depending on the severity of disease).

If limited spider veins are treated, then the stockings may only have to be worn for 3 days continuously and 4-7 days during the day only.

Compression stockings are an essential part of treatment, as they:

• Reduce pigmentation
• Reduce the number of treatment sessions needed
• Reduce the risk of deep vein thrombosis
• Reduce the frequency of recurrence

What can you expect following sclerotherapy / microsclerotherapy?

Usually the veins look worse for a period of time before they start to look better. Improvement is usually seen in a couple of weeks but 6 – 12 weeks may be needed to show the maximum effect.

The following features are expected. They are not a cause for concern although they should be reported at review:

Mild pain or discomfort may persist for several days, and shows that the injections are working. The degree of discomfort is partly related to the initial size of the veins and can be relieved by walking or by taking Paracetamol or Ibuprofen. Rubbing from the bandage or stocking can create soreness behind the knee.

Any discolouration and tender lumps are usually experienced early on. Red raised areas over treated veins are due to “trapped blood” and usually disappear within four to six weeks. At the 2 week review these areas may be pricked to release this trapped blood. It doesn’t occur in every patient but is common enough to be considered a normal event that occurs as part of treatment. It is a sign that treatment has been successful.

Phlebitis, or inflammation of the treated veins, can occur due to reaction to the sclerosant. It is treated by further compression, anti-inflammatories and regular walking. It does not represent infection and does not require treatment with antibiotics.

Migraine This may be provoked by the injection foam sclerosant therapy in patients who are known migraine sufferers. These patients should take their usual migraine treatment an hour or so prior to treatment in the hope of preventing the onset of a migraine.

What are the possible complications from sclerotherapy / microsclerotherapy?

Complications can occur even with perfect technique.

• Deep vein thrombosis (DVT).
  A blood clot can form and extend into the deep veins. The risk is less than 1:2,000 compared to the background risk of about 1:9,000. This potentially serious complication is very uncommon if the protocol of compression and regular daily walking is followed.
  Although DVT post procedure is most uncommon, we at Specialist Vein Care perform Duplex scans routinely on all patients post Sclerotherapy/Endovenous Laser Ablation therapy to exclude this complication.
• Allergic reaction
  Allergy to the anaesthetic solution can occur. This is rare! It can present immediately as an anaphylactic reaction with generalised rash, itchiness or difficulty with breathing. Our practice is equipped and ready to deal with this circumstance if it arises.
• Swelling of the leg or ankle (2:100)
  This is a temporary phenomenon and is due to inflammation.
• Pigmentation (1:10)
  Brown marks may appear near or along a treated vein and are due to haemosiderin, a form of iron from the blood. Most disappear within 3-12 months but in about 5% of patients, this can persist past 12 months. This is of cosmetic importance only and persistent pigmentation may respond to laser treatment.
• Nerve injury (3:1,000)
  Irritation of surface sensory nerves rarely occurs and will disappear within a few weeks.
• Skin ulceration 
  Skin ulceration is very uncommon with foam. It occurs because solution has escaped into the surrounding skin or because of an abnormal connection between small veins and arteries. Most ulcers are small and heal over after a few weeks, leaving a small pale scar.