Sclerotherapy explained

Sclerotherapy explained

Sclerotherapy is a procedure used to treat spider veins, reticular veins and varicose veins. Dilated leg veins can be classified as:

  • Spider veins - red or purple fine veins.
  • Reticular veins - blue mid sized veins often feeding into the spider veins.
  • Varicose veins - large blue ropey veins often traversing the leg.

All these veins can contribute to unsightly and cosmetically dissatisfying appearance of the legs, as well as medical complications such as aching swelling, appearance of bruising, ulceration, eczema and pigmentation.

There are 3 common contributors to dilated veins:

Hereditary - one with a family history of leg veins inherit a genetic tendency for the venous system to have increased pressure over time.

Pregnancy - related to both the increased venous backflow as the uterus grows and pushes on the venous system, as well as the increased blood volume in pregnancy.

Prolonged standing - at rest with our legs up, we have no pressure in the venous system. On standing the pressure increases dramatically to 100mmHg

Walking gets the calf muscle pumping and drops the pressure to 30-40mmHg.

With prolonged standing, the high pressures override the valves assisting in the return of blood, the valves then break down and blood pools in the leg veins.

Contrary to popular belief, crossing your legs has no effect on developing leg veins. Blood in leg veins normally travels upwards to the heart. Due to gravity blood tries to flow back down towards the feet. However, normal veins have valves, which close to prevent abnormal flow towards the feet. It is the breakdown of these valves that leads to abnormal flow, which in turn leads to increased pressure in the vein. The increased pressure eventually causes the vein wall to expand and bulge, producing a varicose vein. Varicose veins serve no useful function to the body's circulation. Our body has the ability to establish alternative pathways to bypass the abnormal varicose veins. When varicose veins are closed down, the circulatory system improves, as do many of the symptoms. It is important to understand that varicose veins can be a progressive condition and that totally new veins can develop with time. Maintenance treatment is likely for most patients.

Due to the causes, there is very little that can be done to halt the development of leg veins. Wearing compression stockings/ support hose only delays their progression. Maintaining a healthy weight can also reduce backward pressure on leg veins. There is a treatment available for these types of veins that do not require surgery or significant interference in one's lifestyle. The procedure is called Sclerotherapy. A liquid solution called a sclerosing agent is injected directly into the veins, causing irritation and inflammation. This makes the vein stick together and scar thus preventing blood flow in the vein. This process takes 6-8 weeks to complete. The procedure involves a series of tiny microinjections into the veins of each leg under direct vision. You may feel a slight stinging or throbbing sensation that is brief and relieved with walking after the procedure.

Sclerotherapy by injection is a very effective method of treatment. You can expect 50-80% improvement with a single treatment and improved success after a course of between 2-5 treatments. The recurrence rate of dilated veins can be up to 30% over time. This can be improved with avoiding stiletto high heels and prolonged standing, maintaining adequate body weight and regular exercise. Realistic treatment results can be noted a while after treatment and that it is not immediate. Legs and veins will often look worse before they look better. Expect a gradual lightening of telangiectasia rather than complete resolution after the first treatment.

You may notice Bruising and reddishness in the areas at the injection sites. The bruises will diminish within two weeks. In many cases, there may be some residual brownish pigmentation which may take up to a year to completely fade.

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