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Sclerotherapy is an effective treatment for varicose veins. Some other types of vascular malformations and cosmetic issues can also improve with this procedure. In aesthetic medicine, sclerotherapy primarily treats telangiectasia (spider veins).

For further information on this topic, you may be interested to learn more about the HealthCert Professional Diploma program in Aesthetic Medicine.

In primary care, physicians can administer sclerosing agents to patients looking to improve their physical appearance. However, adequate additional training is necessary.

Overview

Sclerotherapy is a minimally invasive procedure with therapeutic and cosmetic purposes. It involves injecting sclerosing agents into blood vessels to turn them into fibrous tissue. The common sclerosing agents in use for aesthetic sclerotherapy are:

• Foam,
• Detergents (Sotradecol, Scleromate, Ethamolin, Aethoxysclerol),
• Hyperosmolar irritants (Sclerodex, Hypertonic sodium chloride solution), and
• Chemical irritants (Scleremo, Ethibloc, Picibanil, Sclerodine, Bleomycine).

Sclerotherapy is a simple, low-cost procedure. It is often a quality replacement for surgery.

The mechanism of action

Sclerotherapy damages the endothelial lining of blood vessels or the whole vascular wall, causing occlusion. As a result, sclerosis of the blood vessel occurs, turning the tissue into a fibrous cord.

The procedure normalises venous physiology and effectively eliminates superficial varicose vessels from the system.

Sclerotherapy effectively improves spider veins and small vascular changes. However, it is ineffective against port-wine stains, high-flow lesions, and large varicose veins.

Who can perform sclerotherapy?

Dermatologists and aesthetic medicine specialists usually perform cosmetic sclerotherapy. However, primary care providers can also offer the procedure to their patients with sufficient training.

The knowledge about the anatomy of the venous system and the skills to perform sclerotherapy is a must. They also need to know:

• Pharmacology of sclerosing agents,
• Indications and contraindications for sclerotherapy treatment,
• Potential adverse effects, and
• Technique modifications.

Facility requirements

The physician’s office and primary care setting are adequate for sclerotherapy procedures. The facility needs to have quality lighting, a properly sterilised procedure environment, and other essential equipment. That includes:

• Distilled water
• Saline solution
• Selected sclerosing agent
• Topical antiseptic for sterilisation
• Needles of appropriate size
• Syringes
• Cotton pads, and
• Bandages

The procedure

The physicians use a pre-made sclerosing agent dilution to perform sclerotherapy. Alternatively, they create the dilution by mixing the sclerosing agent with a saline solution of distilled water.

The next step is loading the syringe.

The treatment area requires thorough cleaning with a topical antiseptic.

Anaesthesia is not necessary. Anxious patients may require mild antianxiety or analgesic medications.

Then, the doctor inserts the needle in the treated blood vessel, checking its position with blood aspiration.

The first injection goes into the most prominent vein, remaining varicosities follow.

The injection technique is slow and steady. Post-injection compression of the site is necessary.

Contraindications

Absolute contraindications for sclerotherapy include:

• Immobility (ambulation is essential to prevent thrombosis)
• Superficial or deep vein thrombosis
• Pregnancy
• General infections or local infections at the sclerotherapy site
• Allergies to components of sclerosing agents
• Systemic diseases
• Hyperthyroidism
• Peripheral Arterial Occlusive Disease

Potential complications

Complications with sclerotherapy treatment are rare. However, there is a low risk of:

• Allergic reactions
• Pigmentation
• Necrosis
• Thrombophlebitis
• Nerve damage
• Matting
• Orthostatic collapse
• Thromboembolism

The final word

Sclerotherapy is an effective in-office procedure for spider veins and small primary varices, with high-quality cosmetic outcomes.

– Dr Rosmy De Barros

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References:

• Lorenz MB, Gkogkolou P, Goerge T. Sclerotherapy of varicose veins in dermatology [published correction appears in J Dtsch Dermatol Ges. 2014 Jul;12(7):643. Görge, Tobias [corrected to Goerge, Tobias]]. J Dtsch Dermatol Ges. 2014;12(5):391-393. doi:10.1111/ddg.12333
• Subbarao NT, Aradhya SS, Veerabhadrappa NH. Sclerotherapy in the management of varicose veins and its dermatological complications. Indian J Dermatol Venereol Leprol. 2013;79(3):383-388. doi:10.4103/0378-6323.110746
• Gibson K, Gunderson K. Liquid and Foam Sclerotherapy for Spider and Varicose Veins. Surg Clin North Am. 2018;98(2):415-429. doi:10.1016/j.suc.2017.11.010
• Khunger N, Sacchidanand S. Standard guidelines for care: sclerotherapy in dermatology. Indian J Dermatol Venereol Leprol. 2011;77(2):222-231. doi:10.4103/0378-6323.77478