Sclerotherapy – efficient treatment for varicose veins

Sclerotherapy is a medical procedure used for treating the varicose veins and the visible superficial veins (venectasia, reticular veins). It lacks any actual risks and has a guaranteed efficiency and a long-lasting effect.

During this procedure, the physician injects a special substance inside the vein. This substance irritates the vein wall, causing it to swollen and the vein becomes obstructed. 

Shortly, it transforms in scar tissue and it is then eliminated. Sclerotherapy, as a minimally invasive treatment method is suitable for the small superficial vein dilations, occurred at the ankles, shanks, and ties, having different aspects: red, blue, purple.

scleroterapia - skinmed

The most frequently used sclerosing agents are: polidocanole (aetoxisclerol) and sodium sulfate tetradecil, determining an inflammatory reaction at the vascular level, leading to fibrosis and definitive obliteration of the vein. 

Sclerotherapy improves the look of the affected leg.

For an efficient treatment there might be necessary to have 2-3 sessions in an interval of 2-3 months, thus the uniform aspect lacking any visible veins being restored. Sometimes the laser therapy sessions are also indicated to be associated with sclerotherapy, based on a therapeutic protocol.

Sclerotherapy indications:

Sclerotherapy is performed in outpatient system. Prior to the medical intervention a Doppler vein scan is required for making a map of the dilated superficial veins, of those with incompetent valvules and those with reflux.

The procedure does not require anesthesia and causes a slight local discomfort.

The areas to be injected are marked with a marker or a „veinlight” device is used, highlighting the vein route. 

The patient is sited in supine position, and after making aseptic / sterilizing the areas with disinfecting integumentary solution the sclerosing agent is intralumenally injected into the vein with a very thin needle. 

The sclerosing agent shall cause an inflammation at the level of vascular endothelium, which will determine the occurrence of a fibrous tissue and lumen obliteration. When the sclerosing agent is injected the vein becomes white in a couple of minutes.

scleroterapia - skinmed

After the intervention, on the injected areas sterile dressing shall apply and an elastic bandage for the next 48-72 hours.

The patient shall wear compressive leggings for 3 weeks and anti-inflammatory and sometimes even anticoagulant (Clexane, Fraxiparine) shall be given to the patient.

The patient shall be encouraged to start walking as soon as possible, however without putting up any intensive physical effort.

A session lasts approximately 30 minutes.

Among the possible complications after undergoing sclerotherapy are: thrombophlebitis, skin necrosis, unaesthetic scars, hyper pigmentation, allergic reactions, neoangiogenesis, inflammatory erythema (clubbing), ecchymosis (bruising), and local pruritus (itching). 

The side-effects are rare, in terms of standard performing of this procedure, by specialized medical personnel and based on the medical history / medical exam, during which the patient’s history and any likely absolute/relative contraindications.

Sclerotherapy contraindications:

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Sclerotherapy is a minimally invasive procedure by which a substance is injected into the venous lumen (venectasia), which produces an inflammatory process inside the vessel and in time, within 4-6 weeks, the closure of the vessel (sclerosis).

It involves the use of a transiluminator that helps identify the venous wall, followed by disinfecting the skin with an antiseptic solution, then injecting these venectasia with extremely fine needles, leaving a surplus of substance in the injected vessel. Using sterile compresses press on the injected vessel to achieve hemostasis. After the procedure, at the injection site, the skin is temporarily inflamed (red) due to the surplus substance that produces a minimal skin lesion. After the procedure it is recommended to apply creams with re-epithelial effect, administering an oral venous tonic, wearing compression stockings for one month.

This procedure is for people with venectasia (venous dilatations between 0.1-3mm) who have performed a phlebological medical exam and Doppler ultrasound, investigations that have eliminated the presence of severe venous insufficiency in the superficial venous system (internal or external vein).

Phlebological medical exam: involves the clinical examination of the pelvic limb, specific clinical maneuvers, skin inspection and palpation to reveal possible dermatitis, ulceration, superficial thrombosis. Doppler ultrasound: a map of the superficial and profound venous system that identifies an incompetent closure of a venous valve (venous reflux) and superficial vein dilation, the existence of communicating veins.

The minimally invasive procedure lasts between 30-60 minutes and the amount of substances used (sclerosing agents) is calculated according to the weight of the patient. The concentration of the substances used is chosen depending on the diameter of the vessel requiring sclerosis. It does not require hospitalization, but the patient is encouraged to walk; however fitness and massage are not recommended.

The number of sessions in this procedure is not standard, varying between 4-6 sessions, depending on the resistance of venectasia, their diameter and age.

After sclerotherapy, walking, application of re-epithelial, haemostatic, anti-inflammatory creams, wearing compression stockings (to keep the substance where it was injected) is recommended.

Yes. It is an irreversible method: the substance acts on the vessel and creates a venous cord.

When the patient has a confirmed reflux on the eco-Doppler exam, the method is not indicated before the surgical treatment, represented by crossectomy and safening stripping, a method by which venous reflux is removed. The aesthetic correction by sclerotherapy of these venectasia in patients with surgical indication is achieved temporarily because the injected vein is repermeabilized due to venous reflux.

There is a risk of allergies to people with allergic backgrounds and superficial vein thrombosis in people with clotting disorders (thrombophilia), and an injectable anticoagulant is recommended in these situations. There is also a minimal risk of hyperpigmentation at the site of injection, especially in people with type I skin and those exposed to sun in the post-procedure 1-month period.

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