If you have varicose veins, thread veins or spider veins on your legs, sclerotherapy is a safe and well-established treatment which has been used for over fifty years. Although there are a number of alternative treatments which are effective and preferable for thread veins on the face, it remains the most reliable and successful treatment for leg veins.
Microsclerotherapy is the treatment for spider or thread veins, and foam sclerotherapy is used to treat the larger varicose veins. For more information on foam sclerotherapy, click here.
To find a recommended practitioner who will be able to assess your veins and advise on treatment options, see the Directory of BAS members.
Thread veins are unsightly very small, abnormally dilated blood vessels. They are red/blue in colour and lie very close to the surface of the skin. Usually they cause no physical problems, occasionally they may cause discomfort and itching. Click here to watch Dr Haroun Gajraj discussing the best treatment for small leg veins and demonstrating microsclerotherapy.
The veins in the legs have to return blood from the feet back up towards the heart against gravity. There are two main systems of veins in the legs. The deep system lies within the muscles in the legs and carries the majority of the blood. As the muscles contract the veins are squeezed and blood moves up the veins. Valves attached to the walls of the vessels prevent backward flow and as the blood moves up it is drawn into the deep system from the superficial system in the skin. In healthy veins the valves close and blood only moves in one direction.
Approximately 50% of the population will at some point develop a problem with their veins. Varicose veins occur when the valves in the veins do not close properly and blood leaks back against the flow, this is called reflux. Reflux causes a back pressure in the superficial veins which are not supported by muscle and can dilate. As they stretch their valves do not close properly ,and so the problem develops, leading to varicose veins and thread veins.
Though varicose veins can be very unsightly and uncomfortable only 2% of sufferers will go on to develop skin problems such as swelling, pigmentation and leg ulcers caused by the poor circulation. For this reason the NHS does not usually offer treatment for varicose veins which are considered largely a cosmetic problem.
For thread veins, the best results are achieved if there is no underlying reflux. Your practitioner will assess you for signs of underlying problems and advise you accordingly. Duplex ultra sound is the best way to properly diagnose your symptoms.
Imagine your thread veins as a puddle on the floor. Your practitioner can mop up the puddle on the floor. If the puddle is caused by a leak in the ceiling the puddle will return and may get worse. The Doppler or duplex ultra sound can look in the roof to determine what is causing the leak and how bad it is thus, giving you and your practitioner a better idea of how best to treat your veins. Generally it is better to treat the larger veins (the leaking pipe) first. In some cases removal of these veins may improve the cosmetic appearance of the thread veins without requiring any further therapy.
The causes are largely unknown, but experts agree:
Unfortunately if you have this tendency there is very little that can be done to stop them appearing. Compression stockings may slow the progression down, but it will not stop them completely. There is no clinical evidence that any homeopathic remedies will either remove or stop them appearing. Varicose veins and thread veins may be symptoms of an underlying problem. Whilst these symptoms can be treated there is no cure to prevent them occurring again in the future.
Ask your practitioner about their training or experience. All sclerotherapists should be insured and should practice in an environment that meets Health and Safety Regulations. Often it is best to be recommended to a practitioner.
A full and thorough assessment by your sclerotherapy practitioner should involve a detailed discussion of the best treatment options for your legs.
During your initial consultation you should be assessed in a standing position, this enables the practitioner to fully assess your legs. This can be done by looking and feeling the legs. Some practitioners may use a handheld Doppler machine to listen to the blood in your veins, whilst others may recommend that you have an ultrasound. This will visualise the veins and check for any problems within the veins both superficially and deeper in your legs.
The practitioner should at this time be able to tell you how many sessions you will need and their cost. This varies according to the quantity and type of veins requiring treatment. Most sessions take between ½ to 1 hour. You should budget for at least two treatments.
The results after one treatment vary considerably from one client to another. Some veins may disappear completely whilst others may only fade and some remain unchanged. On completion of a successful treatment you can expect an improvement in the overall appearance of 60 – 80%. We hope that you will see enough improvement to increase your confidence in the way your legs look.
Your susceptibility to thread veins does mean that other thread veins may emerge over a period of time. In most cases, further treatments will be necessary. Some clients prefer to return each year whilst others may come back when more veins appear after a few years.
During this initial consultation you should be given a full explanation regarding the side effects of treatments and the follow up care required. Practices vary, some practitioners may offer to treat you at the same time as your initial consultation, if this is the case you are under no obligation to continue with treatment if you do not want to.
The injections are performed with you lying down. A solution is injected with a very tiny needle, superficially into the veins. This causes the lining of the vein to become sticky and swell. Compression is then applied to close the veins. Over a period of time the vein will heal closed, be absorbed into the body and fade away
Practice varies with each practitioner. Research has shown that ideally there should be some compression of the veins injected. This may be initially with cotton wool/dental rolls and then with a bandage or compression stocking. Length of time wearing compression again varies according to the size of veins treated and practitioners’ preference. Research suggests that the longer it is worn the better. Compression assists a better long term appearance and less side effects. Most practitioners suggest at least 24 -72 hours of non stop compression and then for as long as possible just during the day. Initially if both legs are treated you will be unable to bath during this time, unless you can do so with out making your stockings/bandages wet.
Depending on the solution used, sclerotherapy need not be painful. Occasionally. there may be a feeling of discomfort in some areas of the leg (this varies from person to person).
Once you remove either the bandaging or stockings expect your legs to look worse. There may be marks from the needle, bruising and often the veins may change from their normal red/blue colour, to black/brown, this is all normal and may take a few weeks to settle. Depending on how quickly you normally heal. Some people find the homoeopathic remedy ‘arnica’ helps to improve bruising.
The legs may feel slightly tender for the first few days following treatment. An anti-inflammatory drug such as ibuprofen is often helpful and walking may help.
After about 4 weeks the veins may show some signs of improvement, the true effect of treatment is seen between two to three months. Some larger darker flares may continue to fade for up to six months after the procedure.
The results of treatment can be seen at two to three months after your first treatment.
Small vessels will be absorbed by the body over a three month period and should not reappear. However it is likely that new ones will occur in a similar area. It is possible that larger veins can reopen over time and may need further treatment to close them again.
Although safe, sclerotherapy is not entirely without risk. All sclerosing drugs have similar side effects although their likelihood may vary according to the drug used.
Brown staining (haemosiderin stain) is the most common side effect, it may occur in approximately 15% of cases. It happens when the vein is not entirely closed, blood is trapped and clots. In some people iron pigment leaks from the clot and stains the skin over the vessel. It is more likely to occur in slightly larger veins. This mark is not usually permanent, but may take 6 –18 months to fade. When exposed to the sun they may darken and take longer to fade. However, it is usually less unsightly than the original thread veins. In the unlikely event that the stain does not fade (less than 5%) it is possible to have laser treatment to reduce the brown marks.
Immediately after sclerotherapy you may experience some swelling around the ankle or knee joints. This settles spontaneously after the first 24 hours. You may find that raising your leg whilst sitting helps this to settle.
Telangiectatic matting, this occurs if the fragile vessel is injured during the injection leaving a mat of tiny vessels that looks like blush or red bruise. It usually disappears without needing further treatment over a period of 6 –12 months. If it persists it may be possible to treat with further sclerotherapy.
Blistering, in rare cases the skin overlying the vein may blister, in extreme cases this may cause small scabs (feet and ankle areas are most vulnerable), it can potentially lead to a small scar. Occasionally the stocking may rub and cause small blisters these will settle spontaneously if left alone.
In larger veins it is possible for the vein to become lumpy, tender and warm where blood remains in the vessel. Though normal in larger veins as they heal, if this if very uncomfortable please seek advice from your practitioner. This normally settles without problem over a few weeks, it may resolve more quickly by using anti-inflammatory drugs and wearing the compression hosiery. If you are concerned you should discuss it with your practitioner.
Very rarely after about 2-3 weeks a small area of redness and a throbbing sensation may appear with a white or black centre. If this occurs you should seek medical advice with your practitioner, prompt treatment with antibiotics prevents any worsening.
Allergic reaction to the agents used is incredibly rare and vary according to the sclerosant used, Your practitioner would be able to discuss the incidence of their own specific drug. Any reaction would occur during the session and your practitioner would cease treating you immediately. Some people feel faint as they do not like needles! Itching and some redness is common during the treatment, it is not a cause for concern.
It is possible for the treatment to have little or no effect. Results unfortunately cannot be guaranteed.
Each practice tends to have individual post treatment schedules, but they should all suggest:
Claire Judge demonstrates how to put a compression stocking on a patient: