Advice to Patients

Sclerotherapy is a safe and well established treatment for thread veins on the legs. Although there are a number of alternative treatments, it remains the most successful.

A solution is injected with a very tiny needle into the veins, causing the lining of the vein to swell and become sticky allowing blood to adhere to the vein wall. Compression is then applied to close the veins, usually in the form of a graduated medical compression stocking but bandages are also used. Over a period of time the vein will heal and fade away.

Once a region of veins has been injected they look a little bruised and either blue or brown in colour. Thread veins usually fade completely over a 4-8 week period. Associated blue veins may take a little longer. Not all veins in a treated region will be cured after a single session – further treatment is always needed to improve the result.

Though safe, it is not entirely without risk. The two most common side effects are brown discolouration over a treated vein and telangiectatic matting.

Brown discolouration is due to haemosiderin deposition in the skin when the vein is not entirely closed, blood is trapped and clots. In some people iron pigments leak from the clot and stain the skin brown. These brown marks are usually not permanent but may take 6 – 18 months to fade. They darken when exposed to the sun and will take longer to fade if tanned.

Matting occurs if the fragile vessel is injured during the injection, leaving a mat of tiny veins that look like a bluish or a red bruise. Matting usually disappears completely after 6 – 12 months, but if it persists, it can be treated with sclerotherapy by using a fine needle to treat these veins. Other risks are extremely rare but these include:

Allergic reaction – any drug carries risk of allergic reaction but these are very uncommon with modern solutions. It is common for patients to experience some itching and redness in the treated areas just after injections have been done. This is not an allergy but a mild inflammation in response to the injection. This will pass within an hour. Infrequently, a small ulcer may arise at the site of an injection. This will heal on its own without specific treatment and may leave a tiny white scar.

A course of treatments is required to obtain a good result. You should budget for about 4 treatments but the number of sessions required depends on the extent of veins and how well they respond to injection treatment. People with just a few veins may be cured after one or two sessions but those with very extensive veins may take 6 or 8 sessions. Your practitioner will be able estimate how much treatment will be required. The time between session depends upon the advice of your practitioner but usually varies between 2 and 8 weeks.

The response to treatment varies considerably from patient to patient but in general an excellent result can be obtained with the disappearance of most veins once sufficient treatment has been done. Resistant veins may be due to underlying varicose veins or other “feeding veins”. These can be detected by ultrasound imaging or with the more superficial veins, can be demonstrated by passing a special light through the skin (“VeinLite”).

Before treatment:

  • Avoid the use bath oils, lotions of creams before your injections. These may prevent hold-up stockings from staying on your leg!
  • Dress in loose clothing, jogging trousers or skirt and comfortable shoes to accommodate the support hosiery.
  • If you have already been supplied with a graduated medical compression stocking bring it with you on the day of treatment.

After treatment:

  • Take a 10 minute walk immediately after treatment
  • Wear your graduated medical compression stockings according to the advice of your practitioner. Scientific research shows that wearing stockings during the day for up to 3 weeks helps in achieving the best outcome.
  • Stockings may be taken off at night and for showers or baths.
  • Do not be alarmed that the thread veins look worse, this is normal at this stage.They will improve as time passes.
  • Sun exposure during the initial few weeks after treatment may result in suntanning over the treated veins, which are already dark in colour. This will extend the time taken for resolution of the brown colour from the skin.
  • Air travel is generally acceptable during treatment, although you should wear your graduated medical compression stockings during long haul air travel. You should discuss this with your practitioner
  • Attend for further treatment and review of progress at intervals suggested by your practitioner.
  • Long term wear of medical compression stockings has not been shown to minimise thread vein recurrence. There is no reliable method of preventing further veins from growing and occasional further treatment is likely to be required.