Sclerotherapy FAQs for Patients

This section summarises the answers to questions commonly asked by patients and sclerotherapists.

The information here covers some of the commonly discussed topics.

What is sclerotherapy?
Sclerotherapy is an injection procedure to treat thread veins. The procedure involves injection of a sterile solution (called a sclerosing solution) into the small veins using a very fine needle. This solution irritates the vein lining causing it to undergo fibrosis and eventually disappear. Many veins are injected at each session.

What are thead veins?

Thread veins are most common in women in the age groups 30-50. They may occur during hormone fluctuations of pregnancy and menopause . Thread veins look like a network of small veins. These pink and purple veins usually appear in a lattice pattern and are completely harmless.

Where is the treatment done?

Treatment is usually done in a clinic or hospital. It generally does not require any type of anaesthesia. The patient is asked to come to the clinic in loose fitting clothing and the thread veins are identified. The thread veins are injected with a sclerosing solution that will destroy them. The treatment causes minor discomfort.

What chemicals are used for sclerotherapy?

The thread  veins are destroyed by injecting a small amount of a sclerosing solution into the vein. The sclerosing solution used may be either polidocanol (Sclerovein) or sodium tetradecylsulfate (Fibrovein). The chemical irritates the small vein and causes it to undergo fibrosis and eventually disappear.

Can sclerotherapy be used to treat large varicose veins?

The treatment of large varicose veins is a little different than for thread veins. The technique of ‘ultrasound guided foam sclerotherapy‘ uses a foamed sclerosant to treat large varicose veins. It has been shown to be a safe and effective method of treating varicose veins leading to long term freedom from troublesome veins. It is one of the modern methods for treating varicose veins which is covered in our ‘Public Services‘ section.

How many sclerotherapy treatments are required?

It varies from individual to individual but typically 2-4 treatments are required for the best results. In patients with a few veins, 1-2 sessions will suffice. More treatments are required where veins are more numerous and extensive.

Do I have to limit any activity after the treatment?

Walking is recommended soon after the procedure. Normal activities can usually be continued after treatment.

Does sclerotherapy hurt?

There is a little sting associated with each injection which lasts few seconds. Most individuals tolerate the procedure and do not require any type of anesthesia. The majority of patients claim that the procedure is much less than painful than they anticipated.

What happens if spider veins are not treated?

Absolutely nothing. Thread veins are almost entirely a cosmetic problem. They do not form blood clots and they do not cause swollen feet. A few people find that their veins cause some aching which is relieved by sclerotherapy.

Can sclerotherapy be done on the arms or face?

A small number of practitioners treat arm and face veins by sclerotherapy, but this is not common practice.

Is there any harm in removing thread veins?

Thread veins have no function and removing does no harm. The only reason they are removed is because of their unsightly appearance.

Can anyone undergo sclerotherapy?

Almost anyone with unwanted spider veins can be treated, except women who are pregnant or nursing. Other relative contraindications include those with skin infections, uncontrolled diabetes, fever, history of deep vein thrombosis, anticoagulant therapy those patients taking corticosteroids.

Is there any preparation required before sclerotherapy?

No preparation is required before the procedure.

What happens after sclerotherapy treatment?

There is some mild pain which can easily be overcome with paracetamol or ibprofen. The injected site will appear bruised and swollen for a few days. Many practitioners advise the use of compression stockings or bandages after treatment in order to minimise bruising and maximise the benefit of treatment. The bruising usually disappears in 2-3 weeks. Most patients can resume their normal activities soon after treatment.

How long is each sclerotherapy session?

Treatment sessions usually last 30 – 60 minutes. This varies between different practitioners.

When can the treatment be done?

Sclerotherapy is an elective procedure and can be done whenever the individual wants to have it done. The procedure does not take more than 30-60 mins and can even be done during a lunch break. Treatment is done on an outpatient basis during convenient office hours. You can resume most activities shortly after each session.

What are side effects of sclerotherapy?

Sclerotherapy leads to few side effects other than a little discomfort and some bruising. Severe allergic reactions are rare. A few people may develop intense itching at the site of injection.

Does insurance cover sclerotherapy?

Insurance companies exclude thread vein treatment from benefit under the terms of insurance policies.

What does NICE recommend regarding sclerotherapy and vein treatments?

NICE (the National Institute for Health and Care Excellence) evaluates the efficacy and safety of treatments to determine whether they are appropriate for use by the National Health Service.

In 2013, NICE issued an overview document making recommendations about which patients should be referred to hospital for investigation and treatment of symptomatic varicose veins. This is NICE Clinical Guideline 168 and refers only to patients who might be considered for treatment by the NHS. CG168 makes it clear that minimally invasive procedures are recommended over surgical treatment for varicose veins. No recommendations have been made by NICE concerning the treatment of thread veins since these would not normally be treated by the NHS.

NICE has also issued advice on the interventional procedures commonly used to treat varicose veins:

  • Ultrasound guided foam sclerotherapy
  • Endovenous laser ablation
  • Radiofrequency ablation
  • Mechanico-chemical ablation

Patients seeking treatment for varicose veins may find the advice offered by NICE useful in deciding on which treatment they would prefer.

A randomised clinical trial, undertaken by Rasmussen, has compared the outcome of the newer treatments and conventional surgical methods. His findings were that all treatments resulted in similar clinical and patient reported outcomes. However, foam sclerotherapy was less effective in ablating the saphenous veins, although some experts would argue that the technique used in this study was not very satisfactory.

Patients seeking advice should consult a specialist in the treatment of venous diseases. The European specialism of ‘Phlebology’ does not exist in the UK, but some surgeons consider that they are experts in this field.