Sclerotherapy

Sclerotherapy closes unwanted surface veins with an injection rather than an incision. A fine needle delivers a solution — a sclerosant — into the vein, irritating its lining so the walls seal together. The closed vein is gradually absorbed by the body, and blood reroutes through healthy veins nearby. It is the long-established treatment for spider veins and small varicose veins.

The procedure is performed in the office, takes about 15 to 45 minutes depending on how many veins are treated, and requires no anesthesia beyond the discomfort of the injections themselves.

• Spider veins (telangiectasias) — fine red, blue or purple lines at the skin surface
• Reticular veins — slightly larger blue-green veins beneath the surface
• Small to medium varicose veins, including those remaining after a larger vein has been treated
• Veins that persist after previous vein treatment

Larger, rope-like varicose veins caused by failing valves in the main saphenous veins are usually treated first with vein ablation, because injecting the visible branches while the underlying reflux remains untreated tends to produce disappointing and short-lived results. A venous reflux ultrasound is what determines whether that underlying problem is present — which is why an evaluation, rather than moving straight to injections, is the right starting point.

You stand briefly so the veins are visible and marked, then lie down for treatment. Each injection feels like a small sting or brief burning; foam sclerosants are often used for slightly larger veins because the foam displaces blood and contacts more of the vein wall.

Afterward, compression stockings are usually worn for a period your provider specifies — commonly one to two weeks. Walking is encouraged immediately, and most people return to normal activity the same day, avoiding strenuous exercise, hot baths, saunas and prolonged sun on the treated area for a short period.

Treated veins fade gradually over weeks to a few months, not immediately, and most people need more than one session — two to four is typical — spaced several weeks apart. Setting that expectation early matters, because a single session rarely clears an area completely.

It is also worth knowing that sclerotherapy treats the veins you have now; it does not prevent new ones from forming, and maintenance sessions are common over the years.

• Bruising, mild swelling and raised, tender lines along treated veins
• Small brown lines or spots (hyperpigmentation) that usually fade over months, occasionally longer
• Tiny new red vessels near a treated area (matting), which often resolve on their own

Serious complications are uncommon. They include skin ulceration if solution escapes the vein, allergic reaction to the sclerosant, and rarely a blood clot in a deeper vein. Report increasing calf pain or swelling, shortness of breath, or a skin wound at an injection site. Sclerotherapy is not performed during pregnancy, and you should tell your provider about a history of blood clots, a clotting disorder, or a patent foramen ovale.

Treatment of spider veins is considered cosmetic and is generally not covered. Treatment of symptomatic varicose veins with documented reflux often is covered, usually after a period of conservative measures such as compression. Your vein specialist's office can verify coverage before treatment.