Sclerotherapy

WHAT IS SCLEROTHERAPY?
Sclerotherapy is a popular and long standing method of eliminating superficial telangiectasias (spider veins) through the injection of a sclerosing agent through a tiny needle directly into the vein. The mechanism of action of the sclerosing agent is endothelial damage resulting in vessel injury that ultimately causes the vein walls to seal shut and disappear. In our office, we use the sclerosing agent Sotradecol, one of the only FDA approved sclerosing agents in the United States. Sclerotherapy is done on an outpatient basis and anesthesia is not required. It is a minimally invasive and virtually painless procedure.

WHY DO I HAVE THESE UGLY SPIDER VEINS?
Spider veins (telangiectasias) occur for a variety of reasons:

• Genetics
• Hormonal influences (estrogen and progesterone), as seen after pregnancy
• Increased venous pressure due to occupation or dependency
• Poor circulation
• Sun damage
• Trauma
• Radiation dermatitis
• Corticosteroid use

PLANNING FOR SCLEROTHERAPY

• Prior to the procedure we recommend you do not take any aspirin, ibuprofen, Motrin, Aleve, or other NSAIDS unless medically necessary (always check with your physician prior to stopping any medication). In addition, supplements like Vitamin E, Ginseng, and Fish Oil, may also potentiate bleeding and bruising during and after the procedure. Click here for a complete list of coagulants.
• We recommend that you undergo this procedure in the fall or winter as there is a healing period where the veins will look worse before they look better. In addition, you may require more than one treatment and being treated in the fall and winter will have your legs ready for summertime shorts and skirts.
• Allow yourself one to four weeks healing time. So don't book a trip to St. Croix a week or two later expecting to be vein or blemish free for the beaches there and sun avoidance is important so the treated sites do not develop any hyperpigmentation or tan discoloration.
• Buy an ace bandage or support hose prior to the procedure. Using these pressure/support measures may improve your response after your visit.
• Tell your doctor of any pre-existing medical problems such as genetic bleeding disorders, low platelet count, or if you are on any blood thinning medications which may be contraindications to this procedure.
• Tell your doctor if you have a strong aversion to needles that makes you light headed (vasovagal) or if you have fainted in the past while giving blood.
• Tell your doctor if you have had hip or knee replacement or if you have Mitral Valve Prolapse requiring you to take an antibiotic prior to a dental procedure.
• Tell your doctor if you have ever had sclerotherapy, laser, vascular surgery, or radiofrequency therapy in the past to your leg veins.
• Bring your favorite CD with you to help relax you or put you at east. Dr. Silbret has her own "sclerotherapy music" but would be happy to play your CD to make the procedure more enjoyable.

WHAT TO EXPECT DURING THE PROCEDURE
During the procedure, you will be reclining with your legs elevated. Dr. Silbret and you will discuss the areas to be treated. "I always ask the patient which veins they hate the most and start there. To see them disappear is most gratifying for the patient and the doctor as well." The area is cleaned and prepped. The tiniest of thinnest of needles are used to inject the sclerosing agent into the spider veins. Contrary to any preconceived notions about sclerotherapy, this is a minimally invasive and virtually painless procedure. After a spider vein has been injected, you will see almost a hive like or bug bite reaction at the site. This is normal. The area is then coated with a topical antibiotic and a pressure dressing is applied. Shortly after the completion of the procedure, patients are able to leave the office on their own and without difficulty.

WHAT ARE THE POSSIBLE SIDE EFFECTS?

• Redness and bruising: Commonly seen during the first two weeks after treatment with eventual resolution.
• Itching: You may experience mild itching alone the vein route that may last 1-3 days
• Pain: A few patients may experience pain and some soreness at the site of injection. This may be due to the injection and/or the sclerosing agent. Sotradecol has mild pain associated with it, which is one of the reasons we choose this formulation for the office. Veins may be tender to the touch after treatment and an uncomfortable sensation may run along the vein route. The pain is usually temporary.
• Sloughing: The sclerotherapy solution may infiltrate the surrounding tissue and a small slough may occur. This will result in a scab and potentially a scar. This is very unusual, almost never happens, but we want to appraise you of the possibility.
• Infection: Some patients, especially diabetics, have a risk of infection. If infection does occur, you can be treated with antibiotics. If you are a diabetic or have problems with arterial disease, please let Dr. Silbret know before starting therapies.
• Purple bumps: You may feel a firm area, lump, or bump beneath the skin at the site of injections, Tenderness may or may not be present and it may or may not occur 2 weeks after an injection session. These may resolve by themselves or be treated by aspiration and anti-inflammatory medicines. Always bring this to the attention of your doctor should you experience it so that she may evaluate it properly and treat if necessary.
• Allergic reactions: Very rarely, a patient may have an allergic reaction to the sclerosing agent. It usually manifests itself by hives. Although respiratory problems and anaphylactic reactions have been reported in the dermatology literature, it has not been observed in our office.
• Telangiectatic matters: During the course of treatment, as many as 5% of patients will develop a small network of tiny veins (0.03-0.05mm) near the treatment site. They are symptomatic and one half of the time will go away on their own without treatment. Should they persist, they may be treated either through laser or sclerotherapy.
• Thrombophlebitis: This is a rare complication seen with sclerotherapy. A side effect not seen in our office but reported in the literature and therefore you need to be educated and made aware of this remote possibility. Should you have further questions or concerns about thrombophlebitis, please ask your doctor and she will be happy to discuss it with you.

CAN I UNDERGO SCLEROTHERAPY IF I AM PREGNANT OR NURSING?
While we know of no problems associated with injections during pregnancy, we prefer you wait until you have delivered a healthy baby and have completed nursing.

WILL I HAVE ENOUGH VEINS LEFT AFTER THIS TREATMENT?
It is important to understand that the veins we treat are abnormal and are not necessary for your circulation. Removing these superficial veins may actually improve circulation while also improving the appearance of your legs.

CAN I RESUME NORMAL ACTIVITY AFTER THE PROCEDURE?
For the most part, you may resume normal activity. In the day following sclerotherapy, leave the dressing on the treated veins until the next morning, unless there is swelling or discomfort, in which case, you should remove the dressing at once. Generally, we recommend that you try not to lift heavy objects the first week and stay away from isometric exercises at the gym, like lifting weights. Aerobic and cardiovascular workouts are perfectly fine. In addition, do not wash the area for 24 hours and for the first week showers are preferred over baths. Otherwise, patients are encouraged to engage in normal daily activities. Light support stockings such as Supphose are adequate.

WHAT WILL MY LEGS LOOK LIKE AFTER THE PROCEDURE?
Not pretty. Generally, during the first 2-3 weeks, you will see a darkening purplish discoloration at the treated sites. Bruising is quite common or a period of days or weeks. This time frame is shortened with the compression stockings or dressings. In addition, it is not uncommon to feel a firm area, lump, or bump beneath the skin. It may be non-tender or tender, usually forming a week to 2 weeks after an injection session, or it may never happen. This may be remedied with an aspiration and anti-inflammatory medicines. As with any procedure, should you have a question or concern, you should call the office and be evaluated so that the proper treatment can be given.

Gradually, after 3-4 weeks you will see a regression and disappearance of the injected vein. Should you see any tan or brown discoloration overlying the treated vein, call your doctor, as topical hydroquinine and bleaching agent can help to fade this hyperpigmentation which is a possible side effect of this treatment. You should have a follow-up appointment four weeks after your initial session for evaluation and possibly a second treatment if necessary. However, if you notice any type of adverse reaction, particularly persisting pain, leg swelling, fever, skin breakdown, or shortness of breath, of course, call the office immediately. Having said this, Dr. Silbret, thankfully, has never had a serious side effect or infection in any of her patients in 12 years of performing this procedure.

Ultimately, after you sclerotherapy session(s) are completed, your treated spider veins will disappear leaving you ready to skip into summer!