What is the procedure for sclerotherapy to treat varicose (enlarged) blood vessels?

From the Guidelines

Shrinking blood veins, or varicose vein treatment, is most effectively achieved through endovenous sclerotherapy, which involves injecting a solution directly into the affected veins, causing them to collapse and eventually fade, as recommended by the most recent study 1. The most common procedures for shrinking blood veins include sclerotherapy, endovenous laser treatment (EVLT), radiofrequency ablation, and intense pulsed light (IPL) therapy.

• Sclerotherapy involves injecting a solution directly into the affected veins, causing them to collapse and eventually fade, with solutions like sodium tetradecyl sulfate or polidocanol typically used, as described in 1.
• EVLT uses laser energy to heat and close larger varicose veins, typically requiring only local anesthesia and allowing patients to resume normal activities within 1-2 days.
• Radiofrequency ablation works similarly but uses radiofrequency energy instead of laser, as mentioned in 1.
• IPL therapy can be effective for facial spider veins, usually requiring 3-5 sessions spaced one month apart. These procedures work by damaging the vein lining, causing inflammation that leads to closure and eventual absorption by the body, with the body naturally redirecting blood flow through healthier veins, as explained in 1. Before undergoing any of these procedures, patients should avoid blood-thinning medications for at least a week, and afterward, compression stockings are often recommended for 1-2 weeks to improve results and reduce complications, as suggested by 1. The choice of treatment depends on the specific condition being treated, with endovenous sclerotherapy being the most recommended procedure, according to the latest study 1.

From the FDA Drug Label

Asclera® (polidocanol) is indicated to sclerose uncomplicated spider veins (varicose veins ≤1 mm in diameter) and uncomplicated reticular veins (varicose veins 1 to 3 mm in diameter) in the lower extremity. The procedure for shrinking blood veins, also known as sclerotherapy, involves injecting a solution into the vein to close it off.

• Key points:
  • The solution used is polidocanol, which is administered intravenously.
  • The dosage and administration of the solution depend on the size and extent of the varicose veins.
  • The maximum recommended volume per treatment session is 10 mL.
  • Post-treatment compression is necessary to reduce the risk of deep vein thrombosis.
  • Patients should be monitored for signs of venous thrombosis and pulmonary embolism after treatment 2. The main goal of this procedure is to close off the varicose vein, which can help improve the appearance of the skin and reduce symptoms such as pain and swelling.
• Important considerations:
  • The procedure should only be performed by a healthcare professional experienced in venous anatomy and the diagnosis and treatment of conditions affecting the venous system.
  • Emergency resuscitation equipment should be immediately available in case of an allergic reaction 2.
  • Patients should have post-treatment follow-up of sufficient duration to assess for the development of deep vein thrombosis 3.

From the Research

Shrinking Blood Veins Procedure

• The procedure of shrinking blood veins, also known as sclerotherapy, is a nonsurgical treatment used to eliminate varicose veins and telangiectasias 4.
• Sclerotherapy involves injecting a sclerosant into the vein to cause fibrosis and eventual obliteration of the vein 4.
• The most common sclerosants used in the U.S. include sodium tetradecyl sulfate, polidocanol, 23.4% saline, and a combination of 25% dextrose with 10% saline 4.

Treatment Outcomes and Safety

• Studies have shown that sclerotherapy is a safe and effective treatment for varicose and telangiectatic leg veins, with an average of 70% improvement and 70-72% patient satisfaction 5.
• The safety and efficacy of sclerosing solutions, such as sodium tetradecyl sulfate and polidocanol, have been compared in clinical trials, with no significant difference in adverse effects except for a decrease in ulcerations and swelling in the polidocanol group 5.
• Foam sclerotherapy is an increasingly popular modality in the treatment of varicose veins, and the stability of foam has been found to vary according to the specific sclerosant and concentration used 6.

Post-Treatment Care and Guidelines

• Compression therapy is recommended after sclerotherapy to improve outcomes and minimize complications 7.
• The duration of compression therapy after sclerotherapy is determined by best clinical judgment, as there is no convincing evidence to support a specific duration 7.
• Guidelines for compression therapy after invasive treatment of superficial veins of the lower extremities have been established by the American Venous Forum, Society for Vascular Surgery, American College of Phlebology, Society for Vascular Medicine, and International Union of Phlebology 7.
• Alternative techniques, such as phlebectomy and cyanoacrylate glue, are emerging as alternative forms of treatment for varicose veins 8.