Sclerotherapy | Find a doctor & treatment information

What is sclerotherapy?

Sclerotherapy (also known as sclerotherapy ) is a common treatment method for varicose veins (varicose veins) and spider veins. They occur when superficial veins dilate. Varicose veins and spider veins usually occur in the leg veins.

Varicose veins can cause blood to accumulate. This leads to pain in the legs on the one hand and a feeling of heaviness and congestion on the other. Varicose veins are also a cosmetic problem for many sufferers, as they are noticeable due to their bluish coloration.

Bulging veins can also occur with liver cirrhosis. These are also known as oesophageal varices. They occur in the area of the oesophagus. Doctors also treat these with sclerotherapy.

This also applies to haemorrhoids and vein dilatations in the scrotum (varicocele). Doctors rarely use sclerotherapy to fix organs.

Varicose veins are nodular and tortuous, form clusters or networks and can protrude clearly outwards @ Elena /AdobeStock

How does sclerotherapy work?

During sclerotherapy, doctors use special agents to obliterate the tissue. The injected sclerosing agent causes damage to the inner vein wall. This leads to an inflammatory reaction, which causes the vein to stick together andeventually close (sclerotherapy). The veins are then transformed into a connective tissue-like strand. Blood can then no longer flow through it.

If there are several varicose veins, several sessions are necessary. Careful preparation is important before starting sclerotherapy.

The doctor will carry out various examinations:

• Ultrasound examination
• Venous occlusion plethysmography: This is a functional examination in which doctors measure how quickly the blood flows through the veins.
• Phlebography: In phlebography, the veins are visualized using a contrast agent. It is used to show the course of the veins and possible constrictions, blockages or bulges.

Sclerotherapy itself is carried out using sclerosing agents in liquid or foamed form.

Sclerotherapy with liquid medication

Liquid sclerosing agents tend to be used for smaller veins and short vascular dilatations.

Sclerotherapy is carried out in several steps:

1. First, the doctor draws the sclerosing agent into a sterile cannula using a syringe.
2. The doctor performs an air block on the vein so that the vein section no longer contains any blood. This is important so that the medication comes into direct contact with the vein wall. For the air block, a small, harmless amount of air or gas is injected into the relevant section of the vein. Carbon dioxide, for example, is suitable for this. This displaces the blood in the vessel.
3. The doctor then injects the medication into the vein wall. It is important that the syringe is positioned exactly in the vessel and does not enter the surrounding tissue.
4. After sclerotherapy, the doctor covers the injection site with a cotton pad and a plaster and applies a compression bandage. This compresses the affected area of the body. Compression stockings are also possible(compression therapy).

Varicose veins are sclerosed by injecting various sclerosing agents, which can be liquid or foamed @ Dimid /AdobeStock

Sclerotherapy with foamy medication

In foam sclerotherapy, doctors mix the medication with a small amount of air or gas such as carbon dioxide. This creates a fine bubbly foam. Foamy medication is particularly suitable for long vein protrusions.

The procedure for foam sclerotherapy is similar to sclerotherapy with liquid medication. Here too, the doctor draws the medication into a syringe and then injects it into the vein. By drawing in a little blood, doctors can check whether the syringe is in the right place. With foamy sclerotherapy, however, no air block is necessary as the blood is displaced by the foam. The medication can then reach the vessel walls and take effect there.

Risks of sclerotherapy treatment

Sclerotherapy is one of the standard procedures in modern medicine.

Nevertheless, problems can still occur:

• Injured or punctured vessel wall with subsequent bleeding
• Infection of the puncture site (with possible need for follow-up treatment with antibiotics or surgery)
• Permanent discoloration of the skin around the vessel
• Damage to the tissue (abscesses or death of cells)
• Inflammatory reactions with reddening of the skin
• Wound healing disorders
• Temporary visual disturbances (also known as flickering)
• Crust formation at the puncture site
• Damage to nerves (rarely remaining)
• Migraine attack (only in patients with a history of migraine)
• Allergic reaction to administered medication or intolerance to materials used
• Formation of blood clots
• Lymph congestion

The aftercare of sclerotherapy

Immediately after the treatment, small swellings, feelings of tension, bruising and reddening of the skin may occur at the puncture site. These normally disappear again after a few days and are of no further concern. However, those affected should always consult their doctor if the following symptoms occur:

• Increasing, throbbing pain
• Pressure pain or burning sensation on the skin due to the bandages
• Severe redness, swelling or heat in the treated area
• Numbness or tingling in the foot
• Blueing of the toes
• Fever above 38 degrees

To avoid such complications and incidents, patients must have the bandages checked and changed regularly. At these regular check-ups, the doctor decides how long the patient should wear compression stockings.

After sclerotherapy, patients may shower normally. However, a long bath or a visit to the sauna is only possible again after a few weeks. How long depends on the extent of the varicose veins and the type of sclerotherapy.

Patients should not expose the affected area of the body to direct sunlight for four to six weeks. This increases the risk of discoloration.

To avoid lymph congestion, patients should elevate their legs as often as possible. They should also avoid sitting or standing for too long. However, daily exercise such as cycling or walking is recommended.