Sclerotherapy is a very common and useful technique for the treatment of varicose veins – the word itself actually describes what it does – ‘sclero’ refers to the process of fibrosis that the vein undergoes when injected with a sclerosant chemical – in layman’s terms the vein shrivels up and is turned into a scar under the skin which eventually disappears.Sclerotherapy has been used in medical practice for over 150 years.
Like many medical techniques it has undergone considerable change during that time – the main changes from the way sclerotherapy was initially performed are in the types of chemicals we now use, the use of ultrasound probes to make sclerotherapy more accurate and the use of ‘foam sclero’, where the chemical is mixed with air or carbon dioxide to make it more efficient.
Back in the 19th Century, a wide variety of compounds were injected into varicose veins in an attempt to make then shrivel up and disappear – various acids, iron compounds, mercury salts, quinine, iodine, and tannins were used – seemingly by random choice! This, of course, was well before the days when the pharmaceutical industry was properly regulated!
The biggest advance in the technique of sclerotherapy was probably made just after WW2 when the compound Sodium Tetradecyl Sulphate or STD (better known by its easier to remember the name of ‘Fibrovein’) was developed. Fibrovein is still the best known and the widest used chemical in modern sclerotherapy practice.
Having said that it is by no means the only drug used in this way – polidocanol, hypertonic saline solutions, aethoxy sclerol and alcohol solutions are still used by some practitioners and in good hands, all can achieve good results.In concept the technique of sclerotherapy is quite simple – the doctor will insert a fine needle into the vein that we want to treat. This can be done with the naked eye if the vein is easy to see or under ultrasound control for better accuracy if the vein is well below the surface of the skin.
Once in the vein, the sclerosant chemical is injected slowly. The concentration of the sclerosant can vary depending on the size of the vein being treated – in the case of Fibrovein a weak solution of 0.2% is used for tiny surface thread veins, 0.5 % for slightly larger blue coloured veins, 1% for bulging blue veins and the strongest 3% for really big veins.
Foam sclerotherapy is used to treat larger veins – in this technique, the sclerosant chemical is mixed up with air or carbon dioxide into a foam or mousse. The advantage of this is that the air expands the volume of the chemical and pushes the blood out of the vein to be treated. This allows a longer contact time between the vein wall and the chemical and thereby gives the chemical a stronger effect.
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This is of particular importance when treating larger varicose veins. The development of foam sclero has allowed vein specialists to treat larger veins which previously would have needed surgical removal.
All sclerosants are designed to inflame the inside lining of the treated vein. It is for that reason that we believe that compression of the vein after treatment is quite useful to achieve the object of making the vein block and shrivel up. Opinion still varies among experts as to how long compression should be applied to the leg, but most practitioners will agree that a period of compression initially with bandages and replaced after a few days by compression stockings for a week or two does improve the efficacy of the procedure.
The number of sessions a patient will require treating their veins depends a bit on how many veins they have, how large the veins are and what sort of end result the patient is looking for – it is quite easy to get rid of 80% of thread veins but as the veins get smaller and harder to inject the success of each session reduces in line with the law of diminishing returns! As a rough guide, most patients we treat will attend between 2 and 4 times for injection treatment.