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For most varicose veins, sclerotherapy is the ideal treatment


Sclerotherapy is one of the most commonly used and well known methods in the treatment of varicose veins. It is popularly known as "needle therapy" and "foam therapy" as it has become popular in recent years. Sclerotherapy is simply the injection of certain drugs into the varicose veins that destroy them. Damaged varicose veins, like a healing wound, are gradually reduced in size by the body and disappear completely over time.


How is sclerotherapy performed?

If varices are very close to the skin and are visible to the naked eye, they can be entered directly with very thin needles under special light magnifiers and sclerosing agent is injected (microsclerotherapy). If the varices are deeper and cannot be seen with the naked eye, then slightly larger needles are inserted into the varices under ultrasound guidance and liquid or foam sclerosant agent is injected (ultrasound-guided sclerotherapy). 











What are the types of sclerotherapy in varicose veins?

Although it has been a treatment for decades, only a few drugs have been used in sclerotherapy. Today, polidocanol and sodium tetradecyl sulphate (STS) are used almost exclusively all over the world. Polidocanol is more popular in European countries and STS in America. Both drugs can be foamed by mixing with air (foam sclerotherapy). In sclerotherapy, these drugs can be used both in liquid form and in foam form. There are several advantages to sclerotherapy as foam: 1. Foam sclerotherapy is 3-4 times more effective than sclerotherapy with liquid. 2. The foam can be easily seen on ultrasound so that we can understand which vessels are affected. 3. Foam is lighter than blood because it contains air. Therefore, by lifting or lowering the leg during sclerotherapy, we can make the foam go into the desired vessels.




Is sclerotherapy suitable for all types of varicose veins?

Sclerotherapy is the ideal treatment for capillary and medium varices. Most large varicose veins can also be successfully treated with foam sclerotherapy. However, the greater the diameter of the varicose vein, the less likely the sclerotherapy is to be effective and the longer the healing time will be. Therefore, sclerotherapy is not suitable especially for varices greater than 5-6 millimeters and such varices should preferably be treated with miniphlebectomy.

What are the side effects of sclerotherapy?

The most common side effect of sclerotherapy is darkening (pigmentation) around the varicose vein treated. The higher the intensity of the sclerotherapy drug, the more effective it is, but the greater the likelihood of pigmentation. Therefore, sclerotherapy should be used at the lowest concentration that can be effective. Pigmentation is temporary, usually disappears within a few months, but sometimes may persist for years.


Another common side effect of sclerotherapy is the formation of very thin cloud-like new capillaries around the treated vessels. This condition, called matting, is considered to be a reaction to sclerotherapy, but too intense and pressurized administration of sclerotherapy may increase the likelihood of this condition. Matting is also temporary, as is pigmentation. About 80% of cases disappear spontaneously within a year.


A rare side effect of sclerotherapy is the formation of small ulcers. The cause of the ulcer is either infiltration of the drug out of the vein or escaping it into very thin arteries that supply the skin. In sclerotherapy, administration of the drug in small amounts and at low pressure reduces the likelihood of ulcers. Ulcers usually heal without a scar, but healing times are longer than normal wounds.


Clot formation (thrombosis) is the rare but undesirable side effect of sclerotherapy. If thrombosis occurs in the superficial veins, the vein becomes hard, red and painful (superficial thrombophlebitis). Superficial thrombosis is easy to treat and heals in a few weeks. If clotting occurs in deep veins (deep vein thrombosis), there is a more risky condition and an immediate blood thinner should be started. The risk of clotting can be greatly reduced by appropriate sclerotherapy; Instead of injecting more sclerosant via a few punctures, giving a small amount and diluted sclerosant via multiple injections, emptying the blood of the vessel to be treated before sclerotherapy and accelerating the blood circulation with foot movements during and after the procedure significantly reduces the risk of deep vein thrombosis.


In conclusion, sclerotherapy is the most common and successful method in the treatment of varicose veins worldwide. However, the results largely depend on the knowledge and experience of the physician and the treatment technique applied. Sclerotherapy is a very successful treatment with very little side effects if it is applied with great care and patience. However, if applied by inexperienced physicians and not performed properly, it may cause significant side effects and the cosmetic appearance of the leg may be worse than before.

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