Sclerotherapy

Sclerotherapy is carried out by experienced clinical nurse specialist Maria Cork, with considerable knowledge of the technique.

The legs should be clean with no moisturisers or other skin preparations applied, as these may cause the medical compression stockings to fall down after treatment. It is best to come wearing a pair of trousers or a long skirt to cover your legs and the stockings that will be applied after the treatment. For your own interest, you may like to take photographs of your legs prior to treatment, as it is always difficult to remember how bad they were.

A sclerosing solution (Fibrovein® or Aethoxysklerol®) is injected into the veins using a very fine needle. This solution has an irritant effect on the lining of the veins, causing the walls of the veins to stick together. Blood stops flowing through the veins, which are then absorbed by the body’s natural healing mechanisms over a period of three months. The blood is redirected back to the deeper venous system.

At the end of the session, you should put on a pair of class 2 medical compression hold-up stockings, which you are asked to purchase from us. We keep supplies of these for you. These should be worn for 3–7 days following each treatment session, although they may be removed at night and for baths or showers. Male patients may wear medical compression stockings or bandages, which we supply. A shower can be taken later in the day. The compression stockings can also be worn on long-haul flights to prevent swollen feet and deep vein thrombosis once your treatment is complete.

A course of treatment is required with sessions of sclerotherapy at intervals of two weeks or more. Typically, 4–8 sessions will be needed depending on the extent of the veins.

Bruising may appear in some treated veins and can last from two weeks to three months, depending on the size of the treated veins. Due to bruising following injections, treated areas may look worse before they improve, so patience is necessary to achieve a good result.

In some cases, the appearance can be improved by pricking the treated veins with a needle to remove the bruise. Bruising duration varies greatly between individuals, occasionally lasting several months. The veins can feel tender for a few days, and mild analgesia such as Nurofen or paracetamol can be taken. Larger varicose veins may require stronger compression and bandaging.

It is usually advisable to leave a two-week period between treatments on the same area to allow bruising to settle.

Certain areas are susceptible to swelling, particularly the ankle and knee areas, which usually settle spontaneously. Occasionally, thicker bruises develop in larger veins, which can remain for several months and may cause brown discolouration of the skin that can take up to a year to fade.

It is possible for larger veins to develop a small degree of thrombophlebitis, where the vein feels hard, warm, and slightly sore. These resolve spontaneously and require only simple analgesia.

Rarely, a small area of redness with a white or black centre and some throbbing may appear two to three weeks after a treatment session. You should notify the specialist immediately if this occurs, as prompt treatment with antibiotics prevents progression.

Very rarely, an injection ulcer may develop, which is painful and takes 2–4 weeks to heal. If blisters appear when bandages or stockings are removed, they should be left alone and kept clean and dry to resolve spontaneously.

In some cases, thread veins are resistant to treatment. This can be investigated with ultrasound imaging, and ultrasound-guided injections can treat feeding veins that cannot be seen from the surface of the leg. This usually leads to excellent results, although additional treatment sessions may be required.

A very rare complication is the accidental injection of an artery, which may lead to severe tissue damage and ulceration.

You can drive after each treatment session. Normal exercise can be resumed immediately, including swimming, unless the legs have been bandaged. Air travel may be undertaken straight away. You are advised to drink plenty of fluids during flights and wear class 2 compression stockings for journeys over four hours.

Fifty percent of veins treated in a single session typically disappear. Most veins treated during a course of microsclerotherapy can be expected to be eradicated. Over time, new thread veins may appear, and it is common for patients to return for occasional maintenance treatments.

Microsclerotherapy remains effective for treating new veins as they appear. While no method prevents more thread veins from forming, the treatment is successful for managing surface veins, and good outcomes are generally achieved with realistic expectations.

The most commonly used drug to treat thread veins and small varicose veins is Fibrovein (sodium tetradecyl sulphate). In some cases, Aethoxysklerol (polidocanol) is used for patients intolerant to Fibrovein. These drugs are licensed by the Medicines and Healthcare Products Regulatory Agency (MHRA) in the UK for the injection of varicose and thread veins. Maria Cork has extensive experience using these treatments and finds microsclerotherapy an effective method for managing thread veins on the legs.