Sclerotherapy: Frequently Asked Questions
What are spider veins?
Spider veins, known medically as telangiectasia, (tel-an-je-ek-ta-ze-ah), are dilated blood vessels near the
surface of your skin, most commonly on your legs.
Why do they exist?
The exact cause of telangiectasia is unknown. However, if you have a family history of telangiectasia, your
chances for developing telangiectasia may be greater. The effects of pregnancy, hormones, obesity, prolonged
standing, crossing of legs, and injury are uncertain. However, they are often associated with telangiectasia.
How are spider veins treated?
Spider veins can be treated with a technique called sclerotherapy. A solution injected into spider veins irritates
their inner lining so these vessels stop carrying blood. The body slowly replaces them with scar tissue without
harming the circulation.
What solution is used for sclerotherapy?
Solutions used to inject veins are called sclerosants. Many sclerosants are available and include: 1) hypertonic
saline (concentrated salt water), 2) sodium tetradecyl sulfate (STS), 3) polidocanol (POL), 4) Glycerin. Studies
have shown that Glycerin, STS, and POL are the most effective sclerosants. Glycerin works best for small
veins (red, purplish, or blue veins) while STS or POL are better for larger veins. STS and POL are FDA
(Federal Drug Administration) approved for sclerotherapy. Sclerotherapy with Glycerin
And hypertonic saline is considered off label (off-label: When any drug is used for a purpose, dose or form
other than that approved by the FDA).
How many times does it have to be done?
Everyone responds to sclerotherapy differently but almost everyone needs more than one treatment session. In
most patients, sclerotherapy will eliminate 50 to 80% of the veins after 3-4 treatments.
Most patients will require more than one treatment.
The interval between each treatment varies. Generally, a treated vein is usually not treated again until 6-8
weeks later to allow maximum response from your body.
The precise number of treatments that you will need is difficult to predict. Improvement after each injection
session is gradual, occurring over several weeks.
Compression stockings are required for 2 weeks after each sclerotherapy session.
How many veins can be treated during each visit?
Generally, many veins can be injected in a single session up to the safety limit of each sclerosant. People with
large numbers of spider veins may require multiple visits to treat different areas.
How soon will the vessels disappear?
The vessels usually disappear over a period of two weeks to two months. Sclerotherapy does not prevent new
veins from forming.
Are there certain kinds of veins that are more difficult to treat with sclerotherapy?
Generally, the larger and deeper the vein, the more difficult it is to treat. Ultrasound guidance is needed for
veins that are not visible from the surface. Sclerotherapy is indicated for superficial veins and not for veins in
the deep venous system.
Phone: 936-441-1010
Fax: 832-442-3081
www.theveinsurgeons.com
Sclerotherapy: Frequently Asked Questions
What is ultrasound-guided foam sclerotherapy (UGS)? This is a highly specialized technique that
uses ultrasound guidance to inject a foamy sclerosant into a refluxed vein. Diseased veins that may benefit
from foam sclerotherapy generally are larger, are not easily visible on the surface, or have resisted regular
sclerotherapy.
What are the side effects of sclerotherapy? Side effects can be immediate or delayed,
Immediate Side Effects are experienced within minutes to a few days after injections. They tend to be
temporary.
 Wheal. A wheal is a group of hives that have swollen together around the area that was injected. A
hive may occur soon after the injection, but it usually resolves within a few hours.
 Bruising. Occasionally, blood escapes from the blood vessels and forms a red or brown bruise. This
usually goes away within a few weeks.
 Discomfort. Some people experience a burning or stinging sensation during injection. Others
experience a cramping in the leg that occurs 30 to 60 seconds after the injections and lasts for about
one minute.
 Swelling and Aching. Some individuals, especially those who have had many veins treated, will
experience some leg swelling. This can be accompanied by a vague aching sensation of the legs.
Acetaminophen (Tylenol) and elevation of the legs are often sufficient to alleviate this discomfort.
 Blisters. These may result from the tape or adhesive applied to secure the dressing. They will heal
after several weeks and may leave temporary discoloration.
Delayed Side Effects can develop weeks to months after treatment and may persist for a prolonged period of
time. Some possible delayed side effects are:
 Brown Discoloration. Approximately 5-10% of patients will experience brown lines or spots on the
skin in the treatment sites. These have the appearance of a faint bruise, but they last much longer.
Most of these discolorations go away within one year.
 Pink Blush Spots. Occasionally, in place of the telangiectasias, many fine blood vessels form a small
pink patch called telangiectatic matting. This matting often resolves on its own but may take many
months to do so. This reaction occurs in 1-5% of patients. Most patients feel that the matting is
noticeable than the treated spider veins. Occasionally, persistent blush spots can be treated with
additional sclerotherapy.
 Nodules. Sometimes a scar will form under the skin which feels like a bump. This is a rare side effect
and often softens with time.
 Ulcers. A rare side effect is the formation of a small, painful, slow healing sore at the site of injection.
The occurrence of a small ulcer is unpredictable and the cause is uncertain. If an ulcer develops, notify
your physician to help you begin specialized wound care.
 Allergic Reactions. Allergic reactions are rare, particularly when hypertonic saline (concentrated salt
water) is used. Allergic reactions can be treated if they occur, and should be reported immediately to
your physician.
 Inflammation of the Blood Vessel (phlebitis). Is very uncommon. When it occurs, it can bet related
with bed rest, aspirin, and compression. In rare cases antibiotics are necessary.
Phone: 936-441-1010
Fax: 832-442-3081
www.theveinsurgeons.com

Clotting Sometimes a clot
develops at the injection site. These small
blood clots do not tend to cause
problems. However, removal of the clot
within two weeks of the injected will speed up the healing process.
Post-Sclerotherapy (Injection)
1.
After your procedure, your stockings must be worn once you return home. They must be worn every
day for a minimum of 2 weeks. They may be removed while sleeping and bathing. If your toes turn
blue or feel numb, call the doctor immediately.
2. We encourage you to walk immediately following the procedure. Walk at a relaxed pace and have a
companion beside you. Do not walk so vigorously that your pulse increases significantly. We
encourage you to resume all your pre-procedure activities, including working, immediately. This is
good for you, but take it easy. Continue to keep moving and maintain a normal level of activity.
3. It is important NOT to be sitting or standing for several hours for 2-3 weeks.
4. Leg compression is vital to your success and safety. Compression helps to prevent blood blots and
minimizes pain, swelling, bruising and bleeding. It is needed for a minimum of 2 weeks. If you do not
wear your stockings faithfully for 2 weeks, side effects are much greater and your results are less
optimal.
5. It is very important to put compression stockings on first thing in the morning before doing the rest of
your morning activity. Ideally, take a quick 5 minute shower and then put them on while you are lying
down. Keep them on until you are ready to go to bed, them take them off.
6. Daily walking is encouraged for at least 2-3 weeks after procedures. This activity helps to maintain
good circulation by emptying the leg veins with the muscular activity that walking creates. It helps to
decrease discomfort, promote faster healing, and reduce chance of forming blood clots. Walking 30
minutes a day.
7. For 3 days after treatment: Avoid aerobic exercise, weight training, and all other types of exertion that
increase your breathing and pulse rates. You may exercise after 3 days as long as you have your
stockings on. Good examples are daily walking.
8. For two weeks after treatment: Avoid immersion in hot tubs, hot baths, and sauna. Avoid lifting weights
or squats, high impact weight exercise with legs, high impact aerobics or pounding running. Fast
walking or elliptical machines are acceptable.
9. Direct sunlight to the operative leg is not recommended for two weeks following surgery.
10. The area may look blue or bruising, local swelling and some tenderness. Those are normal after
treatment.
11. Some bumps may form along the treated veins and you may have some redness and tenderness
along the vein route. You may also feel a pulling or tight sensation along the vein. These responses to
the injections are normal. Continued compression, walking and over the counter pain medicines are
usually helpful. For example: Ibuprofen (Advil or Motrin), Naproxen, acetaminophen (Tylenol, ExtraStrength Tylenol).
12. If tenderness, redness or lumpiness persists, please contact us. Sometimes, blood is trapped in you
veins and it can be easily removed through a small nicking with a needle.
If at any point after your treatment, you experience any leg pain or mild swelling, and you are not
wearing your compression house, PUT YOUR HOSE ON.
Phone: 936-441-1010
Fax: 832-442-3081
www.theveinsurgeons.com
On follow-up visits, you may
have injections
(sclerotherapy) which require
compression stockings
afterwards(to be applied at
home) and continued for 2
weeks.
If you have any questions or concerns during office hours, please call 936-441-1010
Phone: 936-441-1010
Fax: 832-442-3081
www.theveinsurgeons.com