However, you should be aware of the limitations and potential risks of sclerotherapy. Women who are pregnant or nursing should not undergo sclerotherapy. About 10% of patients who undergo sclerotherapy will have only fair to poor improvement. In rare instances, the patient’s condition may become worse after sclerotherapy treatments. Even in the same patient, some areas may undergo profound improvement and other areas will show less improvement. After sclerotherapy, compression stockings and exercise seem to help the cosmetic results and Dr. Artwohl asks all his patients to wear support stockings and walk at least 20 minutes daily for at least two weeks after the procedure.
The number of treatments will vary from person to person and Dr. Artwohl will discuss with you the estimated number of treatments that you will most likely require. Although the treatments are carried out meticulously and under magnification, it is unavoidable that some veins will be missed or not be completely eradicated the first time they are treated.
Dr. Artwohl performing sclerotherapy. The sclerosant initially flushes the blood from the spider vein making it less visible for a few moments. The vessel will reappear but then become inflamed and scar down after a few weeks.
RISKS AND SIDE EFFECTS OF SCLEROTHERAPY
The most common side effects experienced with sclerotherapy treatment include but are not limited to:
1. STAINING or HYPERPIGMENTATION: Approximately 10% of patients who undergo sclerotherapy will notice a discoloration (light brown streaks) after treatment. This stain represents an accumulation of hemosiderin, which is the oxidized iron (rust) from the degraded hemoglobin of red blood cells that become trapped in the tissue. Hemosiderin staining often resolves without intervention in about 4 – 6 months and the best approach is patience while waiting for the staining to fade. Although it seems paradoxical, staining seems to more prevalent in patients of Asian or Afro-American descent.
2. ULCERATIONS: This occurs in less than 1% of patients who receive sclerotherapy. Ulceration near the injection site can occur and may take a few weeks to months to heal. A blister may form, break open, and become ulcerated which may or may not leave a scar. Antibiotic therapy may be indicated. This problem is minimized through meticulous techniques that we use here at the Alaska Vein Clinic.
3. ALLERGIC REACTIONS: Very rarely a patient may have an allergic reaction to the sclerosing agent. The most common allergic reaction is hives, usually occurring during the treatment session, although a life threatening reaction can always occur. Allergic reactions are treated with Epinephrine, Benadryl and/or topical lotions that we keep here at the Alaska Vein Clinic. Again, these reactions are very rare. At the Alaska Vein Clinic, we have never had a significant allergic reaction in treating over 2500 patients.
4. PAIN: A few patients may experience moderate pain usually at the site of the injection. The veins may be tender to the touch after treatment, and an uncomfortable sensation may run along the vein route. This discomfort is temporary and is best treated by compression stockings.
5. TELANGIECTATIC MATTING: This refers to the development of new very fine blood vessels in the area of the treated vein. This phenomenon occurs 2 to 4 weeks after treatment and usually resolves within 4 to 6 months. It occurs in up to 20% of women on estrogen therapy and in 2% to 4% of all patients. Again, patience is usually the best remedy.
6. ANKLE/LEG SWELLING: This may occur after treating veins in the lower leg. It usually resolves in a few days but may last a few weeks, especially after treatment of larger varicose veins. Ankle swelling is lessened by wearing the prescribed support stockings.
7. DEEP VEIN THROMBOSIS (DVT): This is a very rare complication seen in approximately 1 out of 10,000 patients treated in the U.S. The dangers of phlebitis include the possibility of pulmonary embolus (a blood clot carried to the lungs) and post-phlebitic syndrome. We have not had a single DVT following sclerotherapy at the Alaska Vein Clinic.