Sclerotherapy is the injection of chemicals into veins to seal them shut. There are several different such chemicals in use and there are different techniques of performing sclerotherapy as well. Several different factors influence these choices. At MD Vein & Skin Specialists we have the expertise to see all the currently approved chemicals and injection modalities.
This is the oldest way of performing sclerotherapy. The sclerosing solution is injected into veins in its liquid form. This is now mostly reserved for treating small surface veins visible to the naked eye. We hardly perform this type of sclerotherapy at our facility. Typically we treat spider veins at the same time as we treat deeper veins using foam sclerotherapy. Asclera (polidocanol) and Sotradecol (sodium tetradecyl sulfate) are the two sclerosants currently FDA approved for sclerotherapy. A session of sclerotherapy typically lasts about half an hour as there is a maximum amount of the chemical that can be used in any one seating. There is some discomfort with the injections which can be numerous. Prescription grade compression stockings are advised for several days after the procedure.
Mixing a liquid sclerosant with a gas immediately before injection enables the use of a foamed solution for sclerotherapy. The foamed sclerosant has been shown to be more effective than the liquid in achieving the goal of closing the vein shut. Traditional liquid sclerotherapy took several sessions done several weeks apart to the same veins to achieve results. Use of foam can achieve similar results with as little as a single session. This is our preferred way of performing sclerotherapy.
Varithena is an FDA approved proprietary type of foamed polidocanol (sclerotherapy chemical). It is effective in the treatment of large veins and may offer an alternative to endovenous ablation with laser or radiofrequency. Endovenous thermal ablation is the standard techniques for treating the big veins of the superficial venous system of the leg. Howwever, it requires injection of a local anesthetic along the length of the vein to be treated. This may not be possible in some patients for any number of reasons. Hence the Varithena procedure is an available alternative. With Varithena some patients need only one treatment; others may require several treatments.
Ultrasound Guided Sclerotherapy
Since the majority of varicose veins are due to abnormal veins not visible to the naked eye, use of ultrasound during sclerotherapy so one can position the injecting needle in the right place, greatly improves outcomes and extends what we can now achieve with sclerotherapy. Indeed, we can now treat major veins of the superficial venous system with sclerotherapy. When it gets to these advanced techniques, however, you probably want a physician vein specialist doing them.