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Medical & Vein Centre > information > sclerotherapy
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Sclerotherapy is an internationally proven treatment method where the doctor uses an extremely fine needle to inject a special solution directly into the unwanted abnormal vein. This solution causes the vein wall to collapse, which then disappears gradually as the body absorbs it.

For the treatment of larger varicose veins, the assistance of ultrasound technology is required to guide the precise placement of the injections into the abnormal veins, which are hidden below the skin.

There are several solutions used in sclerotherapy and they either include a very strong salt water called Hypertonic Saline or a Detergent solution such as Polidocanol or STS. This solution is injected with an extremely fine needle into the affected veins.

The principal of sclerotherapy is to treat the whole patient; that is, one tends to treat the larger veins first starting at the top of the leg and working down. The principle of sclerotherapy is the same for spider vein disease or varicose vein disease, the only difference is the period of compression.

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After your initial assessment, which will include a history, examination and testing of the veins with a Doppler machine, a plan of the treatment can be offered to you. The treatment usually varies between 2 to 6 sessions lasting 30 minutes. In this time one leg is usually treated with a sclerosing solution. This is followed by the application of stocking and an immediate return to normal activities.

Most treatments are followed by the application of compression stockings, which must be worn for one to two weeks. The stockings can be removed for sleeping and showering after 48 hours

All patients are advised to walk regularly, which coupled to the wearing of the compression stocking assists with the success of the procedure.

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The real advantage of sclerotherapy is that it causes minimal interruption to your lifestyle, is virtually painless, is extremely safe, has very few complications and can be done out of hospital without loss of time at work or from social or sporting activities. Most treatments are spaced 2 to 3 weeks.

One can expect a good result with an 80% to 90% improvement in the cosmetic appearance of the leg.

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You must remember we can only 'treat' not 'cure' veins.
  • 80% Good result
  • 10% Fair
  • 5% No change
  • 5% may form new veins

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Even when a highly experienced physician is performing the treatment, there are a number of possible side effects, including the following:

  • Aching in the leg for the first day or two following treatment. Walking usually relieves this and you may also take Panadol.
  • Red, raised areas at the sites of injection. These should disappear within a day.
  • Tender lumps may develop in the injected vessels particularly if the larger vessels are injected. These are areas where blood has been trapped in the sclerosed vein. The blood may be drained out of these lumps a few weeks after injection. This will lessen the resolution of the tenderness, and help prevent the pigmentation that occurs due to haemosiderin.
  • Phlebitis: This is an inflammation of the treated blood vessels. It is due to their action of the sclerosant on the blood vessel wall. When it occurs it is treated with anti-inflammatory medication, heat packs, massage, compression and regular walking.
  • Migraine: Some people who have a history of migraine headaches may develop symptoms of migraine within minutes of the injection session. These symptoms generally will include visual disturbances lasting a few minutes followed by a throbbing headache which can be treating by taking Panadol or Panadeine.
  • Matting: this is the development of networks of the fine red blood vessels near the sites of injection of larger vessels, especially on the thighs. About 10% of patients develop these. Most resolve spontaneously, some resolve with injection treatment, or laser therapy and a few persist. Matting is more common in patients with extensive surface veins and in obese patients who have poor muscle tone. It is important to walk for at least 30 minutes per day during the treatment to improve leg muscle tone. Other exercise such as cycling and low impact aerobics may be substituted.
  • Allergic Reactions: Although on rare occasions such reactions may be serious, they may be treated by immediate injections of adrenaline. Less serious reactions are treated with antihistamines. Minor rashes require no specific treatment but you should inform the doctor if they occur. Rarely, inflammation of the gums (gingivitis) appears to be a reaction to a specific sclerosing solution. If this occurs, a different solution can be used in subsequent treatments.
  • Bruises at injected site. These will disappear in a few weeks and are probably related to the fragility of blood vessel walls. Blood trapped in the sclerosed vein may cause the vein to be more noticeable in the first few weeks following treatment, and is an early sign that the treatment has been successful.
  • Ulcers: Rarely there is the formation of small ulcers at treated sites within 2 weeks of injection. Sometimes these occur because some of the solution has escaped into the surrounding skin. Generally ulcers occur due to the sensitivity of the tissues to the concentration of the solution entering the injected vein. They appear to occur more frequently in patients who smoke cigarettes. These ulcers will heal slowly and may leave a small scar.

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Deep vein thrombosis (clot in a deep vein). A risk of any procedure on veins is thrombosis. This has been estimated to be approximately 1:1,000. In the unlikely event that you do have a thrombosis, it is usually not serious but needs to be recognised and treated appropriately. The treatment will be determined by the severity of the thrombosis. In rare cases a thrombosis can cause a blood clot in the lungs (pulmonary embolism) which in some cases can be fatal. The risk of clotting due to sclerotherapy is reduced by the wearing of compression stockings, walking very soon after the procedure, walking regularly whilst wearing the compression stocking and the use of a blood thinning agent prior to the treatment (and for higher risk patients for a period of time after the treatment). The risk category that you fall into will be discussed with you at your consultation.

Intra-arterial injection. This is an extremely uncommon complication, which may result in muscle and skin tissue damage.

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You must have read this brochure before the commencement of treatment and signed the consent before your first treatment.

  • Wear comfortable clothes, which are either a loose fitting dress or shorts. A gown is provided.
  • Please do not shave your legs for 48 hours prior to the procedure. Should you have any superficial skin infections, you should consult your General Practitioner for treatment prior to sclerotherapy.
  • Avoid the application of moisturisers to the legs on the day of treatment.

You will be able to drive home after the treatment, but I encourage most patients to walk for a period of 20 to 30 minutes immediately following the vein treatment. I would then encourage you to walk at least one kilometre per day for the next three weeks.

My nurse and myself will apply the stockings at the time of injection. They need to be left on continuously for a period of 48 hours without being removed. Some people experience a throbbing at night while sleeping in the stocking. Should this be the case, the stocking may be removed and put back on before getting out of bed. After the initial 48 hours they must be worn for 8 days during the day. They may be removed for showers, swimming and sleeping. The most common cause of complications relate to removing the stocking too early.

Please note:

We will endeavour to remind you of your appointment, however it is your responsibility to arrive on time. If you are unable to keep your appointment please contact us prior to the date.

Treatments are claimable through Medicare however there is NO Medicare rebate for spider veins.

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Every patient is given a quote for treatment as well as an estimate for the rebate from Medicare: including

  • Spider veins
  • Varicose Veins
    • Standard
    • Duplex Guided Assisted Sclerotherapy

Please note

Estimated Medicare Plus Safety net Threshold has been introduced by the Commonwealth government to cover out of hospital medical expenses.

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  • Does the procedure hurt?
    The amount of discomfort felt will vary with the individual. The needles used are extremely fine (similar to acupuncture needles) and many are hardly felt at all. The injected solution can sting slightly for short periods of time.
  • Does the procedure interfere with my work or home duties?
    This is a walk-in, walk-out procedure where most treatments last for about 30minutes. Following treatment your daily routine should not be disrupted, however heavy physical exercise should be avoided for about 2 weeks following each treatment.
  • What if I do not treat my varicose veins?
    Symptoms commonly associated with varicose veins include leg tiredness, heaviness, aching, throbbing, restlessness, tingling, itching numbness and swelling. Complications such as phlebitis, blood clots, dermatitis, ulcers can occur if veins are left untreated.
  • Do I need these veins?
    Varicose veins and spider veins are not functional, and the blood has already found alternative pathways via healthy veins. Varicose veins are not missed by the circulation which, in fact, improves without them.
  • Will the treated veins come back?
    Treated correctly, the veins will not come back, as the body has absorbed them. New veins however, may appear with time, as the same causative hereditary factors still exist. These new veins are generally less pronounced and can be easily treated. In some patients an annual treatment is required to keep new vessel growth to a minimum.
  • What about lasers for vein treatment?
    Despite the proven usefulness in other procedures, the treatment of leg veins by external laser has thus far been disappointing. Currently available lasers can be very useful in treating the tiny cosmetic facial veins, but have been significantly less effective on legs veins when compared to expert sclerotherapy. Also, lasers are far from painless.
  • Should I wait until I have completed my family?
    Becoming pregnant with existing varicose veins will only lead to the veins becoming significantly worse as the pregnancy develops. Most Phlebologists agree that treatment for varicose veins is best performed before or between pregnancies.

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As distinct to solution, foam contains a small volume of air in the form of microbubbles (giving it an appearance similar to shaving foam). Foam is made by agitating a mixture of a sclerosant solution and a small volume of air via a 3-way valve between 2 syringes.

As distinct to solution, foam contains a small volume of air in the form of microbubbles (giving it an appearance similar to shaving foam). Foam is made by agitating a mixture of a sclerosant solution and a small volume of air via a 3-way valve between 2 syringes.

The leading European phlebologists held a European consensus meeting on foam sclerotherapy on April 4-6 2003, in Tegernsee, Germany1. This group concluded, 'Foam sclerotherapy is a promising variation of a well established varicose vein treatment that seems to improve the therapeutic outcome. The use of sclerosant foam is an appropriate procedure in varicose vein management. It is a powerful tool in experienced hands and in general more powerful than conventional liquid sclerosant. It is recommended that anyone using this technique should have good skills in conventional liquid sclerotherapy before starting to apply foam sclerotherapy'.

As per the recommendations of this group licensed approval for foam use has already been granted in Italy with the rest of Europe expected to follow.

In the last 4 years many thousands of procedures using foam have been performed in Australia and New Zealand. Published studies2 throughout the world and more recently in New Zealand3 have demonstrated the use of foam as safe and effective with considerable added benefits. The main benefit of foam is that it is stronger than solution as it displaces blood in the vein allowing for more effective contact within the vein wall. Therefore foam treatments use smaller volumes of sclerosant to achieve the same outcome. This allows for more veins to be treated in the same treatment session. Due to the added benefits of foam the usual protocols in treating varicose veins with solution require modification.

Nominated experts of the Australasian College of Phlebology met in August 2004 to establish an Australian (and New Zealand) consensus group. This group will set an appropriate standard for foam use in Australia. This will assist the long complex process of modifying the current TGA approval for sclerosant solution to include the use of foam. Phlebologists in Australia and New Zealand will be required to present prospective studies comparing the use of foam and solution prior to the granting of licensed approval. As the Australian regulating body has strict requirements it may take some years before licensed approval is granted.

  1. European Consensus Meeting on Foam Sclerotherapy, April 4-6 2003, Tegernsee, Germany, Dermatol Surg 2004;30:709-717.
  2. A Demagny , Comparative study into the efficacy of sclerosant foam and sclerosant liquid in the treatment of Greater Saphenous and lesser saphenous vein with Ultrasound Guided technique, Phlebologie 2002 55 No.2 133-137.
  3. The 8th Scientific Meeting of the Australasian College of Phlebology, Sheraton Mirage Gold Coast 29/4-2/5 2004.

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