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Does Sclerotherapy hurt?

Written by: Erin D., Certified Medical Assistant

There are several procedures which can be used to treat varicose veins. One of which is called Sclerotherapy.
Sclerotherapy may be recommended if you have small varicose veins or so-called spider veins. These veins can be unsightly as well as painful.

I am a previous patient, current employee at Northern Michigan Vein Specialists, and have personally underwent this procedure. If Sclerotherapy is the recommended procedure to treat your varicose veins, it is performed in our office and typically takes about forty-five minutes.

Does Sclerotherapy hurt? Before I address this question, I feel it is important to understand the procedure. Sclerotherapy is non-surgical and requires only a series of small injections.

The Procedure:
Sclerotherapy begins with the patient changing into exam shorts so the doctor can visualize the veins to be treated via ultrasound. While lying comfortably on our exam table the leg is scrubbed with a surgical prep stick to kill any bacteria that may be lingering on the surface of the skin to prevent possible infection. As the doctor locates which veins require sclerotherapy with the ultrasound probe, the medical assistant will prepare the sclerosant. A sclerosant is an irritating solution to be injected directly into the vein; at Northern Michigan Vein Specialists we use a mixture of co2 and Polidocanol. This solution works by damaging the inside lining of the veins causing them to close.

Once the veins requiring sclerotherapy have been located the medical assistant will mix the Polidocanol together by pumping two syringes, separated via stopcock, back and forth to create a foam sclerosant. Foam is used because it is a slightly thicker solution thus less likely to be diluted by the blood upon injection into the vein giving the medication a longer window of effectiveness.

This brings us to our question: Does Sclerotherapy hurt?
A small 25 gauge needle is used to directly inject the sclerosant into the varicose veins. As the sclerosant is injected the patient may feel a burning or stinging sensation. A few patients have thoughtfully referred to the medication as “fire-water” but in general most patients tolerate sclerotherapy very well. Using the ultrasound probe the doctor will follow along the vein as the medication is injected to ensure the medication is not extravasating or leaking out of the vein into the surrounding tissues. If this happens it may sting a bit but will not do any harm. 2.5 cc of sclerosant is typically injected at a time. Sometimes in one vein sometimes in several smaller veins with a maximum of 10 cc of sclerosant per session. The amount of medication is limited just as any other medication specifies the amount a person can consume per day. Because of these limits sclerotherapy can sometimes take three to four sessions depending on the amount of veins requiring treatment. Each session typically takes a series of four to six injections. Once the 10cc maximum is reached or there are no veins left requiring treatment we will clean the surgical scrub off with a moistened towelette, hold pressure at any injection sites that may want to bleed, then apply Dermaka cream. Dermaka is an all-natural cream that we use at Northern Michigan Vein Specialists to soothe the skin and to help prevent any redness, irritation or minimal bruising that may occur. The injection sites can sometimes be red and raised as well as slightly itchy, similar to a mosquito bite. While still lying on the exam table we will apply your 20-30 mmHg (millimetre of mercury) compression stockings. If the veins requiring treatment are below the knee, knee high stockings are all that are required; if above the knee, thigh high or pantyhose stockings will be necessary. Lastly we will apply a coban, or stretchy wrap over the compression stocking at the treated areas to provide added pressure thus keeping the veins closed allowing the sclerosant to work for as long as possible. You will then be able to stand and walk around the room to ensure you are feeling ok and there are no adverse effects before leaving the office.

Compression stockings will need to be worn continuously for the first twenty four hours, removing the coban wrap approximately thirty minutes to a few hours after treatment if not bothersome. After twenty four hours the compression stocking must be worn daily for seven consecutive days removing them only for showering and bedtime. Patients are encouraged to do plenty of walking post-operatively but can otherwise resume normal activities without restriction the same day.

Approximately two to three weeks after sclerotherapy we will see you back in the office for a post-operative appointment just to be sure treatment went well and there is no retained coagulum  or old blood trapped in the treated veins. If you have retained coagulum the area may be hard, tender, red or swollen due to the trapped blood. This is not dangerous but may occur in approximately fifteen percent of patients depending on how large the veins are and which veins are being treated. That retained coagulum, or old blood, can be removed by puncturing the vein with a needle and squeezing the coagulum out. This can be quite painful but provides much faster relief and will prevent any staining or discoloration that may occur on the surface of the skin if left untreated. If your post-operative appointment is unremarkable we will likely schedule a one year repeat ultrasound at our office with our RVT (Registered Vascular Technologist) to ensure there are no further varicose veins requiring treatment.

Discharge instructions will be given both verbally and in writing after the procedure so that patients may refer back to them if needed. Patients will also receive the physicians cell phone number in case of an emergency after hours or over the weekend. Before leaving the office a two to three week post-operative appointment will be scheduled to assess the treated leg. A member of our friendly staff will also call the following business day to check up and make sure you are doing ok and address any concerns you may have.

At Northern Michigan Vein Specialists we are ready and able to treat your varicose veins via sclerotherapy or any of our other vein procedures. As Dr Heeringa would say “any major surgery, is any surgery done on me”. Why should you feel any differently? We understand that procedures can be scary and we are here to help in any way that we can.

Please contact our office directly at 231-946-1488, if you have any questions about sclerotherapy.

Thank you!
-Erin D., CMA

Posted in: Sclerotherapy

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