Sclerotherapy is the most common treatment for spider veins. It is an in-office medical procedure used to treat varicose and spider veins. The procedure of using a sclerosing solution to eliminate spider veins has its origin in 1920s. The solution (hypertonic saline (salt solution) or other agents such as Sotradecol (sodium tetradecyl sulfate)) is injected directly into the damaged spider or varicose vein. Larger veins may be treated with higher concentrations of the sclerosing agent. The solution irritates the lining of the blood vessel, which causes the veins to collapse, turn white and then disappear.

A few sessions are required to improve the cosmetic appearance and associated symptoms as well. Sclerotherapy procedure normally takes 15 minutes to 1 hour, depending on the number and length of the veins. During sclerotherapy a patient can be fully awake due to the low level of discomfort associated with this technique. Duplex ultrasonography, a type of guidance using sound waves, can be used to make sclerotherapy safer. Sclerotherapy is a safe, effective, non-invasive procedure that can greatly diminish the appearance of spider veins.

Side effects can include: brown lines or spots on the skin at the site of the injected blood vessels. Swelling, matting, ulcers and inflammation are also possible.

Sclerotherapy works well for most patients. After several treatments, most patients can expect an 80% – 90% improvement, because each treatment will lighten the spider veins significantly. The treated veins will generally disappear within 3 to 12 weeks after treatment. After the procedure the walking is strongly recommended, because it increases leg circulation and helps prevent blood clots in other veins. Patients can return to normal activity after just 2 or 3 day.

Although treatment does not prevent the development of new spider veins, the removal of existing veins can dramatically improve the appearance of the affected area, providing a more healthy, youthful look and an even color pattern to the skin. Sclerotheraphy does not address the underlying cause of spider veins, therefore it is not a permanent cure – up to 70% of spider veins reappear after about three to four years.

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Ultrasound-guided foam sclerotherapy for varicose veins

In standard sclerotherapy a liquid sclerosant (medicine) is injected into the veins to block them. In foam sclerotherapy, a foam made by mixing a liquid sclerosant with air or another gas is used instead. The foam is injected into the affected vein to fill it. Ultrasound-guided foam sclerotherapy should only be done using medicines licensed for sclerotherapy of varicose veins.

Problems after having foam sclerotherapy included inflammation of veins, blood clots (thrombosis) and changes in the skin’s colouring. The expert advisers were unsure about how well this procedure works. The published evidence did not clearly show a benefit, especially in the long term.