Sclerotherapy is a minimally invasive method used to treat varicose veins and spider vein problems. In this procedure, a sclerosing solution is injected directly into the affected vein, causing it to scar and collapse, redirecting blood flow to healthy veins. Foam sclerotherapy, which mixes the sclerosant with air or gas to create foam, enhances contact with the vessel wall and is effective for larger veins. Ultrasound guidance is often used to increase accuracy and improve outcomes.
| Definition | – Sclerotherapy is a minimally invasive procedure for treating varicose or enlarged veins by injecting a sclerosing agent into the vein, causing it to close and eventually disappear. |
| Indications | – Varicose veins (small to medium size) – Spider veins – Hemorrhoids (in some cases) – Vascular malformations |
| Procedure | – A fine needle injects the sclerosant (e.g., polidocanol, hypertonic saline) into the vein. – The chemical irritates the vessel wall, causing closure. – The closed vein fibroses and is absorbed by the body. |
| Advantages | – Minimally invasive – No general anesthesia required – Quick and simple – Good cosmetic results |
| Risks & Complications | – Mild pain or discomfort – Swelling, redness, or bruising at injection site – Skin discoloration (hyperpigmentation, usually temporary) – Rare ulceration or tissue necrosis around the vein – Deep vein thrombosis (very rare) |
| Success Rate | – 70–90% success for small to medium veins – Multiple sessions may be needed |
| Preparation | – Inform doctor of any blood thinners – Review medical history and allergies |
| Duration | – Typically 15–30 minutes |
| Recovery | – Return to normal activities immediately – Wear compression stockings for a few days – Avoid strenuous exercise briefly |
| Alternatives | – Laser therapy (endovenous laser ablation) – Radiofrequency ablation – Surgery (stripping, phlebectomy) – Foam sclerotherapy (for larger veins) |
Prof. Dr. Özgür KILIÇKESMEZ
Interventional Radiology / Interventional Neuroradiology
What Is Sclerotherapy?
Sclerotherapy is a treatment for varicose and spider veins in which a sclerosing solution is injected into the affected vessels. This causes the veins to collapse and be absorbed by the body. Although its roots trace to the 17th century, modern techniques developed in the 20th century—particularly the discovery of sodium tetradecyl sulfate in 1946 and polidocanol in 1966. In the U.S., these agents received FDA approval in 2004 and 2010, respectively, cementing sclerotherapy’s role as a safe, effective option for venous disease.
How Does Sclerotherapy Work?
Sclerotherapy works by injecting a sclerosant that damages the vein wall, causing it to fibrose and close. Different agents act via distinct mechanisms:
- Detergent sclerosants: Sodium tetradecyl sulfate (STS)
- Polidocanol (POL)
- Osmotic agents: Hypertonic saline solutions
- Chemical irritants: Chromated glycerin
The goal is complete vein closure and fibrotic transformation. Agent choice and concentration are tailored to vein size and type to maximize efficacy and minimize complications. Although technically straightforward, sclerotherapy requires expertise and often uses ultrasound guidance.
When Is Sclerotherapy Used?
Sclerotherapy is especially useful for cosmetic and symptomatic relief of small varicose veins, spider veins, and vascular malformations. Its minimally invasive nature and quick recovery make it ideal for:
- Telangiectasias
- Reticular veins
- Small varicose veins
- Chronic venous disease
- Symptomatic relief
- Vascular malformations
- Adjunctive therapy
It also alleviates pain, swelling, and night cramps from venous insufficiency and complements endovenous laser or radiofrequency treatments by addressing residual branches.
Who Is Not a Candidate for Sclerotherapy?
Absolute contraindications include allergy to sclerosant, acute venous thrombosis, severe systemic illness or infection, critical limb ischemia, and prior severe neurologic or cardiac complications. Relative contraindications include pregnancy, hypercoagulable states, migraine or TIA history, cardiac anomalies like PFO, and uncontrolled diabetes or hypertension. Warnings cover skin necrosis, hyperpigmentation, and drug interactions (e.g., with oral contraceptives, disulfiram, minocycline). A thorough history and exam minimize risks and align patient expectations.
How Is Sclerotherapy Performed?
After medical evaluation and ultrasound mapping, the patient lies comfortably with the treatment area cleansed. A sclerosant—STS or polidocanol—is injected via fine needle. For larger veins, foam sclerotherapy mixes the agent with air/gas for better vessel contact. Ultrasound guidance ensures precise delivery. Post‑procedure, compression bandages or stockings are applied to aid closure. Early ambulation reduces thrombosis risk. Compression duration varies by vein size and physician protocol. Follow‑up sessions and monitoring optimize outcomes.
What Are the Side Effects of Sclerotherapy?
Complications are classified as minor or major:
- Minor: Pain, redness, rash, itching, bruising; hyperpigmentation; telangiectatic matting; transient vision changes or migraine.
- Major: Anaphylaxis; DVT; rare stroke; tissue necrosis from misinjection; nerve injury (numbness); pulmonary embolism.
Foam vs. liquid sclerosants carry different risk profiles: foam is more effective for large veins but may increase migraine or visual symptoms. Proper compression reduces complications.
How Successful Is Sclerotherapy?
Success rates depend on condition, patient factors, and response time. For varicose and spider veins, small vessels respond in 3–6 weeks; larger veins may take months. Overall success ranges 75–90%, with low recurrence. Hemorrhoid treatment shows ~95% success in second‑degree cases, lower in advanced stages. Compared to surgery, sclerotherapy offers similar short‑term efficacy with fewer complications, though surgery may provide more durable results. Sclerotherapy is preferred for patients unsuitable for surgery or with small‑vein disease.
How to Prepare for Sclerotherapy?
Preparation steps include:
- Medical evaluation
- Ultrasound mapping
- Review medications
- Avoid lotions/creams
- Wear loose clothing
- Bring compression stockings
- Stay hydrated and eat lightly
- Arrange post‑procedure transport
History of DVT, pregnancy, or allergies guides suitability. Pre‑procedure ultrasound assesses vein anatomy and deep vein patency. Blood thinners may need adjustment. Avoiding creams enhances agent efficacy. Loose clothes accommodate compression garments. Hydration and light meals prevent syncope.
What Is Post‑Procedure Care?
Key post‑care steps:
- Wear compression garments
- Take gentle walks
- Elevate legs periodically
- Avoid heat (baths, saunas)
- Monitor pain, swelling, redness
- Attend follow‑up visits
- Use acetaminophen if needed
- Maintain healthy weight
- Avoid smoking
- Eat a fiber‑rich diet
Leg elevation and light ambulation promote healing and reduce thrombosis. Avoid vigorous exercise and prolonged immobility. Minor bruising and pigmentation resolve in weeks; persistent symptoms warrant prompt evaluation. Adhering to instructions enhances outcomes.
How Does Resistance to Sclerotherapy Develop?
Resistance may arise from:
- Underlying venous reflux
- Anatomic variations
- Inadequate sclerosant distribution
- Vein diameter and flow dynamics
- Patient‑specific factors
Addressing reflux with ablation or surgery and using duplex ultrasound for personalized planning by experienced practitioners improves success.
Frequently Asked Questions
Sclerotherapy (foam treatment) treats telangiectasias, reticular veins, small varicose veins, and venous malformations. It’s also used for hemorrhoids and hydroceles. By injecting a solution, it causes vein collapse and absorption, relieving pain, swelling, and improving cosmetics.
About 25.6% of patients experience mild discomfort at injection sites during foam sclerotherapy. This is generally less than surgical procedures, and patients resume activities quickly.
Patients can return to daily activities immediately but should wear compression stockings for 1–2 weeks. Light walking is encouraged; avoid heavy lifting and strenuous exercise for a few days. Avoid heat (baths, saunas, sun) for two weeks. Bruising, itching, and discoloration are common but resolve in weeks. Following care instructions improves results and reduces complications.
Sclerotherapy achieves 78–87% complete closure rates. Recurrence varies by technique and patient factors, ranging from 4% to 70%. Serious complications occur in <1%. Common side effects include pain (up to 25.6%), pigmentation changes (17.8%), and thrombophlebitis (4.7%). Relative risk vs. surgery is 0.86, indicating slightly lower efficacy than surgical stripping but fewer complications.
Yes. Recurrence rates range 10–40% depending on technique, disease severity, and patient factors. A study comparing stripping vs. stripping + sclerotherapy found three‑year non‑recurrence rates of 93.5% vs. 88.6%. Neovascularization drives many recurrences. Cochrane reviews show sclerosant type, foam vs. liquid, and compression duration do not significantly alter recurrence. Regular follow‑up is essential to manage new varices over time.
Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
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