Sclerotherapy — Procedure Guide, Recovery & Risks | MyMedicPlus

Sclerotherapy injects a liquid or foam chemical sclerosant directly into abnormal veins, damaging the endothelial lining and causing thrombosis and fibrosis that permanently closes the vessel. Foam sclerotherapy (Tessari technique) is preferred for larger varicose veins as it displaces blood and increases contact time.

Indicated for varicose veins (C2 CEAP class), spider veins (telangiectasias), reticular veins, venous malformations, and residual or recurrent veins following great saphenous vein ablation (EVLA or RFA) or surgical stripping. It can treat veins from 0.1 mm to 6 mm diameter.

Patient stands briefly to distend target veins, then lies supine. Duplex ultrasound guides injections for veins above 3 mm. A 25-30G needle delivers 0.1-0.5 mL sclerosant (polidocanol 0.5-3%, sodium tetradecyl sulfate 0.2-3%) per site. Multiple sites treated per session; compression stocking applied immediately.

Compression stocking worn for 1-2 weeks continuously (spider veins) or 2-4 weeks (varicose veins). Walking is encouraged the same day; avoid hot baths and sun exposure for 2 weeks. Treated veins appear bruised and lumpy for 2-4 weeks before fading. Repeat sessions at 4-6 week intervals.

Hyperpigmentation affects 15-20% of patients and usually fades over 6-12 months. Telangiectatic matting (fine new vessels) occurs in 15%. Skin ulceration occurs in under 1% from perivascular injection. Foam-specific risks: DVT below 1%, visual disturbances, and migraine-like symptoms from microemboli.

Spider vein clearance of 70-90% achieved at 6 months with 2-4 sessions. Varicose vein improvement is seen in 80-85% of patients. Ultrasound-guided foam sclerotherapy achieves great saphenous vein occlusion in 65-80% at 5 years, inferior to thermal ablation but effective for recurrent or complex disease.