What is sclerotherapy?
Sclerotherapy refers to the targeted sclerotherapy of tissue, usually varicose veins (varicose veins). This is done by injecting various sclerosing agents, which can be liquid or foamed. In this way, the physician artificially and intentionally causes localized damage to the inner vein wall (endothelium). The result of the endothelial damage is initially an inflammatory reaction, which later leads to adhesion and narrowing of the sclerosed vein. Eventually, the vessel remodels into a connective tissue strand through which blood can no longer flow.
If a patient has multiple varicose veins, several sessions may be necessary to complete sclerotherapy. There are currently two procedures for the procedure: Foam sclerotherapy and sclerotherapy with liquid sclerosants.
Sclerotherapy with liquid medication is mainly used for smaller pieces of veins or short-stretch vascular dilatations. The drug currently approved for this purpose in Germany is the local anesthetic polidocanol.
In foam sclerotherapy, the physician mixes the sclerosing medication with a harmless amount of air or a gas such as carbon dioxide. This produces a fine bubbly foam. This is particularly suitable for long-stretched bulging veins.
When is sclerotherapy performed?
Vein bulges in the esophagus (esophageal varices, mainly in cirrhosis of the liver), hemorrhoids or vein dilatations in the scrotum (varicocele) can also be treated by sclerotherapy. Rarely, sclerotherapy is also used to reattach organs in their position through the formation of connective tissue.
What is done during sclerotherapy?
Before the doctor can sclerose veins, he or she must perform various examinations for optimal planning of sclerotherapy. These include imaging and functional tests (for example, vein occlusion plethysmography, phlebography, duplex sonography). Then he informs the patient about the procedure and the possible risks of sclerotherapy. For the injection, the patient should usually lie down. The doctor calculates the dose depending on the patient’s body weight.
Sclerotherapy with liquid medication
Foam sclerotherapy
The procedure of foam sclerotherapy is the same as sclerotherapy with pure liquid anesthetic. Here, too, the physician fills the foam mixture into a syringe with a sterile cannula. He disinfects the patient’s skin and stabs directly into the vein with the tip of the cannula. By aspirating a small amount of blood, the doctor checks the correct position of the cannula in the vessel. Slowly, he injects the drug into the vessel. The foamy consistency displaces the blood that is still in the vessel and the drug lines the inner wall of the vessel. There it unfolds its effect.
After sclerotherapy
Once the doctor has injected the required dose, he carefully pulls the needle out of the vessel and presses a cotton pad onto the puncture site. He secures this with a strip of plaster. Now the treated leg must be compressed. To do this, the doctor applies a compression stocking or compression bandage.
What are the risks of sclerotherapy?
Although sclerotherapy is one of the standard procedures in the treatment of pathologically altered vessels, some problems can also occur here. These can be:
- Injury or puncture of the vessel wall with subsequent bleeding
- Infections, possibly with the need for antibiotic treatment or surgery
- permanent discoloration of the surrounding skin
- crust formation at the puncture site
- Wound healing disorders
- Damage to tissue (abscesses, death of cells)
- Damage to nerves, rarely also permanent
- allergic reactions or intolerance to materials and medications used
- temporary visual disturbances (flickering)
- migraine attack (in patients with a history of migraine)
- formation of blood clots
- Lymphatic congestion
Unfortunately, after sclerotherapy, more than 50 percent of patients experience the re-formation of varicose veins.
What do I have to pay attention to after sclerotherapy?
After sclerotherapy, it is quite normal for small swellings with a feeling of tightness, bruises or reddening of the skin to occur at the puncture site. These usually disappear after a few days. However, you should consult a doctor in the following cases:
- in case of increasing, throbbing pain
- if the treated area becomes very red, swollen or hot
- in case of pressure pain or burning sensation of the skin caused by bandages
- if there is numbness or tingling in the foot
- blue discoloration of the toes
- in case of fever over 38° C
The applied bandage should be changed by your doctor, also remove any compression stockings or bandages only in consultation with your doctor.
Body care after sclerotherapy
Sport after sclerotherapy
You should remain physically active following sclerotherapy. Immediately after sclerotherapy, walk up and down for about half an hour and do light physical exercise every day (for example, cycling, walking). Avoid sitting or standing for long periods of time; also, do not cross your legs while sitting. If possible, elevate your legs often to avoid lymphatic congestion. When lying down, light gymnastic exercises are recommended after sclerotherapy: For example, lift your stretched leg slowly and in a controlled manner without counterweight or pull the tips of your feet toward your knee.
