Sclerotherapy is the technical term for the induced and targeted formation of thrombus or sclerus during treatment with subsequent remodeling of the connective tissue. The medical term goes back to the Greek word “skleros”, which is translated as “hard”. Sclerotherapy results in artificial obliteration (hardening) of the treated tissue and vessels. The hardening or sclerotherapy of varicose veins is done with proinflammatory (inflammatory) drugs or chemicals (such as radiation).
What is sclerotherapy?
Sclerotherapy scleroses unwanted vascular dilations, such as varicose veins. Sclerotherapy scleroses unwanted vascular dilatations. This treatment method is induced for various conditions and is classified under the medical specialties of dermatology, vascular surgery and angiology. Varices (superficial veins), varicosis (venous nodules, varicose veins), esophageal varices (varicose veins of the esophagus) and hemorrhoids are eliminated by closing aberrant (normative variants of organs or vessels), varicose or hypertrophic (enlarged) vessels. Mobilized tissues or organs are also treated by this method. The implementation of sclerotherapy depends on the type of varicose veins. Reticular varices in the form of net-like varicose veins (spider veins) are often sclerosed. For more developed varicose veins, vein specialists use microfoam sclerotherapy.
Function, effect and goals
The goal of treating varicose veins and spider veins is to prevent pathological reflux of venous blood. With conventional sclerotherapy, the physician injects vein-damaging drugs into the affected veins using a thin needle. If the physician opts for microfoam sclerotherapy, he injects polidocanol in the form of a foamy sclerosing agent into the affected veins under ultrasound control. Polidocanol causes intentional damage to the endothelium (lining of the inner blood vessels) of the affected vessels. To achieve an effective long-term effect of the injected medication, pre-injection with air is possible. In this way, short-term congestion of the vein is achieved and the drug remains longer at the target site (endothelium). Following the injection, a vasospasm (spasmodic constriction of the blood vessels) occurs, causing localized and wall thrombus formation. This thrombus formation is an intermediate step on the way to the transformation of the tissue by immigration of fibroblasts (mobile cells in the connective tissue) into a fibrinous connective tissue strand. In addition to the agent polidocanol, physicians alternatively use a 27% saline solution (aethoxysclerol). Sclerotherapy is used for mild to moderate varicose veins that are located just under the skin. These most commonly occur in the calves or inner legs. The two most common forms of varicose veins are truncal varicose veins and side branch varicose veins. Truncal veins are located on the surface of the legs where two main veins, the great and small rose veins, run. The truncal veins belong to the superficial venous system. If both or one of the main veins are pathologically dilated, a truncal varicosis is present. Side branch varicose veins develop from the smaller veins branching off from the truncal veins. If these side branches are abnormally enlarged, this is referred to as a side branch varicose vein. Side branch varices often develop from the side branches of the great rose vein. Side branch varices also occur in combination with truncal varices. Despite the use of the vein-damaging drugs, the treated tissue does not suffer any permanent damage because the blood supply to the legs is not affected. The body redirects the blood to healthier veins. A variant of sclerotherapy is micro-sclerotherapy, the fine sclerotherapy of varicose veins. It is an outpatient, non-invasive procedure to remove mini-varicose veins and spider veins. To initiate the sclerotherapy process, the doctor injects a drug into the affected veins using a fine needle. This treatment results in the body’s own adhesion of the vein. Depending on the size and number of spider veins, more than one session may be required. The patient experiences minimal discomfort without incisions or laser use. Sclerotherapy is not possible for every patient. Sclerotherapy is only allowed for veins that are continuous.Contraindications include general infections, a history of deep vein thrombosis, and bed confinement.
Risks, side effects, and hazards
Patients must assume with sclerotherapy that every second varicose vein as well as spider veins will recur within five years. Regardless of the treatment method and correct execution, no physician can guarantee permanent success, as the reformation of the unwanted tissue enlargements depends on the patient’s connective tissue alignment. It is a congenital connective tissue weakness in the form of a predisposition to vasodilatation and favoring factors such as daily overloading of the legs. Nevertheless, sclerotherapy is a proven procedure for the sclerotherapy of unwanted varicose veins. A distinction must be made between functional vein damage and cosmetic problems. Functional problems are classified as severe varicose veins that cause patients great discomfort in their daily lives, such as pain, a strong sensation of pressure, limited leg mobility, and problems with physical activities that involve standing for long periods of time, sitting, and a lot of walking. Cosmetic problems are the finely pronounced, net-like spider veins, which cause hardly any problems for the patients and which are removed for purely aesthetic reasons. In the case of functional complaints, health insurance companies cover the procedure; in the case of aesthetically motivated removal of spider veins, patients are self-payers. A major advantage of sclerotherapy over surgical varicose vein removal is the lower complication rate. Patients can resume their professional activities faster after the procedure than after a surgical procedure. Possible side effects of these treatment methods include skin discoloration and scarring with high-dose sclerosants. In rare severe cases, tissue breakdown may occur if accidentally injected next to the vein or into the artery, as well as if the medication is overdosed. A shock reaction to the sclerosing agent is possible. To eliminate this reaction as quickly as possible, appropriate medications must be available to accompany the treatment. With local anesthesia, the patient does not notice anything about the procedure. Micro-sclerotherapy is suitable for almost all patients with spider veins. Vein specialists refrain from using this treatment method in pregnant women, breastfeeding mothers, circulatory disorders of the leg arteries (shop window disease) and blood clotting disorders. To support the recovery process, compression therapy (bandage or stockings) effectively supports the legs after the procedure to prevent dangerous thrombus.
