Comprehensive Guide to Sclerotherapy - Princeton Vascular Center

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Sclerotherapy for Spider and Varicose Vein Treatment

Varicose veins and spider veins are an unfortunate consequence of our genetics and lifestyle.  While we can’t necessarily escape what’s in our DNA, the truth is that unsightly veins can be treated.  Vein doctors today used modern, minimally-invasive techniques to treat and eliminate undesirable veins with high success rates.

Sclerotherapy is one of the most important treatment choices for spider and varicose veins.  The procedure can be done in an office setting and is suitable for many different types of vein presentations.  The procedure involves small amounts of sclerosant injection into target veins by your vein doctor. The treated veins are then permanently collapsed and eliminated by the body.

Consult with your vein doctor in New Jersey about whether sclerotherapy treatment is right for you.

What Causes Varicose Veins and Spider Veins?

The venous system is a carrying tank for circulating blood, generally holding up to 70% of the blood volume at any given time.  Circulating blood within veins is returned back to the heart using complex interactions between valves and muscle pump function.

A dysfunctional venous system is the result of damage to vein walls and valves that result in varicose vein problems.   Naturally, blood pools in these veins due to gravity, resulting in high pressure within the veins. Whereas the deeper veins are supported by the muscles within our legs, the superficial veins that cause varicose veins will stretch.  Over time, these vein walls can become weakened from the constant pressure and resulting in vein injury. The size of the veins will gradually increase and lead to valve dysfunction and venous reflux. The visual presentation of this is commonly seen as spider and varicose veins on the legs.

Venous insufficiency is more common in individuals who sit or stand for prolonged periods, increasing age, females, obesity, and most importantly patients with a family history.  Developing varicose veins is linked to our DNA and this affects men and women alike.

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What is the Procedure for Sclerotherapy?

When treating with sclerotherapy for spider veins or varicose veins, the vein doctor will first need to consider the target vessel.  Larger, varicose veins or reticular veins require different treatment approaches then smaller spider veins. This can include different concentrations of medications or even alternative formulations, such as foam sclerotherapy.  Nonetheless, the general rules of thumb for successful treatment are:

  1. Go slow with injections to minimize extravasation of sclerosant
  2. Use the minimal sclerosant concentration to minimize the risks of hemosiderin-staining on the skin.  With polidocanol, spider veins are treated with a concentration of 0.25% to 0.5%.
  3. Use the least amount of sclerosant volume to achieve goals.
  4. Start from the larger source veins down to the smaller spider veins


Sclerotherapy is a minimally-invasive procedure and is not surgical in nature.  However, we still recommend that your vein specialist have formal vascular training to perform these procedures.

Your vein doctor will use tiny needles to inject the sclerosant into your target veins.  In some regions, a local anesthetic may be necessary, otherwise, the procedure is done without the need for any sedation.  After the procedure is completed, your vein doctor will likely prescribe compression stockings for a variable period of time to push blood out of the treated veins.  The injected medication will stimulate your body to begin the healing process on your treated veins and gradually eliminate them. At first, you may notice the treated areas to be red or inflammed and this is normal.  During the first 2 weeks, this will resolve and the veins will become lighter and lighter. While each treatment leads to significant improvement, It is not uncommon to need additional sessions of sclerotherapy to achieve better than 80% improvement.

Sclerotherapy Advantages:

Sclerotherapy spider vein removal has the following advantages:

  • It’s a minimally-invasive and efficient spider vein treatment with few risks of side effects
  • With newer solutions such as polidocanol and STS, the discomfort of injections has been virtually eliminated.  The treatment can be similar to botox injections.
  • Sclerotherapy spider vein treatment is very effective and can treat a large variety of vein types as opposed to laser treatment of spider veins.

What are the Risks of Sclerotherapy Treatment?

There are some side effects associated with sclerotherapy treatment.  Most commonly, these issues are benign and self-limiting. Discomfort or cramping at the injection site is the most common question.  This is usually mild and improves within a few days with some patients even reporting superficial phlebitis (inflammation). General measures such as walking and adhering to compression stockings help minimize the occurence and symptoms.  Some patients can also note itching or even red, raised areas around the treated veins. These findings are often self-limited, however if the situation warrants and your vein doctor approves, Benadryl can be effective.

Other potential common side-effects that require attention include:

  • Intravascular hematoma (trapped blood):  This is liquified trapped areas of blood between the two ends of a treated vein.  Even with the most proper technique, this can be seen in a percentage of patients and should be treated at follow-up visits your vein doctor using needle aspiration.  This will help speed up healing and elimination of the vein.
  • Hyperpigmentation: This occurs more commonly in larger treated veins that are breaking down.  The hemoglobin released from these veins contains iron and is deposited on the skin.  In most patients, this will resolve on its own over a period of time. Besides the general rules of thumb for sclerotherapy listed above, early attention to trapped blood, compression stockings, and minmizing sun exposure post treatment reduces the risks of hyperpigmentation.
  • Telangiectatic matting:  These present as a network of tiny, red blood vessels in treated areas that blush with compression.  In most instances, no treatment is warranted and the veins will disappear on their own. However, your vein doctor may consider possible sources of reflux as a potential cause.

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Your vein doctor will also be monitoring for some rare reactions:

  • Allergic reaction to the medical injection: Such reactions are rarely serious, and are immediate.  In this rare event, your physician is prepared with reversal measures.
  • Neurologic complications: Rare event and more likely with foam sclerotherapy.  The mechanism is not entirely clear, but may be related to the presence of a patent foramen ovale (connection between the right and left side of your heart).  Air bubbles that pass through to the left side of the heart can cause mild to severe neurologic symptoms. Visual disturbances or headaches should be reported to your vein doctor, but are likely to be self-limited.


Rare, late-presenting side effects that require immediate notification of your vein doctor:

  • Infection
  • DVT or leg swelling/pain
  • Skin ulcerations

These are signs of a more serious reaction to the treatment that requires your vein doctor to be notified.

What are the Post-procedure Recommendations?

Once your sclerotherapy session is complete, you are free to resume your usual routine with few limitations.   Our vein doctors provide the following rules for maximizing your treatment results:

  • Avoid strenuous exercise for 1 week
  • Avoid hot baths, hot tubs, or sauna treatments for 1 week
  • Avoid NSAIDS or anti-inflammatory medications for at least 48 hours
  • Avoid direct sunlight for 2 weeks and in areas of strong sun exposure, we recommend sunscreen with a minimum SPF of 40 for at least 4 weeks
  • Avoid any long, uninterrupted travel exceeding 4 hours trip duration for 2 weeks unless cleared by your vein doctor


During the recovery period, your best do-follow recommendations are to:

  • Maintain an active routine with plenty of walking. This promotes healthy circulation
  • Wear your compression stockings as directed
  • Tylenol is okay for any post-procedure discomfort

The vein doctors at the Princeton Vascular Center have completed formal vascular training and are board-certified experts with local and national recognition.   Sclerotherapy is our preferred method for treating and eliminating unsightly spider veins. Schedule an appointment online or call the Princeton Vascular Center to learn what vein treatments are best for you.


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