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Sclerotherapy – Procedure, Mechanism and Uses

Sclerotherapy is a minimally invasive procedure used to treat varicose veins and spider veins by injecting a sclerosing agent directly into the affected vessel.

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Things worth knowing about "Sclerotherapy"

Sclerotherapy is a minimally invasive procedure used to treat varicose veins and spider veins by injecting a sclerosing agent directly into the affected vessel.

What is Sclerotherapy?

Sclerotherapy is a minimally invasive medical procedure in which a liquid or foam medication – known as a sclerosing agent – is injected directly into a diseased blood vessel or tissue structure. The goal is to permanently close the affected vessel so that it shrinks and is naturally reabsorbed by the body. The technique is most commonly used to treat varicose veins, spider veins, and reticular veins, but it also has applications in other medical specialties.

Indications and Areas of Use

Sclerotherapy is used across several medical disciplines:

Phlebology (vein medicine): Treatment of spider veins, reticular veins, and smaller varicose veins
Vascular medicine: Treatment of varicoceles (varicose veins of the testicle) and hydroceles
Gastroenterology: Sclerosis of oesophageal varices in patients with liver cirrhosis
Dermatology: Treatment of haemangiomas and vascular malformations
Orthopaedics: Management of chronic tendon and joint inflammation (prolotherapy)

Mechanism of Action

The injected sclerosing agent chemically irritates the inner lining of the vessel wall (endothelium). This irritation triggers a local inflammatory reaction, leading to damage and collapse of the vessel wall. The walls adhere to each other, the vessel becomes fibrosed, and is gradually replaced by connective tissue. Over time, the treated vessel is no longer visible and ceases to function. Commonly used sclerosing agents include:

Polidocanol (e.g. Aethoxysklerol) – most widely used in Europe
Sodium tetradecyl sulfate (STS)
Highly concentrated glucose solution – for very fine spider veins
Ethanolamine – used for oesophageal varices

Procedure

Sclerotherapy is performed on an outpatient basis and generally does not require anaesthesia. The typical procedure involves the following steps:

The treatment area is disinfected and, if needed, the vein is located using ultrasound (duplex sonography).
The sclerosing agent is injected directly into the vessel using a very fine needle – either as a liquid or as foam (foam sclerotherapy).
After injection, gentle pressure is applied to the site and a compression bandage or stocking is placed.
Multiple sessions spaced several weeks apart are usually required for optimal results.

Foam Sclerotherapy

In foam sclerotherapy, the sclerosing agent is mixed with air or gas to create a stable foam. This foam displaces blood within the vessel more effectively and maintains better contact with the vessel wall, significantly improving efficacy – particularly for larger veins. The procedure is often performed under ultrasound guidance.

Results and Effectiveness

Sclerotherapy is considered a highly effective procedure when performed correctly. Success rates of over 80% have been reported for spider veins and reticular veins. However, results are not always permanent – new vessels can form over time (neoangiogenesis), meaning that occasional follow-up treatments may be needed.

Risks and Side Effects

Sclerotherapy is generally safe, but the following side effects may occur:

Common: Redness, swelling, burning sensation, and mild pain at the injection site
Occasional: Hyperpigmentation (brownish skin discolouration) – usually temporary
Rare: Matting (fine red vessels appearing around the treated area)
Very rare: Thrombophlebitis (vein inflammation), deep vein thrombosis, allergic reactions to the sclerosing agent
Extremely rare: Tissue necrosis in cases of unintentional paravenous injection

Contraindications

Sclerotherapy should not be performed in patients with:

Known allergy to the sclerosing agent
Acute deep vein thrombosis or thrombophlebitis
Severe peripheral arterial disease
Pregnancy (relative contraindication)
Immobility or severely restricted mobility

Aftercare

Following treatment, wearing compression stockings for several days to weeks is recommended to support the outcome and minimise the risk of side effects. Light physical activity such as walking is encouraged, while prolonged standing or sitting and heat exposure (e.g. sauna, sunbed) should be avoided during the first few days after the procedure.

References

Rabe E. et al. - European guidelines for sclerotherapy in chronic venous disorders. Phlebology. 2014;29(6):338-354.
Munavalli GS, Weiss RA. - Evidence for laser- and light-based treatment of leg veins. Seminars in Cutaneous Medicine and Surgery. 2007;26(3):111-124.
Nicolaides AN. et al. - Management of chronic venous disorders of the lower limbs. International Angiology. 2018;37(3):181-254.

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