Patient Handouts : Sclerotherapy Informed Consent

Sclerotherapy Informed Consent

Superficial, unwanted and unnecessary leg veins can be destroyed by injecting hypertonic saline, sotradecol or chromated glycerin. (Saline and sotradecol are FDA approved for this; chromated glycerin is not.) Each of these agents works by irritating the lining of the veins. This damaged vein is then removed by the body's own healing mechanisms.

Multiple injections are required, between 2-5 sessions depending on the degree of clearance desired. Complete clearance is not usually reached without multiple sessions, but most patients are quite pleased with the results after two sessions, and only a few feel the need for more. If you need to have every vein disappear completely, without a trace, you will almost surely not be satisfied with this treatment.

The only other treatment for these leg veins is the use of a vascular laser. While we have a state-of-the-art vascular laser, we don't usually use it for leg veins because of the higher rate of hyperpigmentation when it is used.

Sclerotherapy requires multiple injections, which sting. When the sclerosing agent is injected, there is a burning sensation. Saline may cause brief muscle cramping in the leg when it is used. The injections leave small scabs that take 5-10 days to heal. There is often some bruising, which resolves in 1-2 weeks.

Possible side effects include:

  1. Hyperpigmentation at injection sites or along where the veins were. Infrequent. More likely with darker skin. Temporary: clears over weeks to months.
  2. Scarring. Rare. These are small, permanent and usually flat scars. As of the date of writing this (3/2007) I have caused this only once.
  3. Venous matting. This is a collection of fine blood vessels that appear around the area treated. Uncommon. Can be self-limited or can respond to laser treatment.
  4. Ulcers. Extremely rare. I have so far not seen this.
  5. Redness and raised bumps. Very common, especially in people with sensitive skin. Usually resolves within hours. Can itch.
  6. Ankle swelling. Rare, but more common when ankle veins are injected. This can last for weeks.
  7. Clot formation. This can look like purple threads or cords just under the skin surface. Unusual; can be drained a week after the procedure, or left alone -- they will resolve. More likely to cause hyperpigmentation.
  8. Clot propagation. Exceedingly rare, I've only heard about it theoretically. When a clot in a vein forms, it can spread to larger veins. If this affected the large veins of the leg it would be very serious.
  9. Allergic reaction. Only possible to sotradecol or chromated glycerin. Exceedingly rare. This could manifest itself as a rash or hives, or could result in anaphylaxis, which is a life-threatening reaction to a foreign substance.