Sclerotherapy Q&A with Alison Scheib, PA-C – Part 1

Patients often have common questions about sclerotherapy, a minimally invasive procedure used to treat spider veins and varicose veins. To shed some light on the topic, here is a Q&A with Alison Scheib, PA-C, who specializes in sclerotherapy at the Vein Healthcare Center.

What is sclerotherapy?

Sclerotherapy is a medical procedure involving a series of injections into a dysfunctioning vein. The provider uses tiny needles to inject a medicine called a sclerosing agent into the vein's interior wall. This causes the vein to become sticky and seal shut, causing the troublesome vein to disappear. Blood then finds a healthy path back to the heart. “Ultrasound guided” or “light assisted” defines how the vein is visualized during these injections.

Can you explain the difference?

Ultrasound-guided sclerotherapy uses ultrasound echoes to locate veins that are not readily visible and cannot be seen with a light. This procedure is often used to treat perforator veins, or veins that connect the superficial system (above the muscles in your leg) to the deep system (veins under and between the muscles of the leg). During light-assisted sclerotherapy, a small, hand-held light illuminates the veins directly below the skin, which allows the sclerotherapist to clearly identify the source of the dysfunction.

Who is sclerotherapy best for?

Sclerotherapy works best for those with superficial veins that are not directly connected to deep veins by junctions and have a diameter less than 5 mm. It can also be highly effective in patients who have leg symptoms such as heaviness, aching, pain, itching, swelling, throbbing, or skin discoloration or breakdown.

How long does the treatment take? How many treatments do most patients need?

Number and length of each treatment varies from patient to patient. Each session can take between 15 minutes and one hour, depending on the complexity of vein patterns and reflux. Most patients need multiple treatments, 3-6 sessions, on average.

To read part two of our interview with Ali, click here!

Varicose veins during pregnancy—how to prevent them, how to treat them

In honor of Mothers Day, we’re discussing the topic of varicose veins during pregnancy, but with a focus on the positive: prevention and treatment. (We explore the effect of pregnancy on veins in greater depth in a previous blog post. Click here to read more.)

During pregnancy, the two most important preventative things to consider with vein care are periodically elevating the legs and compression. 

Maternity compression stockings come in a variety of styles and strengths, from knee-highs and thigh-highs, to full-length stockings. Many panty hose styles have more room in the belly and are specially designed to expand during pregnancy without restricting the abdomen. Maternity graduated compression stockings are specially designed to fit more snugly at the ankles and calves and less so toward the top. The gradual change in compression helps the weak valves in the veins to circulate the blood more effectively. Many women who wear maternity graduated compression report that it makes their legs feel great!

Though pregnancy compression stockings (and body garments) are available with a doctor’s prescription, many maternity stores also offer them. Accurate sizing is critical, so it is best to check with a doctor prior to purchasing any type of compression while pregnant.

In most cases, women can be safely treated for varicose veins 6-8 weeks after delivery. Hormonal levels are usually back to normal within that time (if the patient is not breastfeeding), and water retention and any clotting risks have usually returned to baseline.

           

Depending on the type of treatment, breastfeeding may be an issue for some patients. Treatments that require a local anesthetic, such as endovenous laser ablation (ELVA) or microphlebectomy, have been proven safe. Sclerotherapy is not recommended if the patient is breastfeeding, as certain medications used during this procedure have not been proven safe and may be excreted in breast milk. However, if the patient is willing to forgo breastfeeding for 24 hours, sclerotherapy is possible.

Another important preventive measure is knowledge. If someone in your family has had a history of vein issues, chances are you might too. Some vein specialists recommend that women seek evaluation, and possibly treatment, for problematic veins before their first pregnancy, especially if there is a strong family history of vein issues. Evaluation and education can be very important for preventing or controlling issues before you need treatment.