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Sclerotherapy - Indications, Treatment, and Complications

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Sclerotherapy is a minimally invasive medical procedure to treat varicose and spider veins.

Medically reviewed by

Dr. Sandhya Narayanan Kutty

Published At January 20, 2023
Reviewed AtMarch 22, 2023

What Is Sclerotherapy?

Sclerotherapy is a minimally invasive medical procedure used to treat varicose and spider veins. It is a well-proven procedure that works well for most people. Approximately 50 % to 80 % of injected veins can be eliminated with each sclerotherapy session. Unfortunately, a few people, less than 10 %, who undergo sclerotherapy do not respond to the injections. While spider veins typically respond to treatment in three to six weeks, larger veins respond in three to four months. Veins that respond to the treatment often do not reappear. However, new veins may appear over time.

Why Is Sclerotherapy Done?

Sclerotherapy is mainly done to improve the appearance of varicose and spider veins. The procedure also improves symptoms of these conditions, such as aching, swelling, burning, and night cramps. Rarely, doctors may recommend sclerotherapy to treat hemorrhoids. During pregnancy or breastfeeding, doctors usually recommend waiting to have sclerotherapy done. Consult a medical professional to determine whether a person is a good candidate for sclerotherapy.

Who Are Eligible Candidates for Sclerotherapy?

Before this procedure, a person must first consult a vascular specialist. The specialist evaluates the person's eligibility for sclerotherapy. If the person is pregnant, breastfeeding, or bedridden, they must wait for at least three months after delivery before being considered for this procedure. One can have sclerotherapy done if taking birth control pills. For people who had a blood clot in the past, the eligibility for sclerotherapy depends on the cause and severity of the clots. Veins potentially usable for future heart bypass surgery may not be considered for this procedure unless they are already deemed unusable.

How to Prepare for Sclerotherapy?

Preparation For Sclerotherapy

Before the procedure, the doctor performs a complete physical examination and gathers the medical history.

1. Physical examination: The doctor evaluates the involved veins and checks for underlying blood vessel disease.

2. Medical history: To obtain the medical history, the doctor may ask the following questions:

  • Recent illnesses.

  • Existing medical conditions, including heart conditions or a history of blood clots.

  • Medications include aspirin, ibuprofen, blood thinners, iron, or herbal supplements.

  • Allergies.

  • Previous treatments or medical procedures for varicose veins and the results of the treatments.

The doctor may ask to avoid certain medications, such as:

  • Tetracycline or Minocin, as these medications, may cause skin staining if taken seven to ten days before or after the procedure.

  • Ibuprofen or other anti-inflammatory medications for 48 hours before and after sclerotherapy because these drugs can interfere with the action of the sclerosing agent or increase bleeding.

  • Prednisone can make the sclerosing agent less effective. Speak to the doctor who prescribed prednisone if it would be safe to discontinue the medication for 48 hours before the sclerotherapy procedure.

3. Ultrasound: Depending on the veins involved, the doctor may request an ultrasound imaging test on the leg veins.

The Day Before Sclerotherapy

Before the procedure, the following guidelines should be followed:

  • Avoid shaving or applying creams or lotions to the legs before or after the procedure.

  • Wear loose, comfortable items of clothing on the day of the appointment.

How Is Sclerotherapy Performed?

  • Sclerotherapy is typically performed in a doctor's office by a surgeon or dermatologist without anesthesia. The whole procedure takes less than an hour (30-45 minutes) to complete.

  • The treatment area is cleansed with alcohol.

  • The solution is injected directly into the blood vessel using fine needles. Some solutions may contain a local anesthetic called lidocaine.

  • Some people experience mild discomfort or cramps after inserting the needle into the vein for a few minutes. They may also experience pain if the solution leaks from the vein into the surrounding tissue.

  • In one session, the number of veins injected typically depends on the location and size of the veins and the person's overall medical condition.

What to Do After Sclerotherapy?

After the treatment, the person may be able to resume regular activities. For example, they may be encouraged to walk and instructed to wear support hose or compression wraps to compress the sclerotherapy-treated vessels.

Follow these guidelines after 48 hours after the procedure:

  • Avoid taking aspirin, ibuprofen, and other anti-inflammatory medications.

  • Avoid taking hot baths or showers. Choose a water cooler than usual for showers.

  • Wash the injection sites thoroughly with mild soap and lukewarm water.

  • Avoid applying hot compresses or any form of heat to the injected site.

  • Avoid direct exposure to sunlight, including sun tanning and tanning beds.

What Are the Possible Complications of Sclerotherapy?

Side effects of sclerotherapy may include the following:

  • Larger veins that have been injected may become lumpy or hard. They take several months to get better.

  • Raised red areas can appear at the injection sites, which should resolve within a few days.

  • Brown lines or spots may develop at the injection site, possibly caused by a form of iron that escapes from the blood in the injected veins. In most cases, they resolve within three to six months, but in a few cases, they can be permanent.

  • Bruising may occur around the injection site, lasting several days or weeks.

  • Temporary tiny blood vessels may develop in the treated area, called neovascularization. They may appear days or weeks after the sclerotherapy treatment but should fade within a few months without further treatment.

  • Allergic reactions to the injected sclerosing agent may occur at the time of the injection, which is rarely serious. A minor allergic reaction includes symptoms like itching and swelling.

Rarely, other side effects can also develop after sclerotherapy. Contact a doctor immediately if a person underwent sclerotherapy experiences the following side effects:

  • Inflammation or swelling within five inches of the groin.

  • Swollen leg.

  • Small ulcers at the injection site.

  • Red streaking, especially in the groin area.

What Is the Outlook for People Who Underwent Sclerotherapy?

People may feel mild discomfort when the veins are injected and cramping for one to two minutes when larger veins are injected. While for small varicose or spider veins, definitive results are usually seen in three to six weeks, larger veins may require three to four months. Veins that will respond to treatment generally do not come back, but new veins may appear over time. The doctor may schedule a follow-up visit month after the procedure to determine how well the procedure worked and if more sessions are required. Generally, one may need to wait about six weeks before getting another sclerotherapy session done.


Sclerotherapy is usually a minimally invasive medical procedure to treat varicose and spider veins. It is a proven procedure that works well for most people. Before the procedure, consult a vascular specialist to know about the eligibility for sclerotherapy. Before making any decision, it is also important to discuss sclerotherapy's benefits and side effects with a doctor. The outlook or prognosis of sclerotherapy is good, as the procedure is generally safe and effective.

Dr. Sandhya Narayanan Kutty
Dr. Sandhya Narayanan Kutty



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