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Sclerotherapy

Sclerotherapy can be used on the larger veins I've described above, but the results may be only temporary, with a good chance of recurrence within two years. Sclerotherapy is best used for small spider veins. While sclerotherapy is usually successful, it occasionally produces new spider veins. These do well when treated with the vein lasers.

When you arrive at the office for sclerotherapy, you'll be put into an examining room and asked to put on a gown. There is no anesthetic necessary, since the procedure uses tiny injections instead of hooking. You may have photographs taken and be given a consent form that describes the possible complications.

The doctor will then inject your spider veins with a tiny needle, almost the smallest ever used in clinical practice, so small and sharp that most people barely feel it. Using magnifying glasses and a good light, the doctor injects solution into the "feeder system" of veins that runs underneath the obvious spider veins. The spiders can also be injected directly, but the feeder method gives the best results. Depending on the number of areas injected, the procedure can take anywhere from 10 to 30 minutes. There is little bleeding or pain, and you'll probably walk out of the doctor's office with nothing more than an ace bandage or a compression stocking. Several injection sessions may be needed to get the best result, depending on your particular veins and the doctor's skill. Allergic reaction to the medication is extremely rare, but can be serious. Your doctor should have the drugs to treat such a reaction. If this injection hurts much, your doctor may be using concentrated salt water (hypertonic saline), which is obsolete for this use.

Recovery

After you leave the office, you may be wearing a compression stocking, possibly covered with an ace bandage. There may be leakage of tumescent fluid if you've had a vein hooking procedure, and this will have a pink tinge or red color. This is the fluid mixed with a tiny amount of blood.

After vein hooking, you can resume limited normal activity as soon as you leave the office. What you don't want to do is to completely immobilize yourself. It's important to keep active in order to keep the blood flowing. Normal activity, like walking, light bike riding, and housework is not only fine, but recommended. Don't overdo it — mountain climbing is out for a while. You'll be wearing a bandage or compression socks for a week, even in the shower (you can cover them with plastic to keep them dry). When you take the bandage off, the big veins are usually gone. You may have a few fragments left, which can be treated with sclerotherapy (or, rarely, another surgery) during your follow-up visits. Brown discoloration for several months (rarely longer) is common.

After sclerotherapy you can do whatever you want. You may be given compression stockings to wear during your waking hours for several days. When you remove these, you may see hard and ropy-looking veins, but don't worry — they're generally on their way to improvement. Sometimes the doctor will remove blood from these during the follow-up. You may also see bruising after sclerotherapy, which most frequently lasts a few weeks. Skin discoloration can occasionally persist for months or even be permanent for a rare patient, but it almost always looks much better than the veins. But while all this is going on, you should see the veins disappearing. You may want to look for that old mini-skirt in the back of the closet.


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