Generality
Sclerotherapy is a medical procedure used to treat blood vessel malformations. The situations that most often require it are varicose (or varicose) veins, telangiectasias and hemorrhoids.
Figure: results of a sclerotherapy operation: before the operation (left), after the operation (right). From the site: allureaesthetics.co.uk
A sclerotherapy session consists in injecting, inside the malformed vessels (whether they are veins, venules, arterioles or capillaries), a dose of sclerosing solution capable of causing them to close and collapse.
Before the procedure, a physical examination and a thorough review of the patient's medical history are required.
In order to appreciate the results of sclerotherapy, it is necessary to wait a few weeks (if the treated blood vessels are small) or a few months (if the treated blood vessels are large).
What is sclerotherapy?
Sclerotherapy is a medical procedure that treats malformations of blood vessels, such as varicose (or varicose) veins, telangiectasias and hemorrhoids.
From a practical point of view, sclerotherapy consists in "injecting" inside the malformed vessel or vessels (whether they are veins, venules, arterioles or capillaries) a particular solution, capable of causing them to close and collapse. This solution is commonly referred to as "sclerosing solution".
Once the collapse has occurred, the blood flow is not interrupted, but takes alternative blood routes.
Sclerotherapy can also be used in case of malformations of the lymphatic vessels, or the ducts of the human body that carry a transparent or milky substance called lymph.
WHAT IS ULTRASOUND SCLEROTHERAPY?
Figure: US-guided sclerotherapy. The ultrasound probe (white instrument) helps the doctor to identify the vessel into which to inject the drugs via syringe. From the site: theveincenternj.com
Ultrasound-guided sclerotherapy is a variant of traditional sclerotherapy, which uses an ultrasound system to identify the blood vessels to be treated.
Generally, ultrasound-guided sclerotherapy is put into practice when the malformations concern vessels located very deep and not visible to the naked eye.
When you do
In most circumstances, sclerotherapy is practiced for aesthetic purposes. For example, it is a widely used treatment for the resolution of imperfections due to varicose veins, present on the legs, or telangiectasias that have appeared on the face.
However, in some situations, sclerotherapy can also represent an adequate solution to vascular and lymphatic malformations, characterized by:
- Ache
- Swelling
- Burning
- Night cramps (when legs are affected)
VARICOSE VEINS
Figure: results of a sclerotherapy operation on varicose veins: before the operation (left), after the operation (right). From the site: youthfullook.com
According to the WHO (World Health Organization), varicose veins (or varices) are abnormal and saccular dilations of the veins, especially those of the lower limbs, which often take on a tortuous course.
TELEANGECTASIE
Telangiectasias are harmless dilations of small blood vessels (such as venules, capillaries and arterioles), visible on the skin surface. Similar to sinuous arborescences or to the webs of a spider (in English they are called, in fact, "spider veins" that is spider veins), they have a reddish-blue color and are often the result of an inflammatory process concerning the skin.
HEMORRHOIDS
In human anatomy, the term hemorrhoids indicates soft and highly vascularized cushions located in the terminal part of the rectum (which is the last section of the intestine, before the anus).
In medical jargon, the term hemorrhoid also refers to a downward and outward sagging of the rectal mucosal tract (ie, the rectum) in which the hemorrhoids reside.
Risks
Sclerotherapy is a fairly safe procedure.
However, in some cases, it can involve complications of a different nature and of varying severity. In fact, it can cause temporary problems, which are resolved within a few days / weeks, and potentially very dangerous problems, which require adequate medical intervention.
Temporary adverse effects
- Bruises
- Red and raised areas of skin
- Minor skin irritations
- Dark spots or lines on the skin
- Skin covered with tiny bright red blood vessels
POTENTIALLY DANGEROUS ADVERSE EFFECTS of sclerotherapy
Although less frequently, sclerotherapy could cause adverse effects of moderate severity and requiring appropriate treatment.
These adverse effects are:
- Processes of an inflammatory nature at the injection site. The area affected by the inflammation may be swollen, painful and hot. In these cases, the doctor usually prescribes anti-inflammatory drugs (NSAIDs) and antibiotics against bacterial infections.
- Blood clots. A blood clot that forms inside a blood vessel can obstruct the passage of blood, compromising proper blood flow to the tissues. The clots that can form after an injection of sclerosing solution can move from the injection site and invade deeper blood vessels, causing a very dangerous phenomenon known as deep vein thrombosis.
Symptoms of pulmonary embolism:
- Breathing difficulties (dyspnoea)
- Chest pain
- Dizziness
- Hemoptysis (coughing up blood)
- Air bubbles in the blood. They can be asymptomatic (meaning no obvious symptoms) or cause visual problems, headaches, coughs and nausea. If, after a sclerosing injection, you feel such sensations, it is best to contact your doctor.
- Allergic reactions to the sclerosing reaction.
Preparation
To understand if sclerotherapy is a viable treatment, the treating physician must subject the patient to a thorough physical examination, also investigating the clinical history, both recent and past.
Once the suitability for sclerotherapy has been ascertained, it is advisable for the patient, in the 24 hours prior to treatment, to avoid shaving or applying creams to the areas that will then be treated with the sclerosing solution.
OBJECTIVE EXAMINATION
During the physical examination, the doctor assesses the patient's general state of health and externally analyzes any veins to be treated.
CLINICAL HISTORY
When evaluating the medical history, doctors investigate whether the patient:
- He has recently suffered from some pathology; it is of particular importance to communicate to the doctor any cardiovascular and / or haematic pathologies (ie concerning the blood).
- He regularly takes antiplatelet drugs (aspirin and derivatives), anticoagulants (which thin the blood) or oral contraceptives (which have an opposite effect to anticoagulants and promote the formation of blood clots).
- He is allergic to some substance.
- Smoke, because smoking promotes blood clots.
- He has previously undergone treatments for varicose veins.
All treatments based on antiplatelet and anticoagulants must be interrupted a few weeks before starting sclerotherapy; otherwise, there is a risk that the injections will cause severe bleeding.
Procedure
The sclerotherapy sessions usually take place in the doctor's office and do not require any type of anesthesia.
Usually, a session lasts less than one "hour: for injections, it takes 10-15 minutes at most; for the post-injection phase, it takes at least 15-20 minutes.
HOW DO THE INJECTIONS TAKE PLACE?
Shortly before injecting the sclerosing solution, the doctor places the patient on a bed and thoroughly cleanses the area of skin to be treated with alcohol.
The injections are done with a very fine needle, ideal for any type of blood vessel, even the smallest.
The sclerosing solution - usually composed of polydocanolic alcohol, sodium tetradecylsulfate, sodium salicylate and chromated glycerin - works by closing the malformed vessel and causing first its collapse and then its disappearance. The blood circulation is not affected by these changes, because the blood takes an alternative route and continues to perform its normal functions.
At the end of the injection, to allow a better diffusion of the sclerosing solution, the doctor gently compresses and massages the entire affected area.
The number of injections depends on the number of malformed veins and their size: therefore, the larger the blood vessel or the area to be treated, the more injections will be.
The liquid and foamy sclerosing solution
The sclerosing solution can come in both liquid and foam form. The foamy preparation is very effective, especially for large venous vessels.
WHAT DO YOU FEEL DURING THE INJECTION?
The injections may cause pain or brief spasms. If the intensity of these complaints is high, it must be reported to the doctor who is performing the treatment, as it could mean that the sclerosing solution has been applied incorrectly.
AFTER THE INJECTION
At the end of the compression and massage phases, the patient is monitored for 15-20 minutes to see how he responds to the treatment. After that, he can go home.
For at least two to three weeks, your doctor recommends avoiding excessive exposure to the sun's rays, as it could lead to dark spots on the skin.
If the sclerotherapy was performed on varicose veins present on the legs
After 15-20 minutes of monitoring, it is good to walk and move the legs for several minutes, in order to prevent blood clots from forming inside the venous vessels.
In addition, for about three weeks, compression bandages or elastic stockings should be applied to maximize the results of the injections. The return to normal daily activities is immediate: it is only advisable not to drive immediately after the session and to avoid excessive effort for one or two weeks.
Results
On small blood vessels, the results of sclerotherapy are noticeable after 3-6 weeks; on large pots, on the other hand, they can only be seen after 3-4 months.
In any case, after 30 days from the session, a follow-up visit is required to evaluate the response to the therapy.
In some cases, it is possible to have to repeat the treatment: in such situations, it is necessary to allow 4-6 weeks to pass between one session and the next.
Compared to surgery for varicose veins, sclerotherapy is certainly less invasive, however further studies are needed to evaluate its long-term effects.
