Sclerotherapy of the lower limbs today: from spider veins to varicose veins

Today, sclerotherapy for venous disease of the lower limbs is confirmed, both in aesthetic and therapeutic contexts, as a safe technique with low complication rates and excellent results. As with all procedures, however, a proper initial assessment is essential: a color Doppler ultrasound study, including infrared and hemodynamic evaluation, is indispensable before treatment, after which the right strategy must be set in terms of number of sessions, drug concentration, and quantity.

What sclerotherapy involves

Sclerotherapy is an intravenous injection of a medication designed to trigger an inflammatory reaction and induce the progressive obliteration, or closure, of the treated vessel. This method, first used in Switzerland in 1682, has evolved considerably over time: the discovery of sclerosing foam — a liquid mixed with air — revolutionized the treatment of veins in the lower limbs. Today the technique has been refined further, reducing complications such as chemical phlebitis, a hard, painful, dark cord left on the vein by an excessive quantity or concentration of medication.

Patients’ most common concerns

Patients often ask whether closing off one vessel causes others to appear: this can happen if the wrong vessel is treated or if concentrations are incorrect. The concentration and quantity of medication are, in fact, essential factors. It’s possible to choose to fully close a vein using high concentrations (occlusive sclerotherapy, for varicose veins) or to reduce its caliber using low concentrations (functional sclerotherapy, for spider veins). The method can thus be applied to all diseased veins: from spider veins, with the aid of special infrared lighting, to varicose veins, under ultrasound guidance (echosclerotherapy).

How the treatment is performed

The treatment, recommended and planned by the specialist following a color Doppler ultrasound evaluation, is performed on an outpatient basis and involves no functional limitations: once the procedure is finished, the patient can immediately return to their usual activities. Afterward, wearing a compression stocking is advisable, in order to optimize the medication’s adherence to the vessel walls. Depending on severity, the treatment is repeated with sessions spaced about a month apart.

In conclusion, modern sclerotherapy is effective and well tolerated precisely because it is preceded by a thorough assessment. Relying on a specialist and a color Doppler ultrasound remains the first step in choosing the right strategy for each vein.