Sclerotherapy: Introduction to Solutions
and Techniques
Charles L. Dietzek, DO, FACOS

Perspectives in
Vascular Surgery and
Endovascular Therapy
Volume 19 Number 3
September 2007 317-324
© 2007 Sage Publications
10.1177/1531003507305884
http://pvs.sagepub.com
hosted at
http://online.sagepub.com

Over the past decade, there has been a renewed interest
in venous disease by the vascular community. This is
predominantly because of new advances in endovenous
treatment and practice economics. To broaden the services provided, vascular surgeons want to learn about
sclerotherapy. Most commonly used for cosmetic concerns, it also plays a role in the broad spectrum of venous
pathology treatment. The supplies and equipment

needed with an overview of available sclerosants are discussed. Basic techniques and compression therapy are
reviewed. This article will serve as a basic primer for successfully adding sclerotherapy to your practice.

S

sclerotherapy for saphenous reflux with junctional
incompetence has been varied.9-11 Presently there is
no consensus in the medical literature supporting
direct sclerosant injection into the greater saphenous vein as effective treatment.

clerotherapy has been performed for decades to
successfully treat spider and varicose veins.
Although the Food and Drug Administration
(FDA)-approved sclerosants are limited in the United
States compared with European countries, the outcomes still remain excellent. The goal of sclerotherapy
is to cause endothelial and vein wall damage in a controlled fashion. The result is removal of abnormal vessels that carry retrograde flow without damaging
adjacent vessels that carry normal antegrade flow. The
sclerosant effect results in a fibrous cord that is
absorbed over time. The visual attributes of these veins
fade often over months, enhancing cosmetic appearance and potential improvement in leg symptoms.
Sclerotherapy has been used to treat all types
and sizes of varicosities. This therapy is considered
the gold standard treatment for leg telangiectasi; as,
venulectasias, and reticular veins.1-4 Sclerotherapy has
been used for large varicosities as well as direct injection into the saphenous vein at the saphenofemoral
junction. For large varicosities, microphlebectomy
results in less frequent complications particularly
hyperpigmentation and blood trapping. Immediate
direct compression and duration of graduated compression therapy for 3 weeks or more are possible
variables of more importance for good results in
these larger vessels.5-8 The treatment outcome for

From Vein & Vascular Institute, Voorhees, New Jersey.
Address correspondence to: Charles L. Dietzek, DO, FACOS,
Vein & Vascular Institute, 1000 White Horse Road, Voorhees,
NJ 08043; e-mail: cdietzek@comcast.net.

Keywords: sclerotherapy; sclerosants; endovenous
treatment, vein injection, spider veins, varicose veins,
phlebology

Getting Started
In starting a sclerotherapy practice, a basic list
of supplies includes the following:
•
•
•
•
•
•
•
•
•
•

Alcohol for leg prep with nonsterile 4 × 4s
Protective gloves—latex free
1-mL and 3-mL syringes for sclerosant
3-way stopcock to create foam
3-mL and 10-mL syringes for foam creation
25G, 27G, 30G, and 32G (G = gauge) disposable
needles
Multiple types of sclerosants
± Compression-foam pads, cotton balls, dental roll
Coban or Medirip short stretch leg wrap
Compression stockings
 Class I (20-30 mm Hg) for spider and reticular
veins
 Class II (30-40 mm Hg) for varicose veins

The workhorse needle for the phlebologist is the
30 G ½ inch needle. This can be used for all vessel
types but most commonly for reticulars, venulectasias,
and telangiectasias. For superficial visible varicosities, a 27G or 30G ½ inch needle is recommended.
If delivering foam, the 27G needle allows for quicker
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Perspectives in Vascular Surgery and Endovascular Therapy / Vol. 19, No. 3, September 2007

instillation of larger foam volumes in veins of this size.
In performing ultrasound-guided sclerotherapy, the
25G needle is advantageous for its length of 1½ inches.
With fine hair-like telangiectasias, matting or marked
skin sensitivity a 32G ½ inch gauge needle is beneficial
to cannulate these small vessels and decrease pain.
Additional equipment recommended but not
needed to get started includes a hydraulic treatment
table. This allows for optimal practitioner comfort
particularly when performing multiple sclerotherapy
sessions. I prefer standing and raising the table height
to avoid back strain. A worthwhile table option is the
ability to place a patient in Trendelenberg. Vein emptying is enhanced in this position, which decreases
sclerosant dilution by blood. In Trendelenberg, the air
composition of foam will potentially result in caudal
distribution of the sclerosant thus delayed emptying
and increased vein wall contact time. This expensive
piece of equipment can be easily justified when used
for other vein procedures—office microphlebectomy
and endovenous ablation.
An equipment recommendation to enhance
visualization of the venous network is the Veinlite or
Syris polarizing headlamp. These pieces of equipment
allow subdermal vein visualization. With the Veinlite,
a fiberoptic ring transilluminator beams a circumferential glow through the skin allowing visualization of
the reticular pattern and feeding veins to telangiectatic clusters. These veins often are not readily visible with the naked eye. It is an excellent tool to allow
for accurate needle entry into veins of this size minimizing potential complications of extravasation. It is
also beneficial to demonstrate these veins to patients,
providing a better understanding of the treatment
plan of sclerosing larger feeding vessels first prior to
the more obvious and cosmetically displeasing telangiectasias and venulectasias. The Veinlite can additionally add accuracy allowing placement of small
incisions for microphlebectomy. In supine positioning
varicosities will be smaller and frequently shift in
location. This can render the outline markings made
during standing often inaccurate. Using the Veinlite
while supine prior to surgery allows the varicose vein
markings and incisions to be more accurate. This can
decrease procedural time, which additionally justifies
the cost of this piece of equipment.
The Syris glasses worn like a headlamp allow visualization approximately 1 mm below the skin’s surface.
This combines optical filters with cross-polarization
technology and magnifying lenses. It allows visualization of the reticular network without having to hold
a light source thereby allowing use of both hands.

Sclerotherapy Solutions
The ideal sclerosant unfortunately does not exist. The
available agents fall into three major categories—
hyperosmolar, detergent, and chemical. Probably
the best-known sclerosant in the United States is
hypertonic saline—sodium chloride 23.4%. This is
of the hyperosmolar class. Hyperosmolar solutions
are nonspecific in cellular destruction affecting
endothelial cells as well as red blood cells through
dehydration. Frequently patients will ask for “saline
injections,” which has become synonymous with
injection sclerotherapy. It is probably the agent that
has created more negative connotations associated
with sclerotherapy because of its burning, stinging,
and cramping pain on injection plus the potential
for ulceration with extravasation. Although an FDAapproved drug, its use is off label for sclerotherapy.
The drug is readily available, lacks allergenicity, and
is inexpensive. In treating telangiectasias it can be
diluted in half to 11.7% to minimize injection complications. For reticular veins it is used at full
strength. The drug is rapidly diluted on injection,
which means injections should be made at close
intervals to assure effective treatment. The rapid
dilution of this agent prevents effective treatment of
larger veins beyond 3 to 4 mm in diameter.
Hypertonic saline can be mixed with 1% lidocaine to
minimize pain on injection.
Sclerodex, another hyperosmolar sclerosant, is
produced in Canada by Omega Laboratories. It is a
combination of 250 mg/mL glucose, 100 mg/mL
saline, 100 mg/mL propylene glycol, and 8 mg/mL of
phenethyl alcohol. It is essentially a 10% saline solution with the addition of 25% dextrose. In the United
States it can be obtained through compounding pharmacies. This sclerosant is not approved by the FDA.
Sclerodex has a low allergenicity and, like hypertonic
saline, works within minutes on the endothelial vein
surface. There is lower potential for hyperpigmentation from hemolyis, skin necrosis, and ulceration
because of the lower saline concentration. There can
be mild pain on injection, similar to 11.7% hypertonic
saline attributed to the reduced salt concentration.
Sclerodex is best used for small vessels like telangiectasias, venulectasias, and for matting.
Detergent solutions are the most versatile
and effective sclerosants available with a capacity
to treat all vein sizes. Their intravascular action
causes cell surface membrane disruption and extraction of cell surface proteins within seconds and its
effect continues on for minutes to hours. Unique to

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this class of drugs is its micellular concentration,
which can be enhanced with foaming. This foaming
nature of detergent sclerosants results in potentially
equal efficacy at lower concentrations. The bestknown detergent solutions worldwide are polidocanol (Aethoxysklerol) and sodium tetradecyl sulfate
(STS). Both are long-chain fatty acids.
Sodium tetradecyl sulfate is approved by the FDA
for sclerotherapy and manufactured by Bioniche
Pharmaceuticals, Ltd. Polidocanol, although probably the most commonly used sclerosant in the world,
is not approved by the FDA and until recently was
obtained in the United States only through compound pharmacies. With the threat of a “warning letter” from the FDA, this has caused most large
compounding companies to halt production. At this
time it is difficult to obtain polidocanol in the United
States. Sodium morrhuate and ethanolamine oleate,
although approved by the FDA have a safety profile
and allergenicity not suitable for treatment of leg
veins and therefore not reviewed in this article.
The advantages of STS and polidocanol detergent sclerosants are the absence of pain with
intravascular injection and a very low incidence of
allergic reactions. There is also no hemolysis as a
direct effect of the drug and therefore the potential
for less hyperpigmentation.12
The main disadvantage of STS is extravasation
necrosis and ulceration. This, however, typically does
not occur with low concentrations, 0.1% to 0.5% STS,
used for telangiectasias and venulectasias. Polidocanol
rarely will cause skin necrosis with intradermal injection. With detergents and hypertonic saline, if there is
extravasation or if a skin bleb is created, injection
should be halted and the area vigorously massaged to
dissipate the solution and help resolve any vasospasm.
If full strength hypertonic saline, 23.4% or STS 3% is
extravasated, hyaluuronidase, 75 units in 3 mL can be
injected into the affected area to decrease the likelihood and possible size of ulceration.13,14 Because STS
is the only detergent class FDA-approved sclerosant in
the United States, it is unfortunately affected by market forces and is expensive.
Chemical sclerosants have a direct corrosive
effect, which disrupts the intercellular cement and
poisons cell surface proteins and affects chemical
bonds immediately on vein wall exposure. The most
common sclerosant used worldwide for telangiectasias is a Chemical class sclerosant called chromated glycerin with trade names Sklermo or
Chromex. This agent is not approved by the FDA and

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is not commonly used in the United States. Reports,
however, have surfaced regarding the efficacy of 72%
glycerin which is an off-label FDA-approved drug.
This agent is not commercially produced but can be
obtained through compounding pharmacies. It is
mixed with lidocaine with epinephrine, 1:10 000 in a
2:1 ratio with a resultant concentration of 48% glycerin. The lidocaine minimizes pain with injection and
decreases viscosity. The epinephrine helps with vessel constriction producing longer dwell times and
helps with its chemical corrosive effect. Typically,
tuberculin syringes are used for injection because of
its viscosity. Injection should be slow to minimize
injection pain and prevention of potential arteriolar
crossover from high pressures delivered using tuberculin syringes. Slow injection is the rule for all sclerosants to minimize this side effect and the potential
for vein matting. In a small study of 13 patients by
Leach and Goldman,15 the efficacy of 72% glycerin,
diluted with lidocaine to 48%, was equal to STS for
veins 0.2 to 0.4 mm in diameter with less hyperpigmentation and quicker vessel clearance.
The initial concentration for different vein diameters treated with the common sclerosants is outlined in Table 1. The sclerotherapist should be
familiar with more than one agent and the appropriate concentrations for different size veins. A few
vials of various solutions should be on hand particularly in cases of suspected allergenicity. The acquisition of different concentrated sclerosants can yield
large volumes in the concentrations used for the
most common types of veins for injection. Therefore
it is not overly expensive to maintain a small supply
of multiple types. Dilution tables should be readily
available for the staff to avoid the potential for mistakes in formulation. An easy formula to develop a
dilution chart for the various concentrations is
(X mL) (stock solution %) =
(desired total volume in mL) (desired concentration %)
Solve for X mL

This X volume is added to a volume of normal
saline or sterile water to reach the desired total volume. This equation can be used to make the solution
per syringe (3 mL and 10 mL) or in vials (10 mL and
30 mL) from which the solution can be aspirated.
Patients are provided a rather lengthy and
detailed consent form outlining sclerotherapy, the
different solutions used and their FDA clearance.
Potential complications of sclerotherapy are listed of

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Perspectives in Vascular Surgery and Endovascular Therapy / Vol. 19, No. 3, September 2007

which hyperpigmentation is noted as the most common, regardless of solution used. It is important to
set realistic expectations for our patients, particularly when you are talking about a cosmetic procedure. Typically 10% to 30% of patients will have
some level of staining from sclerotherapy.16 It is
more common in reticular size veins and larger vessels and in patients with dark complexions. Of that
population in which it occurs, only 10% will last 6 to
12 months. Approximately 1% of patients will experience permanent hyperpigmentation.17 In these
cases bleaching agents, Retin A, or a combination
topical cream, Tri-Luma have been recommended.
Intense pulsed light or laser treatment may also be
of benefit.18 Anecdotally, I have found in some
patients it is helpful to scratch the underside of the
hyperpigmented dermis with a 18G or 22G needle
after the area is anesthetized with 1% lidocaine. The
resultant trauma theoretically enhances phagocytosis and removal of hemosiderin staining.
With detergent solutions it is often thought
hyperpigmentation is less common with polidocanol
than with STS. This, however, was refuted in a doubleblind prospective trial between the 2 agents in 2005.
Rao et al19 reported there was no statistically significant difference in incidence of efficacy, hyperpigmentation, and posttreatment sequelae between
these 2 sclerosing agents, liquid or foamed.19
Trapped coagula is probably the second most
common side effect of sclerotherapy. These areas
may be sore because of vessel distention. Initially
these are best treated with a heating pad and nonsteroidal anti-inflammatory drugs. The trapped blood
is drained using a 22G needle 3 to 4 weeks from the
session. Earlier attempts at removing the collection
will often have a low yield since the blood is organized thrombus. Other potential complications of
sclerotherapy include swelling (particularly with foot
and ankle region therapy), telangiectatic matting,
nerve damage, painless infarction with arteriolar
injection, phlebitis, and rarely deep vein thrombosis/
pulmonary embolism.

Techniques
In my practice a sclerotherapy session is blocked
for 20 minutes with 15 minutes spent actively injecting. This allows for maintaining a smooth schedule
that is difficult to keep if the sessions are based on
volume or area to be treated. After the patient

Table 1.

Common Initial Concentrations

Vessel Diameter
Less than 1 mm

1–3 mm

4–6 mm
Branch varicosities

Sclerosant Concentration
Hypertonic saline 11.7%
STS 0.1% to 0.3%
POL 0.3% to 0.5%
Glycerin 72% / lidocaine-epinephrine
Sclerodex
Hypertonic saline 23.4%
STS 0.5% to 1.0%
POL 1% to 2%
STS 1% to 2%
POL 2% to 3%
STS 2% to 3%
POL 3% to 5%

Note: POL, polidocanol; STS, sodium tetradecyl sulfate.

reviews areas of concern with me, he or she is placed
on the treatment table supine/prone or on the side
where the nurse preps the leg with alcohol-soaked
nonsterile gauze. The hydraulic table is elevated,
and it is placed in slight Trendelenberg position.
This allows me to stand during the session without
excessive bending or twisting. Using 2.5 magnification surgical telescopes and a Veinlite, the reticular
and small varicose veins are readily visualized and
addressed first. These veins are tracked with the
Veinlite to their most distal leg point where injection
is started. The vein is then followed and injected in
various distance intervals based on vein size, solution type, and whether liquid or foam is instilled.
Following treatment of all larger vessels in that particular leg position, supine, side, etc, injection of the
smaller veins in that region is undertaken. In this
systematic approach large areas can be treated
quickly. The dry skin in the treatment area is wiped
with the alcohol-soaked gauze making the skin
more transparent and the superficial small veins
more noticeable. Indirect lighting also adds to vessel visualization. In patients with skin laxity, the
assistant will stretch the skin, which will allow easier vessel cannulation. This is particularly true
around the knee.
My preferred solution choices have varied through
the years based on availability, FDA approval, and
the ability to foam the solution. Within the past year
I have switched over to glycerin for all spider veins.
The patients and I have noted faster vessel clearing.
There still is the potential for hyperpigmentation,
although the possibility is lessened. I reserve detergent sclerosants for reticular and varicose veins less

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Table 2.

Maximum Doses per Session

Polidocanol
STS
HS
Sclerodex
Glycerin 72% with lidocaine
(final concentration glycerin 48%)

12 mL of 1%
10 mL of 3%
8 mL of 23.4%
10 mL
15 mL plus

Note: STS, sodium tetradecyl sulfate; HS, hypertonic saline.

than 4 mm in diameter. For veins larger than 4 mm,
I prefer microphlebectomy. For years I used polidocanol manufactured from various US compounding
pharmacies. I recently switched to STS with the lack
of polidocanol availability in this country. I have not
noticed any significant treatment outcome and side
effect differences using approximately half the concentration of STS compared with polidocanol. The
maximum volumes for each sclerosant at a certain
concentration during one treatment session are
listed in Table 2.
To have sclerotherapy treatment success the
sources of reflux are treated first. If there is reflux in
the greater or small saphenous system, these veins
are treated with endovenous ablation prior to undertaking sclerotherapy. This obviously does not preclude proceeding with treatment of the contralateral
extremity if there is no major source for reflux present in that leg. Although treatment of axial reflux
first may seem obvious, I have seen numerous
patients present to our practice with poor treatment
outcomes when this basic tenant is not followed.
One should not treat visible varicosities without
dealing with their etiology for best long-term results.
Untreated reflux can be the obvious cause for recurrent varicosities, persistent symptoms, and poor
patient satisfaction. Patients with visible varicosities, in our practice, are first evaluated with Duplex
imaging in the standing position to assess for deep,
superficial, or perforator vein insufficiency.
When starting treatment a basic rule for injection sclerotherapy is treat larger veins first before
cutaneous veins. Injection with liquid sclerosant
should proceed from proximal leg veins and progress
distally. The reverse pattern, distal to proximal, is
recommended with foam therapy. This change in
sclerotherapy technique is because of vasospasm
created with foam. The more distal veins subsequently will not be visualized if one starts proximally
and hence require treatment at a later date when
visible. With liquid sclerosant it is recommended not

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to exceed 0.5 to 1.0 mL at any one injection point
and to advance 3 to 4 cm. Foamed sclerotherapy
allows for instillation of larger volumes at one site
and a longer injection interval, which can be 8 cm or
longer. The increased foam volume injected at one
site can be tracked with the Veinlite or ultrasound.
The foam or liquid sclerosant can be massaged in
various directions to get a more widespread effect.
When using foam sclerotherapy there is a longer
dwell time resulting in extended contact period with
the vessel wall. The foam displaces blood from the
vein creating an air block. This prevents rapid dilution and mixing with blood. Lower concentrations of
sclerosants can be used to achieve the same results
in light of these attributes. It is reported by the
American Society of Dermatologic Surgery in their
technology report “The advantage of a foam is that
the sclerosing power of the solution is increased
2-fold to 3-fold, while decreasing the toxicity four
fold.” In addition, the use of lower detergent concentrations minimizes the complication risks with
extravasation.20
Foam is created with a 2-way or 3-way stopcock,
2 syringes, one loaded with a volume of room air and
the other with a volume of detergent sclerosant,
polidocanol or STS. The air solution mix is passed
quickly 10 to 20 times between the two syringes,
which allows for rapid agitation and foam creation.21
During this process the aperture of the 3-way stopcock can be made smaller if rotated off center creating a thicker, longer lasting foamed state. Typically
foam lasts 60 to 120 seconds before it breaks down.
As the foam dissipates in the injecting syringe it can
be recreated in the same fashion as outlined above.
Typical ratios described of air to sclerosant are 3:1 to
5:1.22 Foam can be used for spider veins, but there
can be excessive inflammation with treatment of
vessels of this size. Foam is more commonly used for
reticular size and larger veins. Ultrasound-guided
foam sclerotherapy is an effective treatment adjunct
for nonvisible subcutaneous varicosities and perforator veins. The acoustic shadowing of the foam
injected will be readily appreciated on ultrasound
imaging. The foam air/sclerosant mix can be tracked
to determine which veins have not had exposure and
require additional foam to be injected.
A rare complication of foam sclerotherapy is the
appearance of neurologic symptoms. A large registry
report of 6395 sessions of foam sclerotherapy from
Europe revealed an extremely low risk of complication, 0.4%. There was a rare transient neurologic

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sequelae using foam because of crossover through a
patent foramen ovale (PFO). The most common
neurologic side effect was temporary visual disturbance and headache.23 There has been one report in
the literature of a permanent neurologic deficit with
foam injection. This was reported from Ireland
where the greater saphenous vein under ultrasound
guidance was directly injected with 20 mL of foam.
The patient subsequently was confirmed to have a
PFO.24 With the option of endovenous ablation for
greater saphenous reflux, this treatment complication would have been avoided.
There still remains a lack of data supporting
optimum air/sclerosant ratios and the safe volume of
air that can be injected during one treatment session. The European Consensus Meeting in 2003
provides some guidelines for foam sclerotherapy.25
Still there remain many areas without specific guidance and hence the “art” of sclerotherapy.
My preference is not to exceed a total volume of
8 mL of air. This is used to create 4:1 foam during a
session. I try to avoid injecting foam directly into the
greater or small saphenous vein via injection of varicosities that are adjacent to them. These truncal
varicose veins are usually larger than 4 mm, which I
prefer to remove with microphlebectomy. Using this
approach will help avoid the potential for a bolus
volume of air injected into the central venous system, which could result in crossover through a PFO.
In performing sclerotherapy there are two basic
methods of holding the syringe while injecting. The
plunger can be operated by the index finger or
thumb, which I prefer. Injections around the ankle,
foot, and the popliteal fossa are facilitated with
slight bending of the needle to achieve vessel entry.
With reticular and larger veins you should aspirate
to confirm access. The caveat is to minimize motion
of the syringe needle once you have entered the vein
to avoid extravasation. This may require a two-hand
technique of steadying the syringe with one hand
while aspirating and injecting with the other. If
using a Veinlite, an assistant will often be necessary.
Another technique is to use your fingers to pull and
push the plunger in a one-hand technique. You can
also obtain a thumb finger hole adapter that can
attach to the syringe allowing aspiration and injection with one hand smoothly.
Liquid and foam sclerosants are delivered using
a 3-mL syringe. Tuberculin syringes are used for
glycerin as noted previously because of its viscosity.
When injecting venulectasias, telangiectasias, or

areas of matting, aspiration is not necessary. Gentle
pressure is applied on the plunger while advancing
the needle. The volume of extravasated sclerosant is
minimal prior to vessel entry. Using dilute detergents and glycerin, extravasation necrosis and ulceration are extremely rare. On entering these small
vessels there will be blanching from the liquid or
foam at which point slightly more pressure is applied
to deliver the volume of sclerosant to fill the visualized vein. Do not be tempted to inject large volumes
at one site unless using foam that can be tracked.
Do not inject under pressure. This can rupture the
vein. It is also postulated matting may be secondary
to high pressure injections as well.
After injecting I no longer apply pressure to the
sites for spider or reticular veins. Cotton balls, dental roll, or foam sponges frequently get in the way of
injecting multiple other veins at the same location.
Vasospasm is created by the foam used in the reticulars and therefore not needed during the treatment
session. Direct compression after injection is reserved
for larger varicose veins.
Once the session is completed for the patient
where telangiectasias to reticular veins are treated,
the leg is compressed with a short stretch wrap of
Medirip or Coban, ankle to thigh, worn until the following morning. This is followed by thigh-high class
I compression stockings worn during the day for a
minimum of 3 days and preferably up to 3 weeks
during the day. The biggest impact stocking use has
is on decreasing hyperpigmentation and vessel clearing.26,27 In a controlled comparative study of duration of compression postsclerotherapy by Robert
Weiss, MD, “three weeks of continuous compression leads to the best results, although even 3 days
of compression results in greater improvement than
no compression” at all.28 When larger vessels are
treated, direct compression with foam, cotton balls,
or dental roll is applied with a short stretch compression wrap overnight. Following this, continuous
use of class II compression stockings is advised for
a minimum of 1 week, and preferably 3 weeks, for
achieving good results. Patients are advised to walk
daily to help decrease superficial vein hypertension.
Treadmill or elliptical use is allowed. Patients are
instructed to avoid all high-impact activities and
weight lifting for 1 week. Warm showers are allowed,
whereas hot baths avoided.
Patients are instructed to expect slow gradual
changes over a period of weeks to months. Prior to
treatment, a set of pictures are reviewed with the

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patient showing a treated leg over a year timeline.
The pictures shows areas of hyperpigmentation and
“trapped blood” vein segments to set realistic expectations. This education has resulted in a marked
decrease in patient concerns following treatment.
Patients are informed that retreatment of the same
area will not be entertained for a minimum of 3 to 4
weeks. This does not preclude treatment of other
ipsilateral leg areas or the contralateral extremity.
Patients are advised not to expect complete resolution with only one treatment of a particular vein
area. Like a facial skin blemish, elimination often
requires repeated application of medicine. This concept applies to vein therapy and is easily understood
by all patients. This foundation of realistic expectations and outcomes for this chronic condition avoids
numerous phone calls and the potential for dissatisfied patients with unrealistic goals.

Summary
Sclerotherapy remains the gold standard for leg vein
treatment. There is a relatively short treatment technique learning curve, and skill improves rapidly with
repetition. Using a Veinlite and outlined treatment
protocols increases treatment accuracy and outcomes. Although there are numerous sclerotherapy
agents in use worldwide, there are only a few available in the United States. Familiarity with these
sclerosants and the appropriate concentrations recommended for different size veins is essential.
Additionally, the use of compression gradient stockings will yield successful results with low incidence
of adverse effects.

References
1. Sadick NS. Advances in the treatment of varicose veins:
ambulatory phlebectomy, foam sclerotherapy, endovascular laser, and radiofrequency closure. Dermatol Clin.
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2. Goldman MP. Laser and sclerotherapy treatment of leg
veins: my perspective on treatment outcomes. Dermatol
Surg. 2002;28:969.
3. Weiss RA, Dover JS. Laser surgery of leg veins. Dermatol
Clin. 2002;20:19-36.
4. Eremia S, Li CY. Treatment of leg and face veins with a
cryogen spray variable pulse width 1064-nm Nd:YAG
laser—a prospective study of 47 patients. J Cosmet Laser
Ther. 2001;3:147-153.

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5. Goldman M, ed. Sclerotherapy: Treatment of Varicose
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Book; 1995.
6. Fegan WG. Continuing uninterrupted compression
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7. Hobbs JT. Surgery and sclerotherapy in the treatment o
varicose veins. Arch Surg. 1974;109:793-796.
8. Sladen JG. Compression sclerotherapy: preparation,
technique, complications, and results. Am J Surg.
1983;146:228-232.
9. Neglén P, Einarsson E, Eklöf B. The functional longterm value of different types of treatment for saphenous
vein incompetence. J Cardiovasc Surg. 1993;34:295-301.
10. Kanter A, Thibault P. Saphenofemoral incompetence
treated by ultrasound-guided sclerotherapy. Dermatol.
Surg. 1996;22:648-652.
11. Belcaro G, Nicolaides AN, Ricci A, et al. Endovascular
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