Injection Sclerotherapy Overview
Veins are tubular structures that serve as conduits to transport blood. Veins range in size from tiny to small to large. Injection sclerotherapy refers to the injection of a chemical solution (sclerosant drug) into a problematic vein using a tiny needle to seal it shut and gradually dissolve it over time. An injection sclerotherapy treatment session is performed in-office and takes about 30 minutes to perform. Multiple sessions are often needed at 2-to-6 month intervals to achieve maximal and noticeable results, depending on their severity and responsiveness to sclerotherapy treatment.
At Hogue Vein Institute, our vein specialists use the FDA-cleared liquid sclerosant, Asclera®, also known as Polidocanol. Polidocanol allows for a comfortable injection experience since it has local anesthetic properties. Injection sclerotherapy has been used for over 150 years to treat veins ranging in size from tiny to small to large diameter, including spider veins, reticular veins, and varicose veins.
Injection Sclerotherapy Methods
Sclerotherapy is a procedure that is technically challenging to perform and is best performed by a skilled vein specialist. Determining what veins to treat and what veins not to treat is based on experience, expertise, and the ability of the vein specialist to correctly interpret and treat the patient’s problematic vein pattern.
For treatment of unwanted spider veins, a fiberoptic transilluminating device is used to allow direct visualization of the unwanted surface veins while targeting and injecting them. This type of injection sclerotherapy is called Visual Sclerotherapy (VS).
For treatment of non-visible, more deeply situated veins within the fat space between the skin and the underlying muscle layer, ultrasound guidance is used to guide the tiny needle into the lumen of the varicose veins while targeting and injecting them. This type of injection sclerotherapy is called Ultrasound-Guided Sclerotherapy (UGS).
Insurance Coverage for Sclerotherapy
Sclerotherapy can be done for therapeutic (medical) reasons, or for elective (cosmetic) reasons, or for both. If done for medical reasons, the therapeutic vein treatment is done to improve symptoms including pain, burning, itching, aching, cramping, tenderness, heaviness, restlessness, swelling, and edema. Private insurance and Medicare may provide coverage benefits for a sclerotherapy procedure when done for medical reasons, provided that coverage criteria and necessary documentation of the medical condition are met in accordance with the Summary Plan Document.
Injection sclerotherapy can be done for elective (cosmetic) reasons to improve the quality or appearance of the legs. Since sclerotherapy done primarily for cosmetic reasons is not a therapeutic vein treatment, no insurance coverage or benefits exist. Payment for elective (cosmetic) injection sclerotherapy is required at time of service.
Ideal Candidates for Injection Sclerotherapy
Injection sclerotherapy is used to treat spider veins, reticular veins, and varicose veins, and may be combined with other techniques such as endovenous laser ablation (EVLA) or ambulatory phlebotomy (AP). Vein specialists at Hogue Vein Institute evaluate each individual patient to determine the best treatment strategy.
Leg vein conditions treatable with Sclerotherapy include:
- Varicose veins
- Collateral branches of varicose veins
- Reticular veins
- Spider veins
Recovery after Injection Sclerotherapy
Injection Sclerotherapy treatments provide for a quick recovery with no downtime. Complications are minimal in the hands of an experienced vein specialist. Temporary bruising may occur. Following a sclerotherapy treatment session, patients are encouraged to wear compression stockings for one week. Avoidance of hot bath, hot tubs, heavy lifting, and long travel is instructed for one week following treatment. Daily walking to promote healthy blood flow in the legs is highly encouraged.