WHAT IS INJECTED?
At each treatment multiple veins will be injected with a small amount of the sclerosant and then cotton balls will be placed over each injection site and taped in place. This provides immediate compression over the site. You will then remain with your legs elevated for 10-15 minutes after the treatment is done.
We will then help you put on compression hose. We sell these hose at the office but it is best to get them before your treatment to make sure we have your size. These hose can be used for multiple treatments. You must walk for about 10-15 minutes with the hose on before getting in your car. You will take off the cotton balls that evening before getting into bed. You should wear the hose for at least one week after treatment as this increases the success-rate and prevents bruising and pigmentation after treatment.
WHAT IS INJECTED?
Sclerosants I use are Sotradecol and saline. Sotradecol is FDA approved for sclerotherapy and is very effective and painless. There is a small chance of having an allergy to Sotradecol especially in people who have a history of asthma. Saline on the other hand does cause a burning or cramping sensation when injected which some people find very uncomfortable.
It is not FDA approved for sclerotherapy but is approved for other medical uses. Since saline is merely salt water and no company could claim a patent it is unlikely that anyone will undergo the cumbersome and expensive process for an FDA approval of saline for sclerotherapy. It has been used in Europe, Canada, and the USA for years with good results and minimal side effects. It you have a history of asthma it may be necessary to use saline.
HOW MANY INJECTIONS PER TREATMENTS ARE DONE?
The number of injections per treatment vary with the stage of treatment. At first it is best to make a limited number of injections to determine your response to the medication and treat the major leaky points first.
Later the number of injections is limited only by the maximum acceptable amount of the medication that can be used at any one session, or the allotted time has passed. We schedule 20minute treatments so it is very important to arrive on time so we can start at the time of your appointment.
HOW MANY TREATMENTS WILL YOU NEED?
YOU SHOULD EXPECT TO NEED AT LEAST 2-4 TREATMENTS FOR SUCCESSFUL TREATMENT OF LEG VEINS. These can be done every 4 weeks-6 weeks. I do not treat sooner than every 4-6 weeks as the vein is still undergoing changes form the previous treatment. I start with a weaker concentration of solution and increase the strength based on response.
The best results require patience. It is better to start with a concentration too weak than too strong or you may get small ulcers over the treated vein, pigmentation at the treated site, or more spider veins develop in the treated site due to too much inflammation from the sclerosant.
It seems spider veins are so small that they should respond quickly but these are often the most difficult to treat. Because they have such a small diameter they are under a lot of pressure and do not want to stay closed after treatment. This is especially true of spider veins in the outer thigh.
WILL YOU NEED MORE TREATMENTS AT A LATER DATE?
VARICOSE VEINS INCLUDING SPIDER VEINS ARE A CHRONIC PROBLEM. You developed these because of certain risk factors such as heredity discussed in the first paragraph. Veins can be successfully treated with the measures discussed above but because these factors are still in place you can get more veins even at the site of those previously treated.
Therefore, it is not uncommon that you may need further sclerotherapy even after successful treatment. However, with treatment of existing varicose veins we will not only address that vein but also tend to slow down the formation of other varicose veins. By following the guidelines in conservative measures you can further slow this process.
WHO CANNOT HAVE SCLEROTHERAPY?
Sclerotherapy is contraindicated in those that are bedridden, febrile, pregnant or nursing, have serious health problems, has a deep vein blood clot in evolution, has severe deep venous disease or has a condition which makes them high risk for blood clots.
WILL INSURANCE COVER SCLEROTHERAPY?
Unfortunately most insurance carriers consider the treatment of varicose veins as either cosmetic or not medically necessary. From experience we know that they never pay for spider veins even it they are symptomatic. If you are told on the phone, by an insurance representative, that sclerotherapy is covered note that they often qualify by saying if medically necessary.
Medical necessity is not determined by the doctor evaluating you but by the insurance company. Furthermore it wont be determined until after the treatment has been done. Often, multiple treatments are done before they deny payment because it is not deemed medically necessary by their medical director. Because of the high rate of denials, the amount of time it takes us to deal with insurance carriers, and the low success rate in getting payment once the procedure is done, it is our policy that sclerotherapy must be paid for at the time of treatment.