It is believed that obliteration of varicose veins was first used in the 19th century. It was not earlier than after 1920 when sclerotherapy began to be used as an alternative method for surgical treatment.  

 Sclerotherapy involves an injection of sclerosant, i.e. chemical agent, to the lumen of abnormal vein (or venous network) which irritates the vessel and leads to its fibrosis. Finally, the lumen of improperly working vein is closed. 

What should the patient know prior to the sclerotherapy? 

Having decided to undergo sclerotherapy, patient has to be aware of possibilities and limitations of this method as well as its inconveniences. Prior to the procedure, physician of our team presents all required information in this respect. Additionally, this information is specified in a systematized way in a special informative brochure combined with the informed consent for the procedure.   

Below there are the most important information which should be taken into account while deciding on compression sclerotherapy:

• sclerotherapy should always be preceded  by the Doppler ultrasound of veins of lower extremities.
• sclerotherapy is a safe procedure provided it would be carried out in patient who was properly qualified. There are certain contraindications for the procedure, thus, the physician needs to have all information on patient’s health. If patient intentionally would hide the information, then he/she could be exposed to serious danger. 
• in the majority of cases, microsclerotherapy (refers to the closure of spider veins and venulectasias) is performed without local anaesthesia as the anaesthesia itself is more painful than the procedure. 
• patient may feel a slight discomfort, e.g. pinching or burning at the site of agent administration during the procedure and following it and later painful reddening and thickening around closed veins. It is a typical reaction. If it causes substantial discomfort and it is prolonged, than it should be reported to the physician.
• following the procedure, patient should walk for at least 30-40 minutes. It is a very important element of antithrombotic prophylaxis. 
• just after the procedure, compression stocking is put on the patient’s leg that was processed, it should be worn during the day for 1-3 weeks, it can be removed only at nights. Wearing of compression stocking is a well-proven element increasing the effectiveness of treatment. 
• medical indications following sclerotherapy are aimed at ensuring a better effect and higher safety of the procedure, thus, they should not be modified on one’s own initiative. 
• certain sections on legs are more exposed to the occurrence of complications, thus, the physician performing the procedure should be well-experienced, e.g. removal of spider veins in the ankle area is very risky. 
• sclerotherapy allows for the treatment of various, even very advanced venous conditions, however, long-term effectiveness of such procedures is rather moderate and requires periodical supplementations. It is worth to consider and discuss with the physician the use of other more effective methods, e.g. sclerotherapy with the use of catheter, laser or adhesive – these are methods of the highest effectiveness on the market. 
• satisfactory effect of treatment is quite often reached after several series (2-5) of procedures performed usually at 2-5-week-intervals. Despite technical properties (adequate selection of agent, its concentration, technique and place of administration), unique features of patient are also important, especially lesion locations on legs, skin phototype or healing abilities.
• sclerotherapy of small veins (spider veins and venulectasias) are combined with the procedures using adequate percutanoues laser.
• sclerotherapy (especially microsclerotherapy) should be most optimally performed in colder period, when the temperature is below 20-25°C and we do not plan travels to hot countries within 2-4 weeks following the procedure.
• sclerotherapy may be used in other regions of the body (e.g. dorsal part of hands, intimate or breast area); it should not be forgotten than qualification to such procedures requires the performance of adequate imaging diagnostics (Doppler ultrasound, computed tomography or magnetic resonance imaging with an option of venous system imaging).
• in post-procedural period, patient has to be aware of the necessity of control visits which are placed on several to dozen of months. 

Despite the introduction of more technically advanced methods of treatment of venous conditions, sclerotherapy is still the most frequent examination in the modern phlebology. Its numerous advantages, i.e. minimal pain, quick recovery to mobility following the procedure, short duration, low risk of nerve branch damage, small number of bruising and low cost cause that it is always worth to consider this method and ask the physician about it. 

Can all venous lesions be treated with sclerotherapy?

Undoubtedly, sclerotherapy is the most universal method out of all treatment methods of venous insufficiency of lower extremities. We may apply it to the treatment of lesions of cosmetic character (spider veins or widened venulectasia) as well as insufficient major venous trunks. Twisted nature of treated varicose veins, hindering intravascular procedure, is not usually problematic in case of needle sclerotherapy.

Depending on the needs, i.e. type and size of treated veins, various options of compression sclerotherapy may be applied:  

• microsclerotherapy, a procedure on the smallest veins, i.e. spider veins, which is performed with ultrathin needles (the diameter of our needles is only 3-fold thicker compared to the diameter of human hair!!!)
• traditional injection sclerotherapy using liquid or foam (methods performed under the guidance of eyes or skin illuminator)
• injection sclerotherapy under the guidance of ultrasound, i.e. echosclerotherapy is used mainly in the treatment of major venous trunks 
• catheter tumescent-enhanced sclerotherapy is a variant of echosclerotherapy intended for the treatment of major venous trunks which due to their diameter cannot be treated with standard needle echosclerotherapy
• sclerotherapy using PHLEBOGRIFFE is the newest variant of  echosclerotherapy performed intravascularly using the system of catheters. We qualify it to mechanical and chemical obliteration. It allows for effective closure of major venous trunks after the inflammation experienced. 

All aforesaid methods are available in the offer of our Clinic of Phlebology. Our team organizes numerous trainings with Polish Society of Phlebology accreditation on the use of these methods in the treatment of venous insufficiency. As one of the few centers in Poland, we use sclerotherapy in the treatment of venous malformations and varicose veins in intimate area. 

It is worth to mention that sclerotherapy is an indispensible element of hybrid procedures. These are procedures consisting in simultaneous combining of the several methods of venous insufficiency treatment, e.g. glue treatment of varicose veins, compression sclerotherapy and miniphlebectomy.

What does mechanical and chemical obliteration consist in?

The concept of double damage to the varicose vein from the inside using foam or mechanical irritation was formed together with the progress of new technologies of intravascular treatment. PHLEBOGRIFFE is the most recent achievement in this field. It is available in the offer of the Clinic of Phlebology.  

 It is an alternative method for ClariVein. It is the newest form of catheter echosclerotherapy enhanced mechanically developed by BALTON. Contrary to classic echosclerotherapy, exclusively consisting in chemical damage of vein endothelium, PHLEBOGRIFFE uses simultaneously two mechanisms leading to the occlusion of the vein:

• chemical irritation of vein endothelium resulting from a foamy sclerosant introduced via catheter,
• mechanical damage of vein endothelium using special designed ending in the shape of ‘talon’ 

 Such approach substantially increases the effectiveness of sclerotherapy. In the Clinic of Phlebology, our team uses different variants of catheter methods with tumescence, original aspiration or irrigation, which increase the effectiveness of sclerotherapy as the method of varicose vein treatment.

Can each patient be subject to sclerotherapy?

Sclerotherapy is a minimally invasive and safe procedure. However, it does not mean that it can be performed in each patient. Qualification for the procedure, carried out by the physician, has to consider all information on the general health of patient, i.e. past and present diseases, drugs used and family predispositions.  

 Who cannot be subject to sclerotherapy?

• pregnant women,
• persons with acute venous thrombosis,
• persons who has allergy to sclerosant agents,
• persons with heart defect, e.g. defect of atrial septal defect
• immobilized patients, unable to move on his/her own,
• persons with acute infection,
• person with advanced  lower limb atherosclerosis.

 There is also a group of patients for whom sclerotherapy is associated with higher risk, but still it is possible to perform. However, additional precautions should be taken into account. These are:

• breastfeeding females,
• patients with tendency to migraine,
• patients with thrombophilia and those with a history of deep vein thrombosis.

 If you belong to one of the aforesaid groups, then it is necessary to inform the physician on it. Safety of patient is a priority for us.