Percutaneous sclerotherapy of spider/ reticular/ perforator veins

Percutaneous sclerotherapy is a minimally invasive procedure used to treat spider veins, reticular veins, and perforator veins. This technique involves injecting a sclerosant solution into the affected veins to cause their closure and eventual absorption by the body. The procedure is effective for improving the appearance of superficial veins and alleviating associated symptoms.

Types of Veins Treated

1. Spider Veins (Telangiectasias) (Click here to read more on Spider Veins)
   • Small, thin veins visible near the surface of the skin, often red, blue, or purple.
   • Commonly found on the legs and face.
2. Reticular Veins 
   • Slightly larger than spider veins, usually green or blue.
   • Often located deeper than spider veins but still visible through the skin.
3. Perforator Veins:
   • Veins that connect the superficial venous system with the deep venous system.
   • Can become incompetent, leading to varicose veins and chronic venous insufficiency.

Indications for Sclerotherapy

• Cosmetic improvement of spider and reticular veins.
• Symptomatic relief of pain, burning, or itching associated with superficial veins.
• Treatment of incompetent perforator veins contributing to venous insufficiency or ulceration.

Sclerosant Agents

1. Detergent Sclerosants:
   • Examples: Sodium tetradecyl sulfate (STS), Polidocanol (Asclera®).
   • Mechanism: Damages the endothelium, causing vein spasm and closure.
2. Osmotic Agents:
   • Example: Hypertonic saline.
   • Mechanism: Causes endothelial dehydration and cell death, leading to vein closure.
3. Chemical Irritants:
   • Example: Glycerin.
   • Mechanism: Directly damages the endothelium, causing vein closure.

Procedure for Percutaneous Sclerotherapy

1. Pre-procedure Preparation:
   • Patient Assessment: Review medical history, allergies, and current medications. Obtain informed consent.
   • Imaging: Use duplex ultrasound to assess vein anatomy and plan the treatment.
2. Procedure:
   • Patient Positioning: Position the patient comfortably, often with the legs elevated to reduce venous pressure.
   • Sterilization: Clean the treatment area with antiseptic solution.
   • Injection Technique:
     • Spider and Reticular Veins: A fine needle is used to inject the sclerosant directly into the visible veins.
     • Perforator Veins: Duplex ultrasound guidance is used to accurately inject the sclerosant into the perforator veins.
   • Compression: Apply compression (stockings or bandages) immediately after the procedure to enhance vein closure and minimize bruising.
3. Post-procedure Care:
   • Compression Stockings: Worn for several days to weeks to aid in vein closure and reduce swelling.
   • Activity: Encourage walking and normal activities, but avoid strenuous exercise for a few days.
   • Follow-up: Schedule follow-up visits to assess treatment efficacy and monitor for complications.

Benefits

• Minimally invasive with a quick recovery.
• Effective for cosmetic improvement and symptom relief.
• Can be performed in an outpatient setting.

Risks

• Pain or discomfort at the injection site.
• Bruising or swelling.
• Hyperpigmentation or skin discoloration.
• Allergic reaction to the sclerosant.
• Formation of new spider veins (matting).
• Ulceration or tissue necrosis (rare).
• Deep vein thrombosis (DVT) or pulmonary embolism (very rare).

Conclusion

Percutaneous sclerotherapy is a highly effective, minimally invasive treatment for spider veins, reticular veins, and incompetent perforator veins. It offers significant cosmetic and symptomatic benefits with a relatively low risk of complications. Proper patient selection, technique, and post-procedure care are essential to maximize the efficacy and safety of the treatment. Regular follow-up ensures that the treatment outcomes are satisfactory and any potential complications are promptly addressed.