Sclerotherapy for Leg Veins


Varicose veins are thick, blue, unsightly veins that develop on the lower extremities. These appear mostly in your 30’s to 70’s and affect women more than men. Varicose veins are often accompanied by spider veins, red to blue thread-like veins that often form mats or spider web-like patterns. These vein abnormalities are usually just cosmetic in nature, but can sometimes be symptomatic causing aching or throbbing. There are many ways to treat varicose veins. Here I will review one of the oldest and most popular methods: sclerotherapy.



While muscular arteries carry your blood away from your heart, it is the thin walled veins that bring the blood back to the lungs and heart. Because there is no muscle in veins, the muscles of your legs and feet are what squeeze the blood back up to your heart. One way valves in the veins help keep the blood moving up by preventing it from flowing backwards, down into your legs.

When the veins are damaged, as can happen from excess pooling of blood, from diabetes, and from genetic factors, then the valves fail and the blood begins to pool in the vessels. The result is dilated baggy veins that pouch out from the skin. Over time smaller veins grow to try to redirect the blood flow. These tiny vessels are the spider veins that develop.

Sclerotherapy works by causing the treated veins to scar down, sealing them tight and preventing the blood from filling them again. This is done by inserting a tiny needle into the vein and injecting a substance that causes damage to the blood vessel walls. The two most commonly used substances are hypertonic saline and detergents.

Hypertonic saline is super salty water. The high salt damages the red blood cells in the veins causing a clot to form. Once a clot fills the whole vein, the blood cannot flow back into it. The vein eventually atrophies and disappears. The advantage of hypertonic saline is that it is readily available and often works. The disadvantage is that it can be painful, and if the saline is injected into the tissue outside of the vein, then tissue damage can occur, leading to an ulcer.

Detergents are, just as it sounds, soaps. Injecting detergents into the veins also causes a clot to form and damages the vessel walls. Again, this leads to a sealing of the vessel and eventually the vein disappears. There are several detergents available for physicians to use including sotradecol, which is FDA approved, and polidocanol, which is not FDA approved at this time, but is often preferred because it is effective and less painful than other detergents. These detergents also have a low likelihood of causing a serious allergic reaction which can occur when these substances are injected right into your bloodstream.

Ironically, the larger blue veins (3 mm or less in diameter) are often easier to treat than the smaller ones. Sclerotherapy of larger blue veins usually leads to good results in just a few days. Larger veins can, however, lead to brown pigmentation of the skin. This pigment is from the iron in the red blood cells that were trapped in the vein. The brown color can take 6 months to 2 years to fade. The smaller, red spider veins are less likely to cause this brown discoloration when treated. However, they can be more difficult to treat. It often takes several treatments and can take months to see improvements. They can also regrow more easily. The more times these small red veins have been treated, the less likely that they will go away completely with therapy.

Veins higher on the leg and thigh can also be easier to treat than those lower on the leg or foot. Varicose veins on the inside ankle are notriously difficult to treat and are the most likely to lead to an ulcer of the skin after treatment with sclerotherapy.

6 thoughts on “Sclerotherapy for Leg Veins”

  1. I did have this type of treatment (this was when I was much *younger* and cared more about my legs!) I was very happy with the results, although if I was going to suddenly start wearing shorts now, I’d need to do it again. Hmm, maybe someday.

  2. Veinwave is an alternative treatment for thread veins on the face and legs. At our medical clinic in Essex, we find that while Sclerotherapy is good for veins over 3mm in diameter, Veinwave is better for the tiny veins under 3mm in diameter. Sue Ibrahim

  3. hypertonic saline(HS) is readily available?OTC isnt it?another thing is, HS can be very painful compared to those detergents?why is that so?
    thank you..

  4. I recieved the salt water treatment and it worked very well for my right leg, but when it was injected into my only blue vein (on my left leg) a bunch of tiny red blood vessels all formed around it. Would veinwave or some other therapy be a possible treatment for those then?

  5. At Abate Beauty & Spa Sanctuary – MediSpa est. since 1990 we offer professional treatments that work very well in the treatment of removing leg thread veins such as red, blue and purple type of veins. Sclerotherapy works exceptionally well on larger thread vein on the legs but an alternative method that has been used for many years and works fantastic is thermolysis (short wave diathermy) this method works very well as removing fine red veins on the face around the nose and cheeks and can also be used on fine leg veins following vein removal surgery. The results are instant and the price is very competitive.

  6. Sclerotherapy remains the primary treatment for small-vessel varicose disease of the lower extremities. These small vessels include telangiectasias, venulectasias, and reticular ectasias

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