Potential Risks and Side Effects
Of the veins injected, approximately 30% to 60% fading is expected to occur after the first treatment. Most people require multiple treatments for optimal results. In addition to the cosmetic results, sclerotherapy can often relieve the throbbing, pain and fatigue associated with the abnormal veins. Although this is a safe, minimally invasive procedure that is performed in outpatient clinics, there are potential risks and side effects:
- Pain: You should expect to have mild to moderate discomfort. Pain is experienced by everyone, but the level of discomfort varies. During the procedure, pain is due to the injection and is often described as a bee sting. After the procedure, pain is usually from the intended inflammatory sclerosing process. If the sclerosing agent leaks outside the treated vein there can be more pain at the injection site. Most discomfort resolves within 24 hours of the treatment.
- Swelling: Swelling at the injection site is common, but variable. It is usually due to the injection and inflammatory response and will usually resolves within 1-2 days after injection.
- Bruising: Bruising is common after needle injections when a small amount of blood leaks into the surrounding tissue. This is more common when deeper veins are injected. It should resolve in 3-4 days.
- Bleeding: For those without bleeding disorders, a small amount of bleeding (droplets) can occur, but is easily controlled with pressure dressings.
- Matting (fine red lines): Matting is residual fine “hair- like” spider veins that can occur after multiple injections. Additional consultation with the surgeon may be indicated if this side effect is persistent.
- Hyperpigmentation (brown lines or spots): Hyperpigmentation is any brownish staining of the skin occurring after sclerotherapy. Residual iron pigmentation from absorbed blood cells contributes to this phenomenon. In most patients this condition resolves within 6-12 months, but in 1-%-2% of patients it can persist after one year.
- Ulcers/Infections/Scarring: Ulcers and infections can sometimes develop at the injection site. This occurs when the sclerosing agent leaks into the surrounding tissue, from allergic reactions to the sclerosing agent or from dressing problems (tape abrasions). An ulcer can occur up to two weeks after injection. Scarring from the ulcer may be permanent.
- Reoccurring Varicose Veins: Sclerotherapy is not a cure for varicose and/or spider veins. New ones can occur even in areas previously treated. Previously treated veins may return if there is an underlying large vein abnormality which may require more invasive surgical procedures.
- Allergic Reactions/Itching: Local reactions to the sclerosing agent will look like hives or raised red “wheels” surrounding the injection site. There could also be a local reaction to tape or the compression hose. This type of reaction may last several days. In rare events, a generalized systemic anaphylactic life-threatening reaction can occur.
- Hematomas: Hematomas are an accumulation of blood underneath the skin that feels like a “lump”. They can be painful, warm, and red. If large enough, they may need to be drained by the vascular surgeon.
- Vasovagal Reflex: The vasovagal reflex is a common side effect of any invasive procedure. It presents with light-headedness, nausea, sweating, and occasional shortness of breath and palpitations.
- Superficial Thrombophlebitis: This is an inflammatory and clotting reaction that appears as a tender, warm and red area over an injected vein. It can occur up to 3 weeks after injection and can sometimes be associated with infection of the vein.
- Deep Venous Thrombosis: Occurs when a clot forms and moves into the deeper veins of the legs. The clot has the potential to become dislodged from the leg and travel up to the lungs (“pulmonary embolus”) causing shortness of breath, anxiety, chest/back pain and even death. Fortunately, this is a rare complication of sclerotherapy.
- Localized Hypertrichosis: Hypertrichosis is a temporary increase of hair growth at the injection sites, occurring 4-8 months after injection. This represents a natural response of your body to the injections and is not directly related to the sclerosing agent. This reaction is even less common when hypertonic saline is used.
- Vasospams: Rarely, after injection of a sclerosing agent, an immediate porcelain-white appearance is noted at the site of injection and represents vessel spasm. Most vasospasms are transient, but if it persists, an ulcer can form. This reaction is not common when hypertonic saline is used.
- Arteriolar Injection: Inadvertent arteriolar injection can cause sudden leg pain during the injection. This can lead to ulceration, loss of tissue, nerve damage and possibly limb or life-threatening problems. Fortunately, this is a rare complication and with proper precautions it can be avoided.
There are few absolute contraindications to sclerotherapy, but there are some medical conditions that warrant either postponing or proceeding with caution. Please notify the vein nurse if you have any of these conditions.
- Prolonged Bleeding Diseases
- Connective Tissue Diseases ( Ehlers-Danlos syndrome)
- Arterial Diseases
- Immune Compromised States
- Heart/Kidney/Liver Disease
- History of Keloid Formations
- Medication, Tape or Latex Allergies
- Previous Adverse Reactions to Sclerotherapy