Vein obliteration - or vein sclerotherapy - is a method of treating varicose veins that is several hundred years old. The first attempts to close varicose veins by injecting an active substance were made as early as the 17th century. Since then, a variety of medications have been developed and trialled to achieve permanent closure of varicose veins - with varying degrees of success.
Polidocanol is the only active ingredient authorised in Germany for „vein sclerotherapy“
In Germany today, only polidocanol in various concentrations from 0.25% to 3% remains officially authorised. Polidocanol is the only active ingredient officially authorised in Germany for the sclerotherapy of varicose veins. This medication can be used in both liquid and foam-like consistency (by mixing with air in a ratio of 1:4). Foam is the more aggressive and potent medium and is often used for larger varicose veins.
The frequently propagated injection of high-dose saline solution is not recommended, as the effect is worse than with polidocanol and the complication rate as well as the price of the treatment are higher.
How does „vein obliteration“ work?
The active ingredient polidocanol irritates the inner wall of the vein, causing it to become inflamed and, as a result, the vein shrinks („scleroses“) within a few weeks of treatment. The larger the diameter of the vein to be treated, the higher the necessary concentration of polidonacol or directly the foam form is selected.
Which veins can be sclerosed?
As a rule, all varicose veins can be sclerosed with Polidocanol. The smaller the varicose veins, the better the long-term result. Small spider veins in particular are ideal for liquid sclerotherapy (sclerotherapy) and can be treated even better than with a laser.
This has been proven in several studies. These fine, mainly cosmetically disturbing superficial varicose veins owe their name to their appearance: they are reminiscent of the brushwood that was often used in the past, which was tied together to form brooms. Hence the name broom veins.
How is „vein obliteration“ carried out in practice?
In sclerotherapy, the spider vein is punctured with a fine, sharply sharpened needle, which is also used by a diabetic to inject insulin. A small amount of the liquid sclerosing agent is then injected into the spider vein. This disappears immediately as the blood is displaced by the sclerosing fluid. This is a sure sign that the vein has been hit and the medication can take effect. A short time later, however, the reddish blood filling appears again and the spider vein then disappears completely within 3-6 weeks.
„Vein sclerotherapy“ with the foam method
Larger visible varicose veins that are located under the skin can be treated using the same method. In this case, it is better to use the foam form of polidocanol. The original liquid medication is mixed with air in a ratio of 1:4 and processed into a foam. This foam is more potent than the liquid form and can therefore close larger veins very well. To puncture the vein, the needle, which in this case is the same size as a normal blood sample, is inserted into the vein under ultrasound guidance and the distribution of the foam in the vein can be precisely controlled using the ultrasound device.
The foam method can even be used to close the large trunk vein on the inside or back of the leg (saphenous vein magna or parva). However, the long-term results here are worse than after minimally invasive surgical treatment of the truncal vein with laser or radiofrequency. Foam sclerotherapy of the great saphenous vein is therefore always a second choice treatment if a patient cannot be operated on or does not want to be operated on.
Results of „vein sclerotherapy“
With the exception of treatment of the large truncal vein (see above), the results of liquid or foam sclerotherapy of varicose veins with Polidocanol are good. To further improve the results after treatment, you should wear appropriate class II compression stockings during the day for 14 days afterwards. Sclerotherapy with high-dose saline solution is not recommended for the reasons already mentioned.
What are the dangers of „vein sclerotherapy“?
One of the most common complications after sclerotherapy of a varicose vein is the development of brownish spots in the course of the former vein. This risk of so-called brownish hyperpigmentation is just under 15 %. This risk increases even further if the varicose vein treated in this way is exposed to the sun for 6 weeks afterwards. Sclerotherapy should therefore not be carried out before a planned summer holiday, but only afterwards.
After foam sclerotherapy of a larger varicose vein, the patient often observes a hardening of the vein and a pulling pain in the vicinity of the hardening. This is a consequence of the sclerotherapy and can last for several weeks.
Other risks include the development of a deep vein thrombosis (risk of less than 1 per cent) or the development of inflammation in the area of the treated vein. If superficial clot formation occurs, which is recognisable by the formation of tiny bluish nodules in the vein, it is necessary to open the site of the clot with stitching and expressing (squeezing out) the clot in order to avoid subsequent brownish pigmentation. These risks are even higher after the use of highly concentrated saline solution.
Your phlebologist will draw your attention to the appropriate behavioural measures and warnings after the treatment and provide appropriate complication management should a problem occur during the sclerotherapy.
