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Asclera (Polidocanol) for Varicose Veins?

Does Asclera, Polidocanol work on varicose veins?

Doctor Answers (11)

Asclera for Sclerothrapy


Asclera (Polidochanol) is FDA approved. It has advantages because it is painless on injection, has low likelihood of skin necrosis and is effective.

It is commonly used for feeder veins, reticular veins and some individuals use it for varicose veins. Its concentration when used is 0.5% to 1 %.

Asclera is a wonderful product for cosmetic sclerotherapy.  

Buffalo General Surgeon
5.0 out of 5 stars 8 reviews

Asclera and leg veins

Asclera is a fabulous injection to remove leg veins and superficial spider veins. The injections can be somewhat painful so I always recommend applying Emla to numb the skin before the injections. It usually takes several treatments spaced one month apart to treat these veins. The procedure works extremely well but takes multiple treatments. 

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 37 reviews

Asclera (Polidocanol) Sclerotherapy for Varicose Veins & Spider Veins of the Legs


Yes, Asclera (also known as Polidocanol) does work well for varicose veins, as long as any deeper venous problem is addressed at the same time.  Most patients with varicose veins also have a deeper circulation condition known as venous reflux disease.  This deeper disease results in the varicose veins forming at the surface.  If the underlying vein disease is not treated, the surface branches will not response properly or will occur.  Usually this disease affects the deeper saphenous veins of the legs and can usually be addressed by a laser treatment or radiofrequency treatment prior to or in conjuction with the sclerotherapy.  A good analogy is that the diseased saphenous vein is the trunk of a tree and the varicose veins at the surface are the branches of the tree.  If you only treat the branches, the trunk will just grow new branches (new varicose veins).  If the trunk problem (which is usually present) is successfully identified by ultrasound and treated, then the branches can often be treated with Polidocanol or Asclera sclerotherapy.  Very large surface branches are usually best treated with phlebectomy (they tend not to respond well to sclerotherapy), but small to moderate sized varicose veins or reticular veins tend to respond very well to sclerotherapy with Polidocanol.  Asclera / Polidocanol is an FDA approved medication for both small varicose veins as well as spider veins.

Since you should always have an ultrasound done to check for the deeper vein problem and since this deeper problem should always be addressed before treating the surface branches, I would suggest that you see a board-certified vein specialist for a detailed evaluation before you have any treatments on your varicose veins done.

Joel Gotvald, MD, FACS
Austin General Surgeon
5.0 out of 5 stars 1 review

Painless Vein Treatment


Ascelra is now FDA approved for the treatment of varicose veins. I have found it is most effective for spider and reticular veins, but can also be used for larger caliber vessels. For larger vessels ultrasound guidance often improves outcomes.

Jeffrey Fromowitz, MD, FAAD
Boca Raton Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Polidocanol is effective against larger veins


Yes!  Polidocanol can be used to successfully treat larger caliber veins including varicose veins.  Although these veins can be visualized easily and treated with sclerotherapy, ultrasound-guided sclerotherapy can be more effective in treating affected vessels, by identifying potential feeder vessels called accessory or perforating vessels.  If you have varicose veins, it would be wise to first obtain an ultrasound study of the legs--quick, easy, painless, and informative--to determine if upstream vessels such as the great saphenous veins require treatment first before proceeding with polidocanol sclerotherapy treatment.

Melanie D. Palm, MD
San Diego Dermatologic Surgeon
5.0 out of 5 stars 12 reviews

Spider Vein therapy


It works best on spider veins and reticular veins. i have never used it on varicose veins and am happy with performing microphlebectomy are larger varicose veins if ablation of tributaries dont work to shut the varicose vein down. i have seen a number of complications from other physicians injecting a wide range of agents into larger veins including matting and skin staining with dark brown spots.

Timothy Mountcastle, MD
Ashburn General Surgeon
4.5 out of 5 stars 22 reviews

Polidocanol works!


Yes, Polidocanol (Asclera) does work and is now FDA approved in the US (March 2010).  We've been using it in our office for awhile now with excellent results.  Patients are who've previously were injected in Sotradecol find Asclera to be just as tolerable and effective.

Amir Moradi, MD
San Diego Facial Plastic Surgeon
4.5 out of 5 stars 7 reviews

Options for sclerotherapy


There are many options for sclerotherapy, including polidocanol and STS.  There is no universal medicine that is applicable for every situation.  I would advise you to go to a board certified phlebologist.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 54 reviews



Polidocanol (also known as Aethoxysklerol) is an effective chemical detergant for treatment of a wide range of leg veins. It's concentration is often diluted for differing size veins, and has the advantage of less discomfort and lower incidence of skin ulceration. One big disadvantage is it is not FDA approved for use in the U.S. It also tends to not flow as well into the veins, so more injections may be needed to treat large areas and multiple veins. I have also found it to cause more post-treatment hyperpigmentation (temporary brown spots) than other therapies.

Jeffrey C. Poole, MD
Metairie Dermatologic Surgeon
5.0 out of 5 stars 3 reviews

Effectiveness of sclerotherapy depends on varicose veins cause


Sclerotherapy with Polidocanol can be very safe and effective as long as the cause of the varicose veins is close to the veins that are being injected.

Varicose veins are dilated veins and are the result of abnormally high pressure in the veins. This, in turn, is due to the combination of weak vein walls and broken vein valves.

Typically, surface spider veins are driven by reticular veins just under the skin. These reticular veins may be driven by subcutaneous veins, which may themselves be driven by high pressure in the larger greater saphenous vein or in perforating veins. Perforators connect the surface veins with the major deep veins of the legs.

The more central or the larger the driving veins are, the less likely sclerotherapy will be successful. As a rule, if the varicose veins cause aching or pain in the legs, the veins are so dilated that sclerotherapy with any agent will probably not work, and the patient may need surgery. If the varicose veins are associated with swelling of the leg or other signs of chronic deep venous insufficiency even surgery may not help because the ultimate drivers are the large, deep veins of the leg.

One of the reasons Polidocanol is so safe is that, when given in the proper concentration, it becomes ineffective (too dilute) in larger veins. That means that when it gets to those more central veins it does not damage or destroy them, but it leaves them in tact and still under high pressure - able to continue driving the varicosities.

Although Polidocanol is not yet FDA approved, it is still the gold standard of safe and effective sclerotheraputic agents.

The key to successful sclerotherapy is an understanding of the cause of the varicose veins. If the driving high pressure is close to the veins being treated it will probably work, and Polidocanol is a good agent to use. If the high pressure driver is too deep or central the chance of success is markedly reduced no matter what the sclerotheraputic agent. An agent that will effectively damage an offending central vein is not safe.

This is a complex subject.

Robert Swanson, MD - RETIRED
Bay Area General Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.