Unsuccessful Sclerotherapy. Another Option for Vein Treatment?

I had sclerotherapy last year to try to remove a blue vein on my leg. It wasnt bulging out, was just visible under the skin. I pigmented after the treatment and a year later, I still have pigmentation and the vein is still there! As well, I have since developed a couple other small veins in the surrounding area. I feel like the injections made my leg worse. Because of the pigmenting, I am hesitant to have sclerotherapy done again. What are my other options to get rid of the veins for good?

Doctor Answers 9

Unsuccessful sclerotherapy requires additional testing - Buffalo Niagara Spider Vein Treatments

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A picture would have been very helpful for guidance.

The clinical history you provide is not uncommon, especially when veins are treated by non specialists. The reason for 'failure of treatment' or 'recurrence' is that the underlying problem, such as venous insufficiency arising at the saphenofemoral or saphenopopliteal junction or along perforator veins was NOT addressed at the time of treatment. 

I suggest you see a vein specialist. Read the ebook on the link below. 

Spider veins, pigmentation, venous ultrasound, venous valves

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Your problem is not uncommon.  There are essentially 3 types of veins in the legs-spider veins, blue or reticular or feeding veins and varicose veins.  Think of your veins like a tree with the trunk being what is called the saphenous vein.  This trunk has venous valves which are microscopic and send blood back up the leg.  If these valves malfunction, then the blood has trouble going back up the leg and is diverted into the branches forming spiders, blue veins or varicose veins. In your case, the blue vein (branch) was treated but since the problem most likely is in the trunk (valves), the vein did not resolve and, in fact, more veins formed and the pigment resulted.  You should have a venous reflux ultrasound to look at the valves.  If there are not working(refluxing), then these should be sealed first with a laser before the spiders and reticulars are treated.

John Landi, MD
Naples General Surgeon

Treatment of spider veins with sclerotherapy

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Great question.  I treat most sclerotherapy patients with pre and post treatment lightening creams to prevent pigmentation.  I think, if appropriate, you should consider sclerotherapy again but with pre-treatment.  Call our office to obtain a proper pre-treatment cream. 

Vein Treatment

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You should consider seeing a Board Certified Dermatologist or Board Certified Plastic Surgeon with perhaps a different injection solution or even laser therapy.  The discoloration is going to be there any time a vein is closed as this is just heme staining from the absorbing blood cells leaving a little iron on the tissue.  I like the 1064 Yag or consider a VBeam by Candela.

A: Leg Vein Treatment Other Than Sclerotherapy

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Thank you for your question.

You may be a good candidate for laser treatment for your leg veins. In our San Francisco Bay Area practice we frequently treat leg veins with laser and have a high patient satisfaction rate. Our laser is effective at treating broken capillaries and small spider veins to larger darker veins.

Laser treatment, like sclerotherapy, may require several treatments and may make veins look worse before they look better (usually for less than 4 weeks). Unfortunately both sclerotherapy and laser treatment run the risk of worsening the appearance and neither treatment guarantees the veins will be gone for good. 

I hope this helps.

Treatment options after previous sclerotherapy

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It is not usual to need more than one treatment with sclerotherapy, regardless of what type of solution was used.  Laser vein treatment for blue veins and smaller red telangiectasias is also very effective.  Either laser or sclerotherapy both have their risks, like hemosidirin staining, after treatment.  Another common side effect is the appearance of a new collection of smaller red vessels or matting of vessels in a treated area.  Though your outcome may not have been what you wanted or had hoped for, it is not outside the realm of possibility. I wouldn't give up hope.  Follow up with the office where you were initially treated and see what their possible remedies are.

Good luck.

Dr. Grant Stevens      

Sclerotherapy--a series of treatments, side effects explained

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Sclerotherapy can be accomplished with a combination of solutions.  I would be curious to know what was used for the injection of your blue vein (reticular vein).  Hypertonic saline injections can cause the greatest degree of side efefcts and discomfort during sclerotherapy.  I do not use this solution, but instead use detergent solutions that are foamed (for reticular veins and varicose veins) and a sugar solution called glycerin for smaller telangiectasias.  Sclerotherapy is not a single treatment, I carefully counsel patient it requires multiple treatment for clearance and to expect aroudn 40-50% improvement with each session.  It is paramount to seek a consultation with a qualified physician--an ultrasound to identify deeper vein pathology may be necessary.  Hyperpigmentation, new vessel formation, and ulcerations are all possible with sclerotherapy--however these side effects can be mitigated by using the appropriate solution and concentration, and the use of compression hose.  Don't give up!

Melanie D. Palm, MD - Account Suspended
San Diego Dermatologic Surgeon

Hyperpigmentation following sclerotherapy

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What you are experiencing is very common after sclerotherapy injections.  Hyperpigmentation is due to hemosiderin(iron) staining the skin after the vein is plugged and perhaps you are also experiencing some telangiectatic matting in the area.  The concentration of medicine, injection pressure, and size of the vein all come into play with this side-effect.    The best advice is to use the lowest concentration possible, with the lowest amount of injection pressure followed by continued use of a compression stocking with leg elevation as much as possible until the vein clears.

Dr. Craig Crippen

Craig Crippen, MD
Kelowna Physician

Varicose Vein Road Map

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The usually cause for sclerotherapy failure is poor pre-procedure planning.  Most of the patients that we see with sclerotherapy failure are due to undiagnosed superficial venous hypertension.  In other words, vein pressure due to varicose vein problems below the skin surface.  How is superficial venous hypertension discovered during physical examination?  By ultrasound.  Many offices offer sclerotherapy vein injections to shut down superficial varicose veins and spider veins.  The procedures are completed based on visual observations.  The better approach would involve a formal ultrasound workup with detail reviews of the venous system.  This should be completed as a planning phase to the treatment for varicose veins.   Then proceed with therapy based on good evidence of the underlying problem.

There are multiple reasons why your vein is still present.  1]  The vein never closed down from sclerotherapy to be absorbed by the body  2]  The vein is closed but still present close to the surface causing show  3]  The vein is closed with skin stains [hemosiderin stains] which tattoo the skin .  There are many different types of sclerotherapy agents.  You did not say which type of agent was used in your therapy. 

Recommend that you seek consultation with a vein specialist.  Obtain a good vein evaluation to include standing ultrasound review.  Most vein centers offer complimentary vein screenings.  This way treatment options will be made available based on YOUR road map

James E. White, MD
Chattanooga General Surgeon

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