Sclerotherapy and proper compression afterward?

Hello, I had sclerotherapy done on my ankles 2.5 years ago and ended up with bad matting which never resolved. What is the best treatment for matting and spider veins that are less < 1mm and do open toe compression hose provide enough compression afterward to the foot and ankle to properly heal afterward? My compression hose are thigh high and are 30-40mmhg. I did have ultrasound on my legs about 4 weeks ago and was normal and showed no reflux. Thanks in advance!

Doctor Answers 7

Matting

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The compression hose you describe should be adequate following sclerotherapy.  Open toe/ vs closed toe shouldn't matter.  Matting can be a challenging problem, although rare in my experience.  I have had some success with matting by using a 31 gauge needle (very small) and looking for a feeder vein to the matting.  


Mount Airy Plastic Surgeon
5.0 out of 5 stars 105 reviews

Ultrasound guided foam, VeinWave or VeinGogh, or laser

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Matting around the ankles can be difficult to correct. There are some patients who have tiny areas of reflux that may be difficult to realize on ultrasound - sometimes, the ultrasound doesn't even show the little area of reflux. If at all possible, I try to find a feeder vessel using ultrasound (these are commonly less than 1 mm) and inject that using the ultrasound. If your ultrasound was done carefully (by the treating doctor, not a technologist) and nothing was found, VeinGogh or VeinWave, a tiny electricity-based device, may be a good solution for you.

Albert Malvehy, MD
Miami Beach Physician
5.0 out of 5 stars 8 reviews

Matting issues

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The issue of "matting" is difficult to treat.  If your issue truly is "matting" I would recommend several treatments with intense pulsed light (IPL) treatment. IF sclerotherapy is done below knee a compression sock can be an acceptable option.  Depending on the size of veins treated I generally like to see patients wear compression for 5-7 days.  Bruising is always a possibility but arnica can help reduce the time bruising lasts.  

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Sclerotherapy for Spider or Thread Veins

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Some patients do develop very fine veins, or matting following treatment. These veins may be addressed with further sclerotherapy or laser treatments. Your compression stocking should be fine. Open toe stockings, not a problem.

Gary Nackman, MD, FACS
Clifton Vascular Surgeon
5.0 out of 5 stars 3 reviews

Sclerotherapy

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It is recommended to wear your medical grade compression stockings daily for a period of 1 week after sclerotherapy treatment. In addition to that try to avoid strenuous exercise such as aerobics, weight training, bicycling or running for 1 week. Avoid also weight lifting more that 20 pounds for 2 weeks. However, walking is encouraged. It is normal and expected that your veins look worse before they look better, therefore, don't be concerned about that. It can take up to 2 months to see full results post sclerotherapy, and another treatment should only be repeated no earlier than 2 months. It is recommended to avoid direct exposure to sunlight otherwise use sun block and/or protective clothing. A side effect such as hyper-pigmentation sometimes occur and it is typically temporary in the area of treatment. If micro veins appear called matting like you have experienced before, it can usually be treated with another sclerotherapy treatment, this is one of the reasons why patients need more than 1 treatment for satisfactory results. 

If sclerotherapy does not give you the results you are looking for,  consider another visit to a vein specialist for a repeat scan with ultrasound to your legs to determine if an underlying venous reflux is present. Try to avoid caffeinated products before the repeat ultrasound scan and be hydrated. These preparations help to better assess your lower extremity venous circulation. 

All the best, 

Telangiectatic matting and venous insufficiency - Williamsville, NY and Vein Treatment Center

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Topical laser may help with telangiectatic matting.

You need to see a vein specialist who has ultrasound credentials who will personally do the scan and look for feeder veins, localized relfux, perforator vein reflux.

We accept patietns from PA. 

H Karamanoukian MD FACS RVT RPVI RPhS

Post sclerotherapy matting.

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Post sclerotherapy matting is sometimes difficult to resolve.  I would first look for feeding veins to the area and treat these with foam.  I would also treat the matting with a 33g needle and .15% Tetradecyl. Usually with proper magnification and a small needle these veins can be cannulated. There is no difference in open or closed toe support hose.  See a vein specialist.

John Landi, MD
Naples 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.