A question I get asked a lot both by patients and healthcare professionals is “What is
the best sclerosant?” In this video, I will be joined by an expert, my colleague Richard
Oliver and together we will answer this question.
My name is Dr Haroun Gajraj Director of The VeinCare Academy helping doctors and nurses
by providing online learning courses. If you are new here, make sure you click that subscribe
button and all the links in the video description box below.
So let’s get started. And stay to the end, where I will share with you a resource I have
put together with Richard Oliver. Be warned, this is probably the longest video I have
done here and it is a measure of how interesting I find this topic and I hope you find it interesting
and helpful too.
Thank you for staying to the end. In the link in the description below, you find a link
to the download for Richard Oliver’s slides. ” I look forward to seeing you in my next
video.
A question I get asked a lot both by patients and healthcare professionals is “Is sclerotherapy
safe? In fact, I was asked to address this question at the British Association of Sclerotherapists
Conference in 2019. This video is based on my presentation and specifically answers this
question based on my own personal experience at The VeinCare Centre.
My name is Dr Haroun Gajraj Director of The VeinCare Centre helping you find freedom from
veins. If you are new here, make sure you click that subscribe button and all the links
in the video description box below.
So let’s get started. And stay to the end, where I will share with you a resource I have
put together where you can find out more about the risks and side effects of sclerotherapy.
Sclerotherapy has been described as the “Swiss Army Knife” of vein treatments. What do
I mean by this? Well nearly any vein can be treated by sclerotherapy. Any leg vein - varicose
veins, spider veins, blue veins and veins which have come back after stripping, hand
veins, veins on the chest, veins on the face. In fact, of all the methods for treating abnormal
veins, laser, radiofrequency, medical glue - you name it anything that is called the
GOLD STANDARD - sclerotherapy is without doubt the most versatile treatment option.
So, why isn’t everyone with vein problems treated by sclerotherapy. Well, there are
still obstacles to the use of sclerotherapy. For healthcare professionals it requires skill
and continued practice. Sclerotherapy is ‘operator-dependent”. What do I mean by this? The results of sclerotherapy
depend on the person doing it. Put simply, to get good outcomes from sclerotherapy with
minimal side effects, it needs to be done by someone who is good at sclerotherapy. Seems
obvious doesn’t it, but it is often forgotten, and sometimes, sclerotherapy gets a poor reputation
because some practitioners are quite frankly are not very good at it. Another obstacle
is that patience is needed. The results are not immediately apparent. Sclerotherapy works
by removing the delicate inner lining of veins, the endothelium and it starts a healing process.
For spider veins in particular, it may take several weeks before they fade. For larger
veins, the results may be apparent sooner, but in all cases, the treated veins may be
lumpy, tender and may look and feel worse for a few weeks before they finally improve.
So, sclerotherapy requires patience both on the part of the person who is treated and
on the part of the healthcare professional- the doctor or nurse.
Safety concerns arise, because patients are naturally concerned about having medication
injected into their body and some of the complications after sclerotherapy can be very serious despite
the fact that sclerotherapy is considered by many - doctors and nurses as well as patients
to be a very minor procedure.
The evidence is that sclerotherapy is very safe. Many years ago a large French registry
of over 12,000 procedures confirmed a very low rate of complications and side effects.
This was confirmed by another study in the United Kingdom more recently. Sclerotherapy
has an excellent safety record which compares favourably with other treatment options.
However, like all effective medical treatments sclerotherapy, does have side effects and
complications which can be classified as either major or minor.
These are the major complications: anaphylaxis, venous thromboembolism, tissue necrosis (small
scabs and small ulcers), nerve injury and swelling. The minor complications include
matting which is a very annoying outcome - the formation of small new blood vessels after
sclerotherapy which look like a bruise, pigmentation (sometimes called staining), and disappointment.
My team and I looked back at our records over a 15 year period involving over 5000 episodes
of sclerotherapy. Over this period, we had no serious complications. We did have some
minor complications: 3 people with persistent brown marks (more than 2-years) but all of
these eventually resolved. We had 17 patients with matting, 39 patients with temporary visual
disturbance, 28 patients with wheezing and cough, one patient with tingling and numbness
of the face and hand and
one patient was unable to drive home because of a headache. All of these minor complications
were temporary and all resolved with the passage of time. Visual disturbance, headache and
tingling are a form of migraine reaction.
So based on careful research of the medical literature and my own experience, I can confirm
that Sclerotherapy is very safe. However all of us who treat patients with sclerotherapy
are aware that patients might have allergic reactions and we must be prepared to deal
with these. We are also aware of the contraindications by which I mean those people and those conditions
for whom sclerotherapy should be avoided. We are also aware that people who suffer with
migraines may have an attack of migraine triggered by sclerotherapy. That is why in general,
I don't think it is appropriate for patients to drive themselves home after their first
sclerotherapy session. My team and I are very careful to explain to patients
what they can expect after sclerotherapy. In particular we tell them that sclerotherapy
starts a healing process during which the veins may become lumpy and tender and that
there may be discoloration over the successfully treated veins. For many years now, I have
taken routine clinical photographs of our patients treatment areas before, during and
after their treatment sessions. Clinical photography helps our patients see the improvement and
leads to better satisfaction.
Successful Sclerotherapy relies on a team approach which ensures a good outcome while
avoiding side effects and complications. Important among these are a Medicines Management policy
to avoid medication errors and a policy of preparedness for any serious complications
however rare they may be.
So in summary, yes sclerotherapy is safe provided the team that is administering sclerotherapy
is skilled and experienced.
Thank you for staying to the end. In the link in the description below, you can read my
full article on “Is sclerotherapy safe?” I look forward to seeing you in my next video.