Sclerotherapy for Varicose Veins

Sclerotherapy is a group of vein treatment techniques that involve injecting a medical solution called a sclerosant directly into an abnormal vein. The sclerosant acts on the inner lining of the vein, causing the treated vein to close and gradually undergo healing and reabsorption. Blood is then redirected through functioning venous pathways.

Different forms of sclerotherapy are used depending on the type, size, location, and anatomy of the veins being treated. Treatment may involve liquid sclerosant, physician-prepared foam, or commercially prepared microfoam, with or without ultrasound guidance.

Compression Sclerotherapy

Compression sclerotherapy is used to treat visible superficial veins, including:

Spider veins
Telangiectasias
Reticular veins
Selected small visible varicosities

Because these veins can be identified and accessed directly through the skin, treatment does not require ultrasound guidance.

Compression stockings are worn after treatment to support the treated veins during the early healing process. The duration of compression depends on the type and extent of veins treated.

Ultrasound-Guided Sclerotherapy (Echo-Sclerotherapy)

Ultrasound-guided sclerotherapy is used to treat abnormal veins located beneath the skin that cannot be adequately visualized or accessed by direct inspection alone. At IVSI, treatment is performed using FDA-approved liquid sclerosants.

Using real-time Duplex ultrasound:

The target vein is identified and precisely accessed with a needle
The liquid sclerosant is injected directly into the targeted vein
The distribution of the sclerosant is monitored under ultrasound guidance
The treated vein and surrounding venous anatomy are observed throughout the procedure

Ultrasound guidance allows precise treatment of deeper varicose veins, tributaries, and other selected sources of venous reflux while maintaining visualization of the surrounding venous anatomy.

Ultrasound-Guided Foam and Microfoam Sclerotherapy

Foam sclerotherapy uses a foamed sclerosant injected under Duplex ultrasound guidance to treat targeted varicose veins. The foam displaces blood within the vein and increases contact between the sclerosant and the vein wall.

Two forms of foam treatment are used at IVSI:

1. Physician-Prepared Foam (UGFS)

An FDA-approved liquid sclerosant is prepared as foam by the physician immediately before treatment and injected into the targeted vein under ultrasound guidance.

Physician-prepared foam can be particularly useful for:

Tortuous or irregular varicose veins
Tributary veins that cannot be treated with a laser fiber
Residual or recurrent varicose veins
Selected incompetent perforating veins
Residual sources of reflux following treatment of primary refluxing veins

2. Varithena® (Polidocanol Injectable Microfoam)

Varithena® is an FDA-approved, commercially prepared polidocanol microfoam. Unlike physician-prepared foam, Varithena® is manufactured with standardized foam characteristics and concentration.

Varithena® may be used for treatment of:

Incompetent great saphenous and accessory saphenous veins
Tortuous veins that are difficult to access with a laser fiber
Residual or recurrent varicose veins
Selected veins for which thermal ablation is not the preferred approach

The choice between liquid sclerotherapy, physician-prepared foam, Varithena®, EVLA, or another treatment method depends on the vein being treated, venous anatomy, pattern of reflux, previous treatment history, insurance coverage, and individual financial considerations.

Why Physician Experience Matters

Ultrasound-guided sclerotherapy requires more than the ability to place a needle under ultrasound guidance. The physician performing the procedure must be able to personally interpret Duplex ultrasound images in real time and understand exactly what is being visualized throughout treatment.

Before injection, the physician must identify the target vein, confirm its relationship to nearby arteries, deep veins, nerves, and other surrounding structures, and verify the position of the needle within the intended vein. During injection, ultrasound allows the physician to monitor the distribution of the sclerosant and its relationship to the surrounding venous circulation.

This requires experience in both venous ultrasound imaging and ultrasound-guided vein procedures. When the treating physician personally performs and interprets the ultrasound, procedural decisions can be made directly from the anatomy being visualized rather than relying on a separate ultrasound technician to identify and interpret the target vessels.

At International Vein & Skin Institute:

All ultrasound-guided sclerotherapy procedures are personally performed by Jozef Tryzno, MD, RVT, DABVLM
As a Registered Vascular Technologist (RVT), Dr. Tryzno personally performs and interprets venous ultrasound examinations used for treatment planning and procedural guidance
Dr. Tryzno has treated varicose vein disease and chronic venous insufficiency since 1998
The same physician is involved in evaluation, ultrasound imaging, treatment planning, procedures, and follow-up

What to Expect After Sclerotherapy

After sclerotherapy, the treated vein begins a closure and healing process. The recovery experience depends on the type and size of veins treated, whether liquid or foam sclerosant is used, and the extent of treatment.

Immediately after treatment:

A graduated compression stocking is placed on the treated leg
Patients are asked to walk for 10–15 minutes
Most patients return to normal daily activities the same day

During healing, treated varicose veins may develop localized tenderness, firmness, or inflammation. Larger treated veins may remain firm or palpable for several weeks or longer as they undergo healing and gradual reabsorption.

Patients whose work involves heavy lifting, frequent squatting, ladder climbing, roofing, or other significant physical strain may require temporary activity modification.

Compression After Sclerotherapy

Compression is an important part of post-treatment care after sclerotherapy. Graduated compression stockings support the treated veins during the early healing period and may help reduce discomfort and inflammation.

The compression regimen depends on the type of sclerotherapy performed, the veins treated, the extent of treatment, and the specific treatment protocol. Some sclerotherapy techniques require longer periods of compression than others.

Patients receive specific compression instructions for the procedure performed and should follow those instructions throughout the recommended period.

Individualized Treatment Planning

Sclerotherapy is often one component of a staged varicose vein treatment plan. The appropriate technique is selected according to the source and pattern of venous reflux, vein anatomy and size, previous treatment history, symptoms, and overall clinical findings.

Treatment planning also takes into account insurance coverage and medical necessity requirements, treatment cost, patient preferences, comfort, and recovery considerations.

Depending on the pattern of venous disease, sclerotherapy may be used as a primary treatment or in combination with EVLA and other vein procedures.

Insurance vs. Cosmetic Sclerotherapy

Sclerotherapy may be performed for medical or cosmetic reasons, depending on the veins being treated, symptoms, underlying venous disease, and the purpose of treatment.

Medical sclerotherapy is used to treat symptomatic varicose veins and other clinically significant sources of venous reflux. Insurance coverage generally depends on the patient's diagnosis, Duplex ultrasound findings, medical necessity criteria, prior treatment requirements, and the specific procedure being requested.
Cosmetic sclerotherapy is primarily used to improve the appearance of spider veins, reticular veins, and other small superficial veins and is generally self-pay.

Insurance policies vary, and not every medically appropriate sclerotherapy technique is covered by every insurance plan. When more than one treatment option is clinically appropriate, insurance coverage and patient cost may therefore influence the treatment selected.

Our office reviews available treatment options, insurance requirements, and self-pay alternatives when applicable as part of treatment planning.

Schedule a Vein Evaluation

If you are experiencing varicose veins, leg pain, swelling, heaviness, or other symptoms of chronic venous insufficiency, a vein evaluation can help determine the source of your symptoms and whether sclerotherapy or another treatment approach is appropriate.

📞 Call (847) 518-9999 to schedule a vein evaluation with Dr. Tryzno.

Medical Disclaimer
This information is provided for educational purposes only and does not replace a personalized medical evaluation. Treatment recommendations and outcomes depend on individual clinical findings, venous anatomy, and the treatment performed.

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