Sclerotherapy for Reticular Veins:  What Works Best?

Sclerotherapy

Reticular veins can form unattractive clusters on the legs and can be associated with discomfort. A study examines which type of sclerotherapy for reticular veins works best.

What Are Reticular Veins?

Reticular veins, the visible blue or purplish veins that can develop on the legs, are very common. They are caused when small valves inside the veins become weak or damaged, allowing blood to flow backwards. The increase in pressure causes the veins to enlarge.  Typically, reticular veins are less visible than varicose veins because they form deeper under the skin’s surface. They also tend to be smaller and less twisted or bulged than varicose veins. Contributing factors include genetics, age, weight, hormonal changes, pregnancy, or occupations that require a lot of sitting or standing with little movement.

What is Sclerotherapy?

Sclerotherapy is a largely painless procedure to eliminate reticular veins. A very small needle is used to inject a chemical sclerosant solution directly into the vein. The resulting irritation of the vein’s lining causes the vein to close and shrink. Eventually, the vein disappears altogether. Using ultrasound, a doctor can determine how many injections are required and where they should be given. The success of the treatment will depend upon how well backward flow points are controlled.

Sclerotherapy for reticular veins is FDA approved and very safe. Patients can expect to be able to resume normal daily activities immediately after sclerotherapy. The most common complications are temporary and include itching, bruising, or a tingling sensation due to nerve irritation. However, sclerotherapy is not a cure for reticular veins since it does not prevent new ones from appearing in the same area over time.

Optimizing Sclerotherapy Effectiveness and Minimizing Complications

In a recent study published in JAMA Dermatology, researchers from Brazil compared their country’s two most commonly used sclerosant solutions to see which one worked best.  Ninety-three women were recruited to participate in this triple-blind randomized clinical trial. The medial age was 42 years. All patients had five appointments:

  1. Screening
  2. Ultrasound scanning of the reticular veins
  3. Obtaining clinical data, pre-treatment images, and sclerotherapy session
  4. A follow-up visit one week later (post-treatment images taken)
  5. A second follow-up visit two months later (post-treatment images taken)

While all the women underwent one sclerotherapy session, half were treated with 0.2% polidocanol diluted in 70% hypertonic glucose (HG) and half were treated with 75% HG alone. They found that the 0.2% polidocanol in 70% HG was significantly more effective than the 75% HG sclerosant. No serious adverse effects occurred in either group.

This study indicates that 0.2% polidocanol diluted in 70% hypertonic glucose is a good treatment option for sclerotherapy for reticular veins in lower limbs. This study is important because, although sclerotherapy is the treatment of choice for reticular veins, no consensus has been reached regarding the optimal sclerosant. Further research that compares the safety and efficacy of 0.2% polidocanol in 70% HG with sclerosant solutions typically used in North America would be relevant and valuable to both patients and practitioners alike.

Written by Debra A. Kellen, PhD

Citation: Bertanha, M., Jaldin, R. G., Moura, R., Pimenta, R. E. F., de Oliveira Mariúba, J. V., Lúcio Filho, C. E. P., … & Sobreira, M. L. (2017). Sclerotherapy for Reticular Veins in the Lower Limbs: A Triple-Blind Randomized Clinical Trial. JAMA Dermatology.