Complications of Sclerotherapy

Sclerotherapy is an extremely safe and effective procedure when performed properly.  As with any medical procedures complications can occur. I will review the most common and rare complications.

1) Localized urticaria are small raised hive like bumps that may appear at the injection site, they may feel itchy and may appear red.  They will usually resolve in a few minutes.   Usually patients don’t notice them as soon as they put stockings on.

2) Hyper pigmentation is a brownish discoloration that occurs over the treated vein.  It usually appears a few weeks after treatment.  Hyper pigmentation is due to a hemosiderin (iron) deposition in the skin. Most staining clears gradually in about six months.  Sometimes it will last up to a year and rarely over a year.  Hypertonic saline causes more staining and if a sclerosant is too strong there is more risk of staining.  Sometimes if areas of reflux are not treated (feeding veins) staining can occur.  Certain people with high iron stores are more prone to staining and patients with more pigment in their skin tend to be more prone to staining.  Also patients who are on Minocycline tend to stain.  It is important to drain any trapped blood in treated veins, as the blood is the source of iron.  Treatment for staining is usually tincture of time.   IPL and some laser treatments may speed up the resolution.  Bleaching agents are usually of no help.

3) Matting is an area of blushing or redness that can appear after sclerotherapy.  Matting is made up of very small red telangiectasias or tiny red vessels.  The cause of matting is unknown.  Factors such as obesity or a family history of matting, excess estrogens may predispose to matting.   Sometimes a vein that has not been completely closed may cause matting.  Too strong of a sclerosant, such as hypertonic saline may cause matting and using too much pressure when injecting may cause matting.  Most matting will resolve on its own but at times can remain permanent.   When matting occurs meticulous search for a cause should be sought, this includes ultrasound exam and transillumination to find small feeding veins that may have been missed.  Laser may also work to remove matting.

 4) Cutaneous ulceration is a very rare complication of sclerotherapy.   It is occurs with the use of hypertonic saline most commonly.  Hypertonic saline is a sclerosant that we feel should not be used.  It is not very effective and has numerous drawbacks.  Ulceration can occur with other sclerosants but is very rare.  If a small ulcer develops, they are usually small and will heal within a few weeks.  Ulcers can leave dark shallow scars.

5) Deep venous thrombosis is a very rare complication of sclerotherapy.  Studies have shown that the incidence of DVT is less than the incidence that occurs in the untreated general population.  Important steps to avoid DVTs after sclerotherapy include wearing compression hose and being active.

6) Allergic reactions are very rare complications of sclerotherapy, but can occur with the use of any sclerosant. 

 The most common complications of sclerotherapy are fairly common and often self-limiting.