7 Steps to Safe Treatment of Leg Spider Veins by Sclerotherapy

Microsclerotherapy looks easy, doesn’t it? And yes, for some, with proper hands-on training and a step-by-step approach to injecting leg spider veins, Microsclerotherapy is relatively straightforward. But there is more to treating leg spider veins than simply injecting them.

I am going to cover 7 Simple steps to ensure that the treatment of leg spider veins by micro sclerotherapy is easy, safe and effective. 

So, let’s dive in and towards the end, I will share with you the most common side effect after microsclerotherapy for leg spider vein removal and what you can do about it.

1. Patient Selection for Microsclerotherapy

Before you even pick up a needle and syringe, a thorough patient assessment is crucial.

Assess the patient's medical history, allergies, and any contraindications that might be present.

Examine the patient, both lying down and standing up, and perform any investigations that you think are required such as hand-held Doppler or venous duplex ultrasound. Explain the procedure in detail: its benefits, and potential risks to the patient.

Obtain informed consent in writing. Select your patients well and you will be well on the way to getting great results. If you select the wrong patient, it doesn't matter how good an injector you are, you won’t get great results.

2. Vein Identification For Microsclerotherapy

Carefully check the spider veins that your patient wants to be treated. That’s what they’ve come for, make sure they have those veins treated. Use good lighting and magnification as a routine. You can’t inject veins accurately if you can’t see them properly. 

3. Identify feeder veins - also called reticular veins.

I find a Transillumination device such as Veinlite® to be very helpful in this respect. Having identified any reticular veins near your spider veins, make sure that you are going to treat these first. Make sure that you inject the spider veins and the associated reticular veins as part of the Microsclerotherapy treatment process.

4. Microsclerotherapy Injection Technique

Accurate injection is vital. These veins are tiny. Stretch the skin and insert the fine-gauge needle into the vein using a gentle, controlled motion. Ensure you're entering the vein at the proper angle. Slowly inject a small amount of microsclerotherapy sclerosant solution, looking for blebs, and taking care not to overfill the vein. Stop immediately if your patient experiences any pain. A useful mnemonic is low, slow, low: low volumes of sclerosant, slow injection and low concentrations of sclerosant.

5. Needle Removal and Compression after Microsclerotherapy

Once the injection is complete in that particular area, withdraw the needle slowly and apply gentle pressure with a sterile gauze. This helps prevent leakage of the solution into surrounding tissues and it promotes optimal vein closure. You might also want to massage the treated area and disperse the sclerosant solution evenly within the vein.

6. Microsclerotherapy Aftercare

Make sure your patient understands what will happen after the treatment session. Here, it is very helpful for you to give your patient written information to take away, which will reinforce what is likely to happen, what your patient should look for and what they can expect during the healing process, and give them contact details, how and when to contact you should they have any concerns. 

7. Microsclerotherapy Documentation

Arrange the Follow-up and complete the documentation. I think you should do this before the patient leaves and also arrange a follow-up appointment with your patient. You can check on their progress and you can address any concerns. Also, before your patient leaves, document the procedure details carefully: which areas of the leg you treated, what sclerosant you used, what the strength was, the expiry date, batch number and document any reactions that your patient may have had, did they find it particularly painful, where there any blebs during the procedure? Accurate documentation is very important for medico-legal reasons and also to help you assess their progress at subsequent follow-up.  

Summary of 7 Simple Microsclerotherapy Steps

And there you have it - Microsclerotherapy Made Simple in 7 steps. Remember that patient selection, constant practice, precise accurate injections, and good patient care are paramount in mastering the whole process of microsclerotherapy for leg spider veins.

In the beginning, I told you I was also going to share with you what I think is the most common side effect patients have after microsclerotherapy and what you can do about it. Well in my experience, it is that patients are often surprised and sometimes even alarmed when they look at their spider veins a week or two afterwards and see that they actually look worse. 

Even after a careful explanation of the process at the initial consultation, many people after microsclerotherapy are alarmed at the appearance of their legs. These injections are not going to get rid of spider veins immediately. Microsclerotherapy is not a quick fix for spider veins, it’s a process - 2 or 3 injection sessions may be required with a gap of 6 to 12 weeks.

To anticipate this side effect of Microsclerotherapy, be sure to emphasise at your initial consultation that for up to a month after their injection session, their spider veins may look worse, considerably worse actually. This is important for two reasons: firstly it will help manage your patient’s expectations. The other reason that it is important is that your patient may wish to defer treatment because they have an important upcoming social event or they're about to go on holiday. 

I find it really helpful to see my patients about two weeks after their Microsclerotherapy session as a routine.  I can then reassure them that the appearance of their spider veins at this stage of the healing process is normal and if there is any clot formed within the vessel,  I can then release it at this stage - a process called micro-thrombectomy - and this will reduce the risks of pigmentation after the treatment. Micro-thrombectomy involves pricking any excessive clot formation with a needle and releasing it. 

If you are interested in learning more, here's a link to my free mini course “How to Inject Leg Spider Veins and Blue Veins by Microsclerotherapy”, where you will find more tips for successful injections.