June 2, 2010

What is sclerotherapy?

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Dear Dr. Perry,

I'm one of your avid readers. I would like to share my problem with you. I'm 28 years old and married with three children ages 5, 4, and 3. Last December 2009, I underwent vein stripping done by a doctor here in our province. But, to my dismay, my varicose veins have become worse. Behind my left knee, the veins are now protruding and swelling and on my other leg are small spider-like veins.

I'm very worried about my condition. I want to have this treated immediately but I am just a mere government employee.

Please tell me about the possible remedies for varicosities. I've heard of this method called sclerotherapy. How much would this cost and would my varicose veins really disappear? How many hours will the operation take and are there other fees involved?

I hope you will answer this email. I really need your advice. Thank you.

—Name Witheld

Dr. Perry replies:

Sclerotherapy is a procedure where a solution (sodium tetradecyl sulphate or Trombovar) is injected into the varicose veins followed by application of a compression dressing (elastic or tensor bandage). Compared to conventional surgery, it has less morbidity and mortality. However, this can only be used in selected patients who are not allergic to the solution or those without obvious sphenofemoral or sphenopopliteal incompetence.

To check if the patient is a good candidate for the procedure, the following precautions are done: With the patient standing, the most distal point of control is entered and blood is withdrawn into a 1cc. tuberculin syringe containing Trombovar. If the color of the blood is dark (venous) and no pulsation is noticed, the patient is asked to lie down while the surgeon holds the syringe firmly attached to the skin. The leg is elevated and the segment to be injected is isolated and the vein is injected slowly.

After the needle is withdrawn, a cotton wool ball is applied over the needle hole and this is fixed in position with one-inch wide nonallergenic porous tape. The bandage is then applied smoothly but firmly with steadily reducing pressure up the leg.

The procedure is repeated until the last suspected incompetent perforated vein is injected. Trombovar is not given more than six times at any time. If the patient feels the pressure bandage is tight, it should be reapplied before he or she leaves the clinic. The patient is asked to walk immediately following the injections and, if it is possible, to walk 2 km. everyday for six weeks.

Cost of surgery will depend on the severity of the problem. I suggest that you consult a competent surgeon who does this procedure for proper evaluation if you are a good candidate for sclerotherapy.

Dr. Perry de la Cruz obtained his medical degree from the University of Sto. Tomas. He is a diplomate of the Philippine Board of Cosmetic Surgery; a fellow of the Philippine Society for Cosmetic Surgery and the American Academy of Cosmetic Surgery; and a member of the Asian Pacific Academy of Cosmetic Surgery. He pioneered research on "Serial Revision of Leg Scars" in 1988. His clinic is at:

Asian Hospital and Medical Center
Unit 518 Medical Office Building
205 Civic Drive, Alabang, Muntinlupa City
Telephone no. (632) 771-9246

Visit his web site at www.geocities.com/docperryster or e-mail him at docperryster@gmail.com.

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