Sclerotherapy of Leg Veins: Techniques, Complications, and Pigmentation Management

Conclusions

• Sclerotherapy can be performed safely with low rates of serious adverse events when the sclerosant, volume, and technique are carefully matched to the vessel being treated.
• Postsclerotherapy pigmentation is usually driven by trapped or extravasated red blood cells and inflammation, and it is more likely when reflux is not eliminated, injection pressure is excessive, or compression is inadequate.
• Treating the underlying reflux source first is essential, because superficial telangiectasias and matting often will not resolve if proximal venous pressure remains untreated.
• Telangiectatic matting is often a sign of residual reflux or, in some cases, angiogenesis, so management should be guided by duplex evaluation and may require additional sclerotherapy or vascular laser treatment.
• Foam sclerotherapy is generally effective and safer than older liquid techniques for many indications, but higher potency means less volume should be used and rare complications still must be respected.
• Major complications such as ulceration, cutaneous necrosis, arterial injection, DVT, or neurologic events are rare but are more likely when technique is poor, volume is excessive, or foam is injected into larger truncal veins.
• Visualization, gentle injection, minimal pressure, and stopping immediately when blanching or a bleb appears are key practical measures to prevent tissue injury.
• Compression, prompt follow-up, and early drainage of retained coagulum can shorten the course of pigmentation, tenderness, and matting after treatment.
• Residual pigmentation and matting can often improve with time, but persistent cases may need lasers, repeat sclerotherapy, or removal of coagulum.
• Using FDA-approved sclerosants and avoiding compounded nonstandard solutions is important because concentration variability and contamination increase risk without offering a clear benefit.