Sclerotherapy is a common, minimally invasive procedure used to treat spider veins and smaller varicose veins by injecting a sclerosing agent directly into the vessel. This solution irritates the inner lining of the vein, causing it to swell and eventually close off. The body then naturally absorbs the treated, non-functional vein over time. Following this procedure, compression stockings are universally recommended to maximize the treatment’s success and are considered the standard of care for optimal recovery.
The Critical Function of Compression After Sclerotherapy
The primary goal of sclerotherapy is to achieve permanent closure of the treated vein, a process medically known as fibrosis. Compression stockings directly support this process by applying consistent external pressure to the vessel walls. Immediately after the injection, the pressure helps to physically push the treated vein walls together, keeping them in close contact.
This consistent apposition of the walls is necessary for the sclerosant solution to work effectively and for the body’s natural healing response to begin. Compression prevents the treated vein from refilling with blood, which would otherwise push the walls apart and dilute the solution. Preventing blood re-entry is crucial because it allows the irritated lining of the vein to scar down and seal itself shut.
Compression also works to reduce the diameter of the treated vessel and improve blood circulation in the leg. By supporting the surrounding tissue, the stockings help accelerate venous return, or the movement of blood back toward the heart. This improved circulation reduces the pooling of blood in the lower limbs, which is a common issue for people with vein disease.
Furthermore, the mechanical pressure helps to limit the formation of a large blood clot within the treated segment. While a small, contained clot is part of the desired sealing process, minimizing the volume of this clot is important for better long-term cosmetic results and reduced inflammation. The compression effectively manages the inflammatory response caused by the sclerosing agent, leading to a smoother recovery.
Practical Guidelines for Wearing Stockings
Compression must begin immediately after the procedure, often before the patient leaves the treatment office. The initial duration typically involves continuous wear, day and night, for the first 24 to 48 hours to ensure the immediate closure of the treated vessels. Following this initial period, the recommendation is to transition to wearing the stockings only during the day for one to three weeks, depending on the size and number of veins treated.
The specific pressure level required is not one-size-fits-all, but medical-grade stockings are necessary, differing from athletic or fashion compression wear. A common pressure gradient is between 20 to 30 millimeters of mercury (mmHg), though some providers may recommend up to 30 to 40 mmHg for larger varicose veins. Graduated compression is preferred, meaning the stocking is tightest at the ankle and gradually lessens in pressure up the leg to push blood upward.
Proper fitting is paramount; a stocking that is too loose will not provide the necessary therapeutic pressure, and one that is too tight can be uncomfortable or cause skin issues. The length of the garment, whether knee-high or thigh-high, is determined by the highest point of treatment, extending slightly above the treated area. Patients are advised to put the stockings on first thing in the morning when the legs are least swollen and to avoid rolling or folding the top band, which can create a restrictive tourniquet effect.
Risks of Skipping Compression
Failing to adhere to the prescribed compression protocol significantly increases the likelihood of a poor outcome and complications. The most immediate risk is treatment failure, where the treated vein may not fully seal and can reopen, leading to a recurrence of the spider or varicose vein. This happens because blood pressure inside the vessel overcomes the intended closure, nullifying the effect of the injected solution.
A common negative cosmetic consequence of insufficient compression is hyperpigmentation, which appears as brown staining on the skin over the treated area. This discoloration occurs when blood and its breakdown products, particularly iron, leak into the surrounding tissue. The consistent pressure helps to minimize this leakage and accelerate the clearance of these pigments.
Non-compliance also elevates the risk of developing localized complications like superficial thrombophlebitis, where a painful, hard lump forms due to trapped blood within the treated segment. While rare, skipping compression can also slightly increase the risk of deep vein thrombosis (DVT). Overall, the absence of compression can result in increased swelling, bruising, and discomfort, leading to a prolonged recovery period.