Sclerotherapy is a common, minimally invasive procedure used to treat visible varicose and spider veins. It involves injecting a liquid or foam solution, known as a sclerosant, directly into the affected vessels. This solution irritates the vein’s inner lining, causing it to swell, collapse, and seal shut. Successful treatment requires specialized compression stockings, as applying external pressure is necessary to achieve the desired therapeutic outcome.
The Mechanism of Compression After Sclerotherapy
Compression stockings apply a controlled amount of external pressure to the leg immediately following the injection. This mechanical force physically collapses the walls of the treated vein, ensuring the procedure’s success. By keeping the vessel walls pressed together, compression prevents blood from re-entering the treated segment. This focused pressure maximizes the contact time between the sclerosant chemical and the vessel’s inner lining, known as the endothelium.
Prolonged contact with the sclerosant initiates fibrosis, the formation of scar tissue inside the vein, leading to its permanent closure. Without adequate compression, blood flow could wash the sclerosant away, allowing the vein to reopen. Lack of compression may also encourage blood clot formation, potentially leading to post-procedure complications like hyperpigmentation or bruising. Compression also supports the surrounding tissues, helping to reduce swelling and discomfort.
Determining the Required Compression Strength
The appropriate compression strength is measured in millimeters of mercury (mmHg) and is determined by the treating physician based on the patient’s anatomy and the extent of the vein disease. Compression levels are generally categorized, and the lowest effective strength is often preferred to promote patient comfort and adherence to the regimen.
Compression Levels
For very small spider veins, or telangiectasias, a lighter compression level of 15–20 mmHg may be adequate. This level provides mild support and is considered a prophylactic or over-the-counter strength.
For treating larger spider veins, reticular veins, or most small-to-medium varicose veins, the standard recommendation falls into the moderate compression range of 20–30 mmHg. This is the most common strength prescribed following routine sclerotherapy procedures because it provides sufficient pressure to maintain vein closure without being excessively difficult to wear.
In cases involving very large varicose veins, particularly when foam sclerotherapy is used, some specialists may prescribe a firmer compression of 30–40 mmHg. This is less common due to the difficulty patients often experience in putting on such a tight garment.
Duration and Schedule for Post-Procedure Wear
The total duration and daily schedule for wearing compression stockings are typically divided into two distinct phases. Immediately following the procedure, patients are instructed to wear the stockings continuously, even while sleeping, for a period ranging from 24 to 72 hours. This initial, uninterrupted compression is designed to maximize the effectiveness of the sclerosant and minimize the risk of the treated vein reopening.
After this initial continuous phase, the regimen transitions to a daytime-only schedule for the remainder of the recovery period. This secondary phase usually lasts between one and three weeks, depending on the size and number of veins treated. Patients are advised to keep the stockings on whenever they are upright or active, removing them only for bathing and sleeping at night.
Practical Advice for Stocking Fit and Use
Proper sizing is the most important practical aspect of compression therapy, as an incorrect fit can negate the therapeutic benefit or cause discomfort. Compression stockings are sized based on specific circumference measurements of the ankle, calf, and sometimes the thigh, not on shoe size or general clothing size. Measurements should ideally be taken by a professional to ensure the pressure profile is correctly applied to the leg.
Effective compression relies on a principle called graduated compression, meaning the stocking is tightest at the ankle and gradually decreases in pressure as it moves up the leg. This gradient helps push blood upward toward the heart against gravity. When wearing the stockings, it is important to smooth out any wrinkles, folds, or bunching, especially behind the knee or around the ankle, as these can create localized pressure points that may impede circulation. For higher-strength stockings, specialized donning aids can be helpful to overcome the significant resistance and make them easier to apply.