Sclerotherapy (Varicose veins treatment) : Best costs in Turkey

What are varicose veins and when do they become a medical problem?

Varicose veins are abnormally dilated, tortuous superficial veins caused by incompetent venous valves that allow blood to pool in the lower limbs rather than returning efficiently to the heart. They are a manifestation of chronic venous insufficiency (CVI), a condition that, if left untreated, can progress well beyond cosmetic inconvenience.

According to the American Heart Association, venous insufficiency affects approximately 40% of adults over 50. The CEAP classification (C0–C6) is the internationally accepted grading system for chronic venous disease severity, used by phlebologists worldwide to determine the appropriate treatment.

The CEAP classification: stages of chronic venous disease:

• C0 - No visible venous signs (symptoms only).
• C1 - Telangiectasias or reticular veins (spider veins, purely cosmetic stage).
• C2 - Varicose veins (dilated veins > 3 mm).
• C3 - Oedema (ankle and leg swelling).
• C4a/b - Skin changes (pigmentation, eczema, lipodermatosclerosis).
• C5/C6 - Healed or active venous ulcer, urgent specialist referral required.

Source: Eklöf B, et al. Revision of the CEAP classification for chronic venous disorders. Journal of Vascular Surgery, 2004;40(6):1248-1252.

What is sclerotherapy and how exactly does it work?

Sclerotherapy is a minimally invasive, non-surgical procedure that eliminates unwanted varicose veins and spider veins (telangiectasias) by injecting a chemical solution, called a sclerosant, directly into the affected vein. The sclerosant damages the vein's inner lining, causing it to swell, shut, collapse, and gradually be reabsorbed by the body.

The most commonly used sclerosing agents are polidocanol (Aethoxysclerol) and sodium tetradecyl sulfate (STS),both approved by the FDA and widely used across Europe under ESVS guidelines. Within 4 to 6 weeks of treatment, treated veins fade and become invisible.

A 2021 Cochrane systematic review confirmed sclerotherapy as more effective than compression stockings alone for symptomatic varicose veins, and broadly comparable in short-to-medium term outcomes to endovenous laser ablation (EVLA) for small-to-medium diameter varicosities.

Who is a good candidate for sclerotherapy and who should not have it?

Sclerotherapy is suitable for a wide range of venous conditions, but it is not appropriate for everyone. Here is a clinically structured eligibility overview:

All Turquie Santé partner centres perform a pre-treatment assessment, including a duplex ultrasound scan to identify the underlying source of reflux before proceeding with sclerotherapy. Treating only the surface veins without addressing deep reflux increases the risk of recurrence.

What sclerotherapy techniques are available and which is right for you?

Modern sclerotherapy has evolved significantly beyond simple liquid injection. The technique chosen depends on the size, depth, and location of the vein to be treated. Here's a structured overview:

Technique selection is determined by the treating phlebologist or dermatologist following a duplex ultrasound assessment. Most patients receive a combination of techniques in a single or multiple sessions.

How is sclerotherapy performed in Turkey: step by step?

Here's what you can expect during your sclerotherapy session in Turkey:

1. Pre-procedure duplex ultrasound: The phlebologist maps the venous anatomy and identifies reflux points, perforator veins, and the appropriate injection sites.
2. Patient positioning: You lie on a treatment table, typically with legs slightly elevated. No anaesthesia is required.
3. Injection: A very fine needle (typically 26-30 gauge) is used to inject the sclerosant directly into the target vein. For foam sclerotherapy, the liquid is pre-mixed with air or CO₂ to create a foam that provides greater contact with the vein wall.
4. Compression: A compression bandage or stocking is applied immediately after treatment to keep the vein walls in contact and prevent reflux during healing.
5. Walking: You are asked to walk for 30-60 minutes immediately after the session to promote venous flow and reduce the risk of deep vein thrombosis.
6. Discharge: Sclerotherapy is entirely outpatient. You return to your hotel the same day. Most Turquie Santé patients include their session in a 2-3 day Istanbul itinerary.

Total procedure time: 15 to 60 minutes per session, depending on the technique and the area treated. No hospitalisation, no general anaesthesia, no sutures.

What is the recovery like after sclerotherapy?

One of the reasons sclerotherapy remains the most popular minimally invasive vein treatment worldwide is its minimal downtime. Here's what to expect:

Important: compression stockings must be worn continuously for 48-72 hours after treatment (or as directed by your physician). Walking should begin immediately and continue daily throughout recovery. Prolonged immobility, hot baths, and saunas should be avoided for the first 2 weeks.

What are the risks and side effects of sclerotherapy?

Sclerotherapy is considered safe and minimally invasive, especially when performed in accredited centres, but like any procedure, it carries some potential side effects. Most are temporary and mild, while serious complications are rare.

Common, expected and temporary side effects

• Bruising at injection sites typically resolves in 1-2 weeks.
• Temporary hyperpigmentation (skin darkening over treated vein),fades in most patients within 3-6 months.
• Vein hardening / tenderness, the treated vein may feel firm for several weeks as it is absorbed.
• Mild inflammation and redness around injection sites resolve within days.
• Telangiectatic matting; appearance of new fine capillaries near the treated area in a small proportion of patients.

Uncommon but serious reactions (<2% at accredited centres)

• Allergic reaction to sclerosant (urticaria, bronchospasm),patch testing available for high-risk patients.
• Phlebitis (superficial thrombophlebitis),treated with anti-inflammatories and compression.
• Skin ulceration at the injection site, rare, associated with inadvertent peri-vascular injection.
• Neurological disturbances (headache, visual disturbances, transient ischaemic attack),reported in very rare cases of foam sclerotherapy, related to patent foramen ovale.
• Deep vein thrombosis, very rare; risk minimised by post-procedure walking and compression.

Clinical reference: van den Bos RR, et al. Endovenous therapies for lower extremity varicosities: A meta-analysis. Journal of Vascular Surgery, 2009. Sclerotherapy complication rates <2% in experienced centres.