Asclera Spider Vein Treatments

What Is Asclera® (pronounced a skler ah)?

Asclera® (polidocanol) Injection is a prescription medicine that is used in a procedure called sclerotherapy and is administered by a healthcare provider to treat two types of veins:

  • Uncomplicated spider veins (very small varicose veins ≤ 1 mm in diameter)
  • Uncomplicated small varicose veins (1 to 3 mm in diameter) known as reticular veins<
Asclera® is a sclerosing agent that is injected into the vein. It works by damaging the endothelium, the cells lining the inside of blood vessels. This causes blood platelets and cellular debris to attach to the lining of the vessels; eventually, cellular debris and platelets cause the blood vessel to clot. Over time, the clotted vein will be replaced with tissue.
How Does Asclera® Work?
What are spider veins?
Spider veins are very small and very fine red or blue veins. They are closer to the surface of the skin than varicose veins. They can look like a thin red line, tree branches or spider webs. Spider veins can be found on the legs and face and may cover a small or large area.
What are reticular veins?
Reticular veins, also be known as feeder veins, are the blue and green veins beneath the surface of the skin. Reticular veins enlarge because of increased pressure in the vein. You may have reticular veins alone but you may also have spider veins at the same time.
What are varicose veins?
Varicose veins are large blue or dark purple veins. They protrude from the skins surface and many times have a cord-like appearance and may twist or bulge under the skin. Any vein may become varicose, but the veins most commonly affected are those in your legs and feet.
What causes spider and reticular veins?

Spider and reticular veins can be caused by many factors such as the following:

  • Heredity. Having a family member with prominent veins may increase the risk of you developing them. Approximately half of the people who get varicose veins have a family history of them.
  • Age. The normal wear and tear of aging may cause valves in the veins to weaken and not work as well.
  • Gender. Women are two to three times more likely to develop varicose veins than men. Up to half of American women have varicose veins. Changes in hormones due to puberty, pregnancy, menopause, or taking birth control pills may increase a woman’s risk of developing varicose veins.
  • Pregnancy. During pregnancy, the growth of the fetus increases the pressure on the veins in the legs. Varicose veins that occur during pregnancy usually improve within 3 to 12 months following delivery.
  • Overweight and obesity. Having extra weight on the body can put additional pressure on the veins.
  • Prolonged standing or sitting. This is particularly true with legs bent or crossed. When standing or sitting with legs bent or crossed, the veins have to work harder to pump the blood up to the heart.
  • Other possible causes for varicose veins are race, posture, occupation, hormones such as estrogen and progesterone, primary valvular incompetence, and incompetent perforating veins.
What is sclerotherapy?

Sclerotherapy is a minimally invasive procedure administered to treat uncomplicated spider veins and uncomplicated reticular veins. The treatment involves Dr. Thomas injecting the Asclera solution with a small needle directly into the affected veins. The number of injections you receive will depend on the number of spider or varicose veins being treated. Asclera must be injected slowly into the vein. Dr. Thomas will apply slight pressure to the vein during an injection. After the needle is removed from the vein, a compression bandage will be placed on the area to prevent blood clots from forming. When your treatment session is finished, Dr. Thomas will want you to walk around for 15 or 20 minutes and he will also want you to wear compression stockings. He may also instruct you to take daily walks for a few days after your treatment with Asclera. You may need to wear compression stockings for several days or weeks after your treatment with Asclera. Carefully follow Dr. Thomas’s instructions about caring for yourself after receiving this medication.

It is usually recommended to maintain graduated compression as follows:

  • 2-3 days after treatment of spider veins
  • 5-7 days after treatment of reticular veins
  • For extensive varicosities, longer compression treatment is recommended
  • Post-treatment compression is necessary to reduce the risk of deep vein thrombosis.

You may also need additional treatment sessions with Asclera to best treat the veins. It is recommended that at least 1 week should pass between treatment sessions.

What should I avoid?

Patients should avoid heavy or strenuous exercise for 2 or 3 days after treatment. We also recommend to avoid sitting for long periods of time, such as long-distance travel in a car or on an airplane. Lastly, patients should also avoid exposure to sunlight, tanning beds, hot tubs, or saunas for 2 or 3 days after your treatment. We also recommend that you do not use ice or a heating pad on your treated leg without the doctor’s advice.

Are there any possible side effects to Asclera® treatments?

Yes, they may include:

  • Severe allergic reactions have been reported following polidocanol use, including anaphylactic reactions, some of them fatal. Severe reactions are most frequent with use of larger volumes (> 3 mL). The dose of polidocanol should therefore be minimized. A doctor should be prepared to treat anaphylaxis appropriately.
  • In rare cases, formation of small “burns” or ulcers form, usually due to leakage of Asclera® into the skin. They heal in time, but may leave a scar.
  • Inadvertent perivascular injection of Asclera® can cause pain. If pain is severe, a local anesthetic (without adrenaline) may be injected.

*You should tell your doctor about all the medicines you are taking, including prescription and nonprescription medicines, vitamins and herbal products.


You should not be treated with Asclera® if you:

  • Have a known allergy to polidocanol
  • Have an acute vein or blood clotting (thromboembolic) disease
  • Are pregnant or nursing

Indication:
Asclera® (polidocanol) Injection is a prescription medicine that is used in a procedure called sclerotherapy to remove unwanted veins on your legs. It is administered by a healthcare provider to treat two types of veins:

  • Uncomplicated spider veins (very small varicose veins ≤ 1 mm in diameter)
  • Uncomplicated small varicose veins (1 to 3 mm in diameter) known as reticular veins

Asclera® has not been studied in varicose veins more than 3 mm in diameter.

IMPORTANT SAFETY INFORMATION FOR PATIENTS:

For intravenous use only.

CONTRAINDICATIONS: Asclera® (polidocanol) Injection is contraindicated for patients with known allergy (anaphylaxis) to polidocanol and patients with acute vein and blood clotting diseases.

WARNINGS AND PRECAUTIONS:
Anaphylaxis: Severe allergic reactions have been reported following polidocanol use, including anaphylactic reactions, some of them fatal. Severe reactions are most frequent with use of larger volumes (> 3 mL). The dose of polidocanol should therefore be minimized.Please notify your healthcare provider if you have a known history of severe allergies or allergy to polidocanol.

Accidental injection into an artery can cause severe necrosis, ischemia or gangrene. If this occurs, consult your healthcare provider or a vascular surgeon immediately.

Unintentional injection of Asclera® outside of the vein can cause pain. If pain is severe, a local anesthetic (without adrenaline) may be injected by your healthcare provider.

Severe adverse local effects, including tissue necrosis, may occur following flow of the product outside of the vein; therefore, the smallest effective volume at each injection site should be used.

After the injection session is completed, apply compression with a stocking or bandage, and walk for 15- 20 minutes. Your healthcare provider will provide monitoring during this period to treat any possible anaphylactic or allergic reactions.

Maintain compression for 2 to 3 days after treatment of spider veins and for 5 to 7 days for reticular veins, or as directed by your Healthcare Provider. For extensive varicosities, longer compression treatment with compression bandages or a gradient compression stocking of a higher compression class is recommended. Post-treatment compression is necessary to reduce the risk of deep vein thrombosis.

ADVERSE REACTIONS: In clinical studies, the following adverse reactions were observed after using Asclera® and were more common with Asclera® than placebo: injection site hematoma, injection site irritation, injection site discoloration, injection site pain, injection site itching, injection site warmth, neovascularization, injection site clotting.