ULTRASOUND GUIDED SCLEROTHERAPY
Ultrasound guided sclerotherapy was developed in Australia, USA, Canada and
France in the late 1980s. It is the process of injecting varicose veins that are visible
on the ultrasound monitor but are not visible externally. It enables the eradication of
medium sized varicose veins as a rooms procedure. Patients do not lose time or
income from work, are able to continue normal daily activities, do not undergo
anaesthesia or hospitalisation and have no stitches or scars. This is achieved with a
procedure that takes about half an hour. Abnormal reverse flow of blood back into
the leg (reflux) is the fundamental problem of varicose veins. UGS eradicates reflux
by closing the veins.
Sclerotherapy is the injection of a solution (sclerosant) into varicose or smaller veins
to cause them to close and subsequently disappear. This practice has been used for
many years to treat varicose veins and surface veins.
There is no limit to the size of varicose veins that can be treated by this method,
though larger veins respond better to endovenous laser. The superior safety and
cost effectiveness of ultrasound guided sclerotherapy should be considered when a
choice of treatment exists. Over the past 15 years the understanding, application and
refinement of sclerotherapy techniques has created a very safe and effective
treatment for varicose veins.
Following the initial consultation and assessment, a duplex Doppler study is required
to create a map of the superficial veins and to assess the competence of deep veins.
This is essential information that enables treatment of all sources of reflux. The map
is our guide during the treatment and is a reference point should varicosities occur.
PROCEDURE
Ultrasound guided sclerotherapy usually involves up to 10 injections into the
saphenousvein – most commonly from the groin to the knee. The sclerosant is
injected as a foam which provides extensive coverage of the varicose veins with
small doses of sclerosant. Afterwards, a compression stocking is worn for 2 weeks.
A 30 minute daily walk is mandatory. Patients are reviewed in 6 weeks and 6 months
after the initial treatment. Side effects and complications are similar to those for
standard sclerotherapy.
People who are prone to developing varicosities may develop more with time. With
proper assessment, non-surgical techniques should achieve the best possible results
for the longest period of time with minimal risk and discomfort.
The cost of the procedure does not include subsequent treatments for cosmetic
surface veins. A Medicare rebate is available for ultrasound guided sclerotherapy.
BEFORE TREATMENT
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You will be asked to sign a consent form for the procedure.
The leg is commonly treated from the skin crease of the groin to the ankle and
needs to be accessible. This enables the effectiveness of the procedure to be
assessed along the entire length of the veins to be treated.
Moisturiser on the skin does not affect the treatment.
AFTER TREATMENT
To ensure the success of the treatment it is essential to observe the following
instructions.
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You are able to drive home after the procedure.
Walk for at least half an hour a day for 6 weeks.
Continue to wear the stockings during the daytime.
Avoid standing still for long periods of time if practical.
You will be able to carry on with your normal lifestyle, however, you should
avoid vigorous exercise or strenuous activities (such as tennis and aerobics)
for the first few days after treatment.
You may experience slight aching/pain in the legs in the first few days after
treatment. If this occurs, take 2 Nurofen tablets three times daily. Do not
specifically rest and continue to walk as before. If you have any severe or
continuous pain or swelling of the leg please contact us on 4227 2000.
Should the stocking cause any disturbance at night, remove it. The stocking is
far less important when lying flat.
Trapped blood is relatively common. The treated veins can become firm, red.
And/or tender up to 3 months after the procedure. This is unpleasant but not
serious. If it causes significant pain contact the clinic as trapped blood can
usually be released and the symptoms improved. It may look infected,
however antibiotics are inappropriate (unless you have a fever). It generally
resolves in a week or so and normally responds well to anti-inflammatory
tablets.
Follow-up appointments will be made for you following treatment. Please
ensure you keep these appointments so that Dr Mizori can review your
progress.
COMPLICATIONS
The common side effects and complications are:
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Blood trapping can form tender lumps along the course of treated varicose
veins. It is harmless but may be tender, red, and angry. Blood can be drained
from these lumps by needle prick. This can occur 1-12 weeks after the
procedure and will hasten the resolution of any tenderness and help prevent
pigmentation of the skin. Blood trapping is most common in large varicose
veins.
Aching in the leg can occur during the treatment and for the first day or two
following treatment. It is more common following the treatment of larger
varicose veins and is usually relieved by walking. Nurofen, Voltaren rapid or
Panadol tablets may be taken if necessary.
Brown lines or mark on the skin at the sites of treated veins can occur when
blood breaks down , leaving iron behind in the skin. These pigmented areas
are composed of haemosiderin, an iron containing pigment, and are common
in patients who have navy-blue spider veins treated. This will generally
disappear within months, occasionally longer. In a small percentage of
patients it can persist for years.
Matting is the name given to networks of fine red veins which develop near
the site(s) of previous injections. The thighs are the most common site. Some
areas of matting resolve spontaneously, and some resolve with further
treatment. Matting is more common in patients with extensive surface veins,
patients who are overweight or have a very fair complexion.
If you have any questions, concerns, or problems please contact South Coast Skin &
Vein Clinic on 4227 2000.