Sclerotherapy

Direct Vision Sclerotherapy

This is the treatment of small spider veins using injections of a solution (sclerosant) that cause the veins to collapse and be absorbed. This procedure is well-tolerated and does not require any anaesthetic. You may feel a stinging sensation for a few moments after the solution enters the vein. The discomfort is transient and will settle after a few minutes. This treatment takes approximately 30 minutes and you may need from one to three treatments per leg depending on your condition. Treatment success depends on age, severity, other concurrent medical conditions and healing rate but most patients see an impressive improvement.

Ultrasound Guided Sclerotherapy (UGS)

This procedure is a breakthrough in the management of advanced varicose vein disease, using duplex ultrasound to precisely locate the abnormal veins as well as the adjacent structures such as deep veins and arteries. The doctor injects a precise amount of the solution in the abnormal vein while watching the whole process on the ultrasound monitor, enabling real-time visualisation and tracking of the solution. This ensures that the sclerosant is delivered to the vein rather than to adjacent structures, increasing the success and the safety of the procedure. A number of injections, all monitored by the ultrasound, are usually required along the length of the vein to achieve complete sealing of the abnormal vein. This treatment takes approximately 30 minutes.

Catheter Directed Sclerotherapy (CDS)

This technique involves using a catheter under ultrasound guidance to inject the sclerosants. We use this technique to treat the lower half of the Great or Small Saphenous veins and any other long segments. A needle is put in the vein through which a fine catheter is inserted and advanced along the whole length of the abnormal vein. Local anaesthetic is then injected around the vein to compress the vein down. The sclerosant is then injected via the catheter while the catheter is being withdrawn. This way large veins can be treated successfully using one entry point only. This technique was developed by Dr Parsi in 1997 and has been adopted internationally.

Solutions used for injections

The solutions used are modern sclerosants that are used in Australia including Sodium Tetradecyl Sulphate (FIBRO-VEIN) and Polidocanol (AETHOXYSKLEROL).These are available in liquid form but for large veins injected under ultrasound, we may use them in a foam form. Please note the doctor will make up the foam during the procedure. Using the product in the foam format (rather than liquid) is an off-label use of the product but international experience and research shows that it is safer and a more effective option when compared to liquid.

After the Procedure

A compression stocking will be fitted at the end of the procedure. You will then be required to walk for 30 minutes at a moderate pace immediately after the procedure and then on a daily basis. A routine deep vein thrombosis (DVT) scan may be scheduled for you within seven days.

Recovery

How soon will you see an improvement after the varicose vein treatment? Be patient - the treated veins will look worse before they improve. The injection associated discoloration and bruising may last for a few weeks and there will be some darkening of the veins due to retained blood within the treated vessel. In the first month, the treated leg may look worse but is mostly covered by the compression stockings. In the second month when the leg is out of compression, patients may notice ‘hot spots’ or phlebitis (inflammation of the vein) along the course of the treated vein. This settles with short-term compression and anti-inflammatory medications that the doctor may wish to prescribe. From the third month onwards, the treated vein will progressively soften and clear. Spider veins and small green veins will clear within 2-3 months. Large varicose veins may take up to 6 months or more to fully resolve.

Further treatments

The number of treatments needed to clear or improve the condition differs from patient to patient. One to three treatments per leg may be required to remove the varicose veins and the same number of treatments may be required to remove the spider veins.

Exercise

This is a critical part of your recovery. You must complete a daily 30-minute walk. This promotes the development of new blood flow, and helps with healing of the treated areas. Doing more than 30 minutes may be counter-productive and you should certainly not go for a bushwalk lasting a whole day! Also avoid strenuous exercise such as running, aerobics, cycling, and do not lift heavy weights and do not perform any activity that would raise your heart rate above 120 beats per minute. Yoga and Pilates involving the legs should be avoided during the treatment period.

Compression Stockings

Compression is a very important part of your treatment, preventing excessive bruising, reducing the pain and soreness, preventing blood clots and unwanted complications such as staining and matting. You must wear the stockings for the stipulated time which is usually one to two weeks after each procedure. Stocking should be worn day and night with no interruption for the first 2 days. Then they can be taken off for a quick short (and not too hot) shower. After that they should be worn for the remaining of the first week day and night and during the second week day only. In certain circumstances we request the stockings to be worn day and night for 2 weeks. Also following certain procedures we apply compression bandaging over the stockings that should be maintained for 48 hours.

Travel

Due to the potential risk of clotting, you should not fly or travel for more than 5 hours in one journey within 4 weeks of your procedure. Shorter trips are allowed but when you do travel, wear your compression stockings, take regular breaks, stretch and walk for 10 minutes every 2 hours.

Treatment Follow-up

It is important to detect signs of any early recurrence. We therefore have a strict protocol of follow-up examinations at 6 weeks after the completion of the treatment course and then anything between 6 months to 1 year. The followup will include a fresh ultrasound map and a clinical examination by the treating doctor.

Medications and Supplements

There are several medications and supplements that you should cease before and during the treatment period. Some of these medications increase the tendency to bleeding and may increase the post-treatment bruising. Any bruising is temporary and will not compromise the effectiveness of treatment. Iron can increase the risk of staining which can persist for many months. Female hormones (contraceptive, hormone replacement therapy [HRT]) can increase the risk of clots and matting (lots of small capillaries growing on the skin surface) and should be stopped a month before the treatment. If you are on any of these medications or supplements please discuss this with your doctor.

For more information on 'What to expect and possible side effects of sclerotherapy' Click Here.

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