Ultrasound Guided Sclerotherapy (UGS) for venous disease has been in use for many years. This is a very successful therapy, especially when used in the treatment of medium to small sized veins, although it can also be used to treat the Great or Small Saphenous Veins and their tributaries, depending on their size.
Using ultrasound guidance, a medicine is injected into the vein. Success rates for the Ultrasound Guided Sclerotherapy procedure compare favourably to published results of surgery. The two products that we use are Polidocanol (Aethoxysklerol) or Fibrovein (Sodium tetradecyl sulphate). Both are detergents and act by washing away the lining of the vein, allowing the two walls to stick together.
This is typically performed by mixing the medicine with air or carbon dioxide to form a foam.
Admission to hospital and anaesthesia are not required. There is usually no need to take time off work and you are able to continue with your everyday activities. The Small Saphenous Vein often responds better to EVLA than to Sclerotherapy. There is a dose limit to the amount of sclerosant that can be injected in a single session and so, on occasion, several sessions may be needed to effectively treat all the diseased veins. This will vary from patient to patient and whether one or both legs are being treated in a single session.
This is not a particularly uncomfortable procedure and is well tolerated, although the amount of discomfort will vary with the individual. The needles used are extremely fine (similar to acupuncture needles) and many are hardly felt at all, while the injected solution can sting slightly for short periods of time. If EVLA (Endovenous Laser Ablation) is used or Phlebectomy performed, then minimal discomfort is experienced as these are performed under local anaesthetic.
Prior to the procedure at our Melbourne clinic, a Sonographer will perform an ultrasound of your leg, similar to the one done at your initial screening, to familiarise us with the veins. Injections are performed with you lying on a treatment couch, which may be tilted at stages through the treatment.
The needles used are very fine and produce minimal discomfort and ultrasound is used to track the injected medicine along the veins that are being treated. After completion, a stocking will be applied to the treated leg. Occasionally, a subcutaneous injection of the anticoagulant drug Clexane may be given.
You will be asked to go for a 20-30 minute walk immediately after treatment.
You can drive to and from the practice on the day of treatment.
Walk for 20-30 minutes each day for 1-2 weeks. Maintain normal daytime activities and avoid standing still for long periods. Avoid strenuous physical activity such as aerobics for 2-3 days after treatment since this increases the risk of blood flow returning into the treated veins. You are required to avoid any flights of longer than 2-4 hours duration for 4 weeks and any flights of greater than 4 hours duration for 6 weeks after treatment. If travel is unavoidable, then anticoagulants should be administered prior to the flight.
The stocking are typically worn continuously for 4 days. They are then worn for a further 3 days through the day, removing them at night and replacing them in the morning after your shower (1 week in total). It is routine practice to perform an ultrasound scan at 2 weeks (occasionally earlier) after treatment to determine that the treated veins have been 100% successfully treated and to exclude the small risk of DVT. If any residual veins are shown, these may require further UGS at a subsequent appointment. It may be necessary to come back once or twice at weekly/fortnightly intervals complete treatment of all veins.
The following features are expected, are transitory and may not occur at all. They are not a cause for concern, although they should be reported at review:
Adverse reactions for UGS are similar to those for EVLA. Complications can occur even with perfect technique.