Ultrasound Guided Sclerotherapy

Ultrasound-guided sclerotherapy is a walk-in/walk-out procedure for the treatment of varicose veins. It involves using an ultrasound to guide a fine needle in to the defective veins, followed by injection of a sclerosant in to the veins to cause them to collapse and clot off. It is often used in conjuction with other procedures such as radiofrequency ablation (to treat varicose veins) and microsclerotherapy (to treat spider veins).

The treatment cannot be performed during pregnancy.

The procedure is performed in Mr Milne's rooms and takes between 15 - 30 minutes, depending on the number of veins needing injection. No anaesthetic is required. You will lie on a treatment couch during the procedure and a gentle tourniquet may be applied to the leg/s being treated.

During ultrasound-guided sclerotherapy, an ultrasonographer will assist Mr Milne with guiding needles in to the varicose veins for injection of a foamed sclerosant. The sclerosant (Aethoxysclerol/polidocanol) acts to damage the lining of the diseased veins, causing them to collapse and clot off. An inflammatory reaction ensues which absorbs the vein over the following months.

Multiple injections are required for each leg being treated, the exact number depends on the extent of disease. It is normal to experience a fine stinging discomfort from the injections. Multiple cotton wool balls will be taped over the injection sites to help maintain compression of the veins and absorb any ooze.

You will be fitted with a full-length class II compression stocking to wear following the procedure.

Please Note:

- Ultrasound-guided sclerotherapy is a highly-effective treatment for varicose veins. Despite optimal filling of veins with sclerosant during treatment, some residual veins may remain at follow up. For optimal results, additional treatment sessions may be required.

- After treatment, it is expected that the varicose veins become hard, lumpy, and a little tender when pushed on. This is a sign of successful treatment. The veins will gradually soften and be absorbed by the body over time. In about 25% of cases, a degree of light-brown pigmentation occurs along the course of treated veins. This typically fades slowly over time. 

You will be asked to walk for 10 - 15 minutes following the procedure before returning home. This clears the deep veins of any residual sclerosant, minimizing the risk of deep vein thrombosis (DVT).

It is important to walk regularly in the days following the procedure. Avoid standing still for prolonged periods. When not mobilising, you can rest with your legs up. Whilst you can return to regular activities the next day, you should hold off on any heavy leg exercises (e.g. running, cycling, gym exercise classes) for 7 days.

The compression stocking should be worn full-time for 48 hours.
After 48 hours, the stocking and cotton wool balls can be removed and the legs washed in the shower with luke warm water. Depending on the case and anatomy, Mr Milne may also arrange for a follow up ultrasound to be done after 48 hours to check for any evidence of DVT. After 48 hours, the compression stocking can be worn during the day for comfort if desired, and removed at night when in bed until day 7.

Large reticular veins and varicose veins treated with Ultrasound-Guded Sclerotherapy are expected to become hard, lumpy, and a little tender when pushed on. This is a sign of successfull treatment. The veins will gradually soften and be absorbed by the body over time.

You will be scheduled for a review appointment with Mr Milne after 6 weeks.

Travelling:

You may travel short distances, under 4 hours, 1 week following the procedure. It is ideal to avoid flights/train/car travel over 4 hours duration for 4 weeks following the procedure. It is important to stay hydrated and walk around the cabin regularly whenever flying.

Headache:

• This occurs occasionally, particularly in people predisposed to migraine. It is treated with aspirin, and usually resolves quickly.

• This occurs with higher doses of sclerosant and usually resolves within 30 minutes.

Fainting:

• This is uncommon, but can occur in patients with needle phobias or those who stand up quickly following the procedure.

Discomfort/bruising/swelling:

• It is normal to expect some discomfort and bruising overlying the treated veins. It is expected that they will be tender to push on. This is related to the procedure itself, but also the inflammatory process which consumes the vein over the weeks to months following the procedure.
• Usually no pain relief is required, but Paracetamol and topical Voltaren gel can be used.
• It is important to stay active during this time. 

• Light-brown staining occurs in about 25% of cases along the course of treated veins.
• This is related to the iron component of blood being absorbed by the skin and usually fades slowly over time. 

Persistent veins:

• A small proportion of patients have veins which do not respond effectively to sclerotherapy, even when using very strong concentrations of sclerosant

• This is rare (<1% of cases)
• If this occurs, a course of oral anticoagulation is prescribed with a follow up ultrasound

Very rare complications (<0.5% of cases):

• Allergic reaction/anaphylaxis
• Ulceration
• Infection

Recurrent veins:

• After successful treatment, the recurrence rate for varicose veins is ~20% in the first 5 years following treatment.
• If this occurs, a repeat ultrasound scan can be performed to determine the nature of recurrence and best treatment option.

Note: A complete and detailed list of potential risks/complications of sclerotherapy (including very rare and extremely rare complications) will be provided at the time of consultation.