ULTRASOUND GUIDED SCLEROTHERAPY

Introduction

Sclerotherapy is a treatment that uses a sclerosing agent to treat blood vessels that are not functioning correctly, for example varicose veins. Sclerosing agents are generally either a liquid or a foam which are introduced into the vein.

Sclerotherapy is primarily used to treat spider veins and smaller varicose veins (although it can be used for larger veins), and the technique has been in use for this purpose since the mid-1800s.

The sclerosing agent works once it has been injected into the vein by irritating the vein wall lining, resulting in the vein shutting off so that blood can no longer flow in that vein. As the venous system allows multiple different paths for blood to flow via different veins, the loss of the affected vein does not impact overall blood flow in the body.

The modern technique involves the use of ultrasound to guide the doctor as they introduce the sclerosing agent into the vein, and so it is referred to as 'Ultrasound Guided Sclerotherapy' or simply 'UGS'.

It is a minimally invasive treatment only requiring small incisions, as opposed to open surgery which requires larger incisions. As a result, the procedure is fairly quick (normally less than half an hour to complete) and no anaesthetic is required as there is either little or no pain during the procedure.

This means that most patients are able to leave straight after the procedure and return to normal activities. This is in contrast to alternative procedures, such as 'surgical stripping' which is more invasive and requires a longer recovery period.

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Preoperative instructions

Little preparation is required before this procedure. It is advisable to avoid exposing the skin of the affected part of the body to sunlight or tanning for a 14-day period both before and after the procedure - this is to minimise skin discolouration.

On the day of the procedure you should not use any creams or moisturiser on the affected area and avoid tight clothing or footwear to allow the wearing of a special compression stocking immediately after treatment.

Procedure

Although the procedure itself takes no longer than 30 minutes, you should allow at least an hour to include preparation, including a duplex ultrasound examination, which creates a map of the veins in the leg.

For the procedure you lie down on a treatment bed with the affected leg exposed. A fine needle is then slowed introduced into the affected vein and the sclerosing agent is injected at around 2-3cm at a time until the entire vein is treated. Sometimes a number of injections sites are needed to treat an entire vein.

Once complete, the (final) needle is removed and a compression bandage is applied. During the entire procedure the doctor is guided by real-time images on the ultrasound monitor.

Postoperative instructions

Straight after treatment patients are advised to go for a 20-40 minute walk - this is to encourage blood flow into the larger veins.

For optimal recovery patients should go for a 20-30 minute walk every day for the 10-14 days after the procedure. Normal activity can be resumed immediately, however it's important to avoid long periods standing still and strenuous physical exertion should be avoided during the 2-3 days immediately after the procedure.

The compression stockings should be worn regularly as directed by your vein specialist.

It is advisable to avoid any long-distance air travel (i.e. flights of over four hours) during the six week period after the procedure. If a flight is absolutely necessary, anticoagulant medication may be taken prior to the flight/s, but should be discussed with your doctor.

A follow up appointment will be made for 7-14 days after treatment. This is to check that the treatment worked successfully (via an ultrasound scan) and to treat any residual varicose or spider veins using a technique called microsclerotherapy. Very occasionally a series of appointments may be required to complete the treatment.

Risks

UGS is regarded as a low risk procedure. If any of the following occur after undergoing UGS you should seek urgent medical attention:

Chest pain (this may indicate DVT / pulmonary embolism)

Formation of small ulcers or wounds at injection site

Swelling in either or both legs

Acute inflammation/swelling in the treatment area

It is normal for there to be a low level of discomfort affecting the area treated. This may persist for 3-5 days and can be relieved with pain medication or by taking a walk. Similarly, skin discolouration or small tender lumps may appear after the procedure and these generally disappear within six weeks.