Sclerotherapy for Varicose Veins
Sclerotherapy is when a chemical is injected into the veins to destroy it. It is done in outpatient setting, therefore does not require an anaesthetic and you can resume normal activities the following day. An ultrasound machine is commonly used on larger veins to guide the injection process and the chemical as foam is injected. The number of needles (injections) can vary from 3 to 10 depending on the amount treated and number of legs treated. Following the procedure, you need to wear stockings for two weeks.
Sclerotherapy is effective, but when treating large areas or large veins, it requires multiple injections and may need to be repeated every few years as it has higher recurrence rate compared with other options.
What are the benefits of this procedure?
The procedure provides a less invasive, non surgical treatment option for varicose veins. It is preformed as outpatient setting with no general anaesthesia or hospitalisation required. Most people can return to work the following day and causes minimal disruption to your life. For patients with multiple coexisting medical problems it provides a safe alternative to surgery.
Are there any alternatives to this procedure?
- Elastic compression hosiery (stockings) long term. They help to relieve the pain and swelling in your leg and shown to effective to heal ulcers. It is as effective as any of the other treatments.
- Surgery involves an anaesthetic (general or spinal) and cut in the groin. The vein is then stripped out. Multiple tiny cuts are made in the calf to remove all the varicose veins. It is high effective treatment in one setting. It is done as day stay procedure and patients need a week or two to recovery time.
- Radio-frequency and Endovenous Laser treatments involve destroying the vein under local anaesthetic. A catheter is inserted using ultrasound and heated to destroy the vein from the inside.
It is important to have a discussion with your surgeon about which option is right for you and the potential benefits, limitations of injections.
What is involved?
Prior to you procedure you will need a duplex scan of the veins. A duplex scan is similar to an ultrasound scan in which jelly is placed on your legs and a detailed picture to show the veins and identify where the problem areas.
Well fitting compression stockings are an important part of the post injection regime and therefore you should have your stocking available to put on immediately after you injection.
The procedure will take place in the Out Patient’s Department. Although the procedure will take approximately 45mins to 1 hour you should allow 2 to 3 hours for the visit. You should wear loose trousers, shorts or skirts to your appointment as stockings will need to fit under them. Please wear flat shoes so that you can walk comfortably after the procedure.
A fine needle is used and guided by ultrasound. The ultrasound probe is able to track the needle entering the vein and ensure the injection takes place in the appropriate place. The dispersion of foam is then tracked by ultrasound.
What happens after the procedure?
You will have your compression stocking to mid thigh put on after the procedure. Stockings should be worn at all times day and night for the next 2 weeks. After three days you may remove them for a shower and then put them back on. Cover stocking with a plastic bag prior to this when showering.
You will be asked to have a walk immediately after treatment for the next 15 to 20 minutes. After that time you can carry on normal daily activities. But avoid vigorous or strenuous activities. Try to avoid standing still for long periods. If you are on your feet it is better to keep walking and if sitting keep your legs elevated.
Your leg may feel sore for a day or two following your procedure. If this happens take some simple analgesia such as Paracetemol. It is important you remain mobile. You should aim to walk at least 30 minutes per day. Do not confine yourself to bed.
You will attend a review appointment 6 weeks after you procedure. Please bring your stocking.
Normal effects from Sclerotherapy
- Aching in the leg for the first few days after treatment this is usually relieved by Panadol and walking.
- Brown staining (pigmentation) of the skin corresponding to where the vein was treated. This is common and usually resolves within 6 weeks but may last up to a year.
- Phlebitis is an inflammation of the treated veins, which may also be associated with a throbbing feeling or tender lumps along the line of the treated vein. These lumps are normal and are due to the reaction of the sclerosant on the blood vessel wall and the ‘trapping’ of old blood. If this is for a prolonged period it may be treated by aspiration of the clot by a small needle puncture at 2 weeks. The lumps will disappear but may take several months.
Potential Complications
- 90% of patients will only require a single treatment session. However 25% of patients will require further treatment intervention within 2 years.
- Bruising
- Allergic reaction to sclerosant
- Follicilitis in about 1-2% of patients
- Redness around area of injection
- Deep vein thrombosis (DVT)
- Very rare cases of stroke has also been reported