Sclerotherapy for Varicose Veins
Sclerotherapy is when a chemical is injected into the veins to destroy it. It is done in an outpatient setting, therefore does not require an anesthetic and the patient 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 the foam is injected. The number of needles (injections) can vary from 3 to 10 depending on the amount treated and the number of legs treated. Following the procedure, the patient may 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.
Are there any alternatives to Sclerotherapy for Varicose Veins?
- Elastic compression hosiery (stockings) long term. They help to relieve the pain and swelling in your leg and are effective for heal ulcers. It is as effective as any of the other treatments.
- Surgery involves an anesthetic (general or spinal) and cuts 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 highly effective treatment in one setting. It is done as day stay procedure and patients need a week or two recovery time.
- Radio-frequency and Endovenous Laser treatments involve destroying the vein under local anesthetic. 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 in Sclerotherapy for Varicose Veins?
Prior to the procedure, the patient will need a duplex scan of the veins. A duplex scan is similar to an ultrasound scan in which jelly is placed on the patient’s 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 the stocking available to put on immediately after injection.
Although the procedure will take about 45 minutes to 1 hour, the patient should allow 2 to 3 hours for the visit. The patient should wear loose trousers, shorts or skirts to the appointment as stockings will need to fit under them. Please wear flat shoes so that the patient 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 Sclerotherapy for Varicose Veins?
The patient will have 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 the patient should remove them for a shower and then put them back on. Cover stocking with a plastic bag prior to this when showering.
The patient will be asked to have a walk immediately after treatment for the next 15 to 20 minutes. After that time the patient 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.
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 associated with Sclerotherapy for Varicose Veins
- 90% of patients will only require a single treatment session. However, 25% of patients will require further treatment intervention within 2 years.
- Allergic reaction to sclerosant
- Folliculitis in about 1-2% of patients
- Redness around the area of injection
- Deep vein thrombosis (DVT)
- Very rare cases of stroke have also been reported