Introduction
Sclerotherapy of varicose veins is a simple effective and safe method to treat telangiectasias (spider veins) and reticular veins (small blue varicose veins) in the legs. This method has been commonly used for over a century. Like any other treatment, it does not prevent the future appearance of new varicose veins that are related to progression of the venous disease. Therefore, patients should plan to attend control visits and undergo later "maintenance" treatment.
Indications
A clinical examination and Duplex ultrasound will be performed to specify the cause of your symptoms, origin of the varicose veins (specifically looking for truncal/axial reflux) and to define treatment.
Preoperative Instructions
- Take a last bath or shower just before the procedure, since you won't be able to wet the limb on which the procedure will have taken place until the following day.
- DO NOT apply any type of moisturiser to your leg on the day of the procedure. DO NOT apply artificial tanning products one week prior to or one-week post procedure.
- Please have a light breakfast or lunch prior to your procedure. Be well hydrated.
- Plan to wear shoes that are large enough, since the stocking will start near the toes.
- Wear loose-fitting clothes.
- You can take your normal medications on the day of the procedure. Please notify Dr Campbell if you are taking any blood thinners such as Aspirin or Warfarin. Please bring a list of your current medications with you.
- If you have been professionally fitted and supplied with Grade II compression stockings, please bring these with you. If not, we will supply the stockings for a fee.
- Finally, make sure to be relaxed. The procedure is very well tolerated.
Procedure
Sclerotherapy is a minor procedure. It takes place in the Doctor’s Rooms and does not require anaesthesia. Sclerotherapy involves the injection of a solution into the vein using a very fine needle. This irritates the vein wall causing the walls to swell, collapse, stick together and seal shut, shrinking the diseased veins.
This procedure is most effective when no major saphenous truncal/axial reflux is present. If truncal reflux is present, this technique can be very effectively combined with other modern treatments such as endovenous laser using the Biolitec ELVeS radial system.
Sclerotherapy must be combined with good compression and regular walking.
The procedure does not require that you interrupt your professional or domestic activities.
Postoperative Instructions
- Active walking is required. It is the best and most natural way to prevent any complications, although they occur very rarely with this procedure. Immediately after the procedure you must walk for 20 minutes. Please continue this at least daily for the next week. Keep the leg elevated as much as possible during the first 24hrs.
- Normal daily activities can usually commence straight away, however there are some restrictions. Avoid long periods standing still, particularly during the first week. Strenuous activity is best avoided for 2-3 weeks. Do not fly for the first 2 weeks if flight is more than 2 hours duration. Flying must be avoided for 4 weeks for flights more than 4 hours.
- The stockings should be worn continuously for the first 12-24 hours. You may remove the stockings the following morning to have a shower and reapply them immediately. The stockings may then be removed that night. Avoid hot baths or saunas for 4 weeks following treatment.
- Please then wear the stockings from first thing in the morning until last thing at night for a total of one week.
- Post-procedural pain should not be severe and easily controlled with Panadol. This may be required for the first few days after the procedure.
- Avoid excessive sun exposure during the 2 weeks following the procedure.
- Bruising, local swelling and some tenderness are normal after treatment. This should be temporary.
- Signs that may be of concern include tenderness associated with redness and warmth. This could indicate infection or a local inflammatory response, known as thrombophlebitis. Infection would generally be accompanied by systemic symptoms such as fever, loss of appetite and a general feeling of malaise and is best treated with antibiotics and drainage where necessary. More commonly (1 in 10), a local inflammatory response known as superficial thrombophlebitis can occur. This appears at 2-4 weeks post treatment as a firm, tender, painful lump and may have associated redness. This is not accompanied by constitutional symptoms.
Thrombophlebitis is best treated with:
- Further compression and massage to the area.
- Hirudoid cream – massage in to the area.
- Walking (half an hour each day).
- Anti-inflammatory medication such as Nurofen – for 48 hours.
At your first review, any areas of thrombophlebitis may be treated with gentle expression of the thrombus via a small incision, usually a needle prick.
If bleeding appears on the stockings, please elevate your leg and apply local compression. Dr Campbell should be contacted via mobile phone 0412 509 504 or at the Rooms 03 9429 4111 during business hours.
Risks
Allergic Reaction
Allergic reactions are exceptional. Minor reactions such as itch are common within 30 minutes and usually settle. A more serious form of allergy is anaphylaxis which can be life threatening. This has been estimated to occur in 0.001% (1 in 100,000) people. We are always prepared for this and have emergency resuscitation drugs and equipment in the consulting rooms.
Pigmentation
This is brown pigmentation that forms along the course of the injected vein. This is caused by the release of haemosiderin from extravasated red blood cells. Pigmentation is usually temporary. 1 in 100 people (1%) will have persistence of pigmentation at 1 year. Laser therapy can be effective in removing this pigmentation in about 50% of people.
Telangiectatic Matting
This can occur in up to 30% of patients and represents the appearance of previously unnoticed fine red telangiectasia (spider veins). The incidence can be reduced to 5% with wearing of compression for 2-3 weeks after treatment. Telangiectatic matting usually resolves spontaneously over 3-12 months. It may persist longer than 1 year in less than 1% of people.
Scarring from local skin ulcer
This is rare and usually limited, occurring in less than 0.1% (1 in 1000) of patients. This can occur if the sclerosant solution leaks from the veins. This is usually detectable and can be treated promptly to prevent ulcer formation. This may also occur if sclerosant is injected into an arteriole or from reactive spasm of the vessel. The sclerosant used by Dr Campbell has one of the lowest incidences of ulceration.
Deep Vein Thrombosis
People with varicose veins are more susceptible to deep vein thrombosis. These blood clots can also form in the deep veins as a result of treatment of your varicose veins. This is extremely rare, occurring in less than 1% of patients, especially if patients follow instructions regarding stockings and walking. If you are unable to perform the required walking please discuss this with Dr Campbell prior to your procedure.
Deep venous thrombosis is most likely to occur in patients who have significant risk factors for thrombosis. This includes those who are smokers, overweight, have poor mobility, do not comply with post-procedure orders such as walking and compression, hormone intake (HRT and OCP) and those patients who have a past history of deep venous thrombosis or a thrombophilic disorder.
Your risk of DVT is doubled if you are taking any form of hormone treatment such as the oral contraceptive pill, hormone replacement therapy or a hormone containing IUD, such as Mirena. You may consider ceasing the hormone treatment one month prior to treatment and for one-month post treatment to reduce the elevated risk of DVT. However, the consequences of unplanned pregnancy and return of menopausal symptoms must be considered. Safety of sclerotherapy during pregnancy has not been proven and if sclerotherapy is performed whilst pregnant it may affect the foetus.
Nerve Injury
Veins and nerves lie close together. These nerves can be injured during injection, either via direct trauma from the needle or from the sclerosant. More commonly, however, the nerve can become inflamed secondary to vein inflammation (thrombophlebitis). This can result in localised numbness that is usually temporary and recovers within 6 months. Rarely this loss of sensation is permanent or painful, however, it should not affect the function of the leg and diminishes with time.
Related Information
Dr Claire Campbell
Compression Fitting Service
Endovenous Laser Therapy
Haemosiderin Staining
Ultrasound
Ultrasound Guided Sclerotherapy
Deep Vein Thrombosis
Lipodermatosclerosis
Spider and Reticular Veins
Superficial Thrombosis and Thrombophlebitis
Varicose Veins
