Ultrasound Guided Sclerotherapy

Sclerotherapy is commonly used for the treatment of unwanted, visible spider veins and superficial (surface) varicose veins. It can be used by doctors in a weak form as liquid or an agitated form (after being mixed with air) as a strong form of medicine. The word sclero derives from Greek origins meaning to harden i.e. the treatment hardens veins after which they are absorbed by the body and disappear.

Ultrasound allows the doctor to visualise all the veins under your skin that need treatment, and to precisely guide a tiny catheter into the varicose vein. The first part of the title ultrasound-guided refers to the fact that your doctors will use ultrasound to visual guide your treatment. This will allow for medicine to be precisely deposited into the right areas so that problems can be sealed shut.

The second part of the sentence refers to the medication type. A special medicine known as a sclerosing agent can be injected to the veins which causes them to collapse and seal shut. The body then absorbs the vein into the surrounding tissue. After a number of weeks, it disappears from view.  At the same time, blood is rerouted to healthier veins in the area which are deeper down.

Most patients will describe a very small amount of "stinging" pain owing to the activity of the medicine. Tiny fine needles are used to treat the varicose veins so it's often not the pain from the needle which is most worrying. The stinging pain will go away with walking after the procedure or with the application of compression stockings.

Foam sclerotherapy simply means that the medicine is agitated or "mixed" with Room Air or CO2 to achieve a shaving cream like consistency.  When used with the guidance of an ultrasound machine the procedure can be referred to as ultrasound guided foam sclerotherapy. The use of agitated or mixed medicine is a major advancement in vein treatment and improves treatment in two distinct ways:

First, the foam displaces blood within the vein, permitting the full strength of the sclerosing agent to be in direct contact with the vein wall for an extended period of time without any dilution effects.

Second, the foam is visible via ultrasound imaging and can be easily tracked and guided to the source of the venous problem. For large veins, foam is used with conjunction of the ultrasound machine.

Sclerotherapy is an excellent treatment option for smaller varicose veins with more than one session usually required. You may have your doctor peform a "trial" treatment session to make sure that your skin does not pigment after the use of sclerotherapy medication. After this further sclerotherapy sessions can continue. For larger veins sclerotherapy is usually not recommended.

Sclerotherapy does cause mild discomfort but is usually quite tolerable for the vast majority of patients. The discomfort is due to the medication and tends to resolve within 10 minutes. Many patients will describe the pain as a stinging sensation if small veins are being treated. For larger veins there may be some cramping but again this is usually quite temporary and resolves with walking.

This will depend on the duration of each treatment session and strength of medication used. As with any medicine a maxiumum dose can only be administered per day. Most sessions will last approximately 30 minutes. You will likely require repeat sessions of sclerotherapy in the months following your first session.

Sclerotherapy is usually quite safe but some rare and serious sides effects do exist. Common sides effects of sclerotherapy include:

a) Having raised lumps for weeks after the procedure - this is considered normal. You will feel lumps along the vein or the whole vein as a cord. This is NOT considered a complication of the treatment but part of the healing process. Your doctor may decide to release the trapped blood if the lumps cause excessive soreness which can be done using local anaesthetic. If left alone the lump and tenderness will resolve over time.

b) Bruising. After treatment, some bruising is to be expected which often lasts 7 days. Using creams with an Arnica base will often resolve the bruising quicker. It's important not to use creams such as Hirudoid before or after the treatment.

c) Aching. Some aching is to be expected after the procedure owing to the effect of the medication. The inflammation caused by sclerotherapy suggests that the procedure is working. No, minimize this pain plenty of walking and the use of Nurofen may assist. Alternatively, ice packs in the early hours of the morning will assist some patients.

d) Pigmentation which may take months to resolve. This is due to the deposition of iron in the skin. 90% of staining will resolve within 1 year and is generally considered a cosmetic concern. For those seeking to remove any staining marks often a referral to a dermatologist using Q Switched laser is beneficial.

e) New spider vein formation known as matting. Tiny capillaries may form after treatment with sclerotherapy the cause of which is not known. Matting often tends to resolve spontaneously after a few months and is most likely to affect women using the oral contraceptive pill. Some doctors will advise to have these vessels treated whilst others will adopt a wait and see approach. Skin lasers may have a small role to play if matting develops.

f) Soreness of the veins knowns as phlebitis.

Serious but very rare side effects include:

a) A pulmonary embolism or lung clot which occurs 1/10000 cases.

b) A deep vein thrombosis or DVT approximately 1/1000 cases

c) A serious allergic reaction occurring 1/100000 known as anaphylaxis

d) A mini-stroke occurring 1/100000

Both medications used at our clinic known as Sodium Tetradecyl Sulfate and Aethosxysclerol are approved by the Therapeutic Goods Administration of Australia for the treatment of varicose veins. There are some practitioners who still use concentrated normal saline or "salt injections" for spider veins which is aslo an approved use. The concentration of medications used will be determined by your doctor during your treatment consultation. Many specialists will use Aethoxysclerol for small spider veins and Sodium Tetradecyl Sulfate for larger varicose veins.

For smaller veins measuring less than 4mm sclerotherapy is quite successful. For larger varicose veins, sclerotherapy is not an ideal treatment with endovenous ablation being a preferred option. Failure rates can be as high as 50% for larger varicose veins when being treated by sclerotherapy whilst endovenous ablation failure rates are less than 5%.

While you may have some bruising for a week after sclerotherapy there is usually very little pain. Appearance wise your veins may look worse before they look better after a 4-6 weeks.  During your recovery period it is quite important to use bandages or compression stockings to assist in the healing process of sclerotherapy.

Doctors usually recommend you walk for about half an hour each day after having sclerotherapy. It’s also important that you don’t stand still for long periods. When sitting, elevate your legs so that your ankles are higher than your hips.

All treatments will require medical consultation. Like all medical procedures, some risks do exist. The benefits and minor risks will be discussed during your first consultation before treatment with one of our specialist doctors.

If you are having sclerotherapy treatment it's important that you do not travel oversease or long distance (>5hours) for 3 weeks. If you must travel after treatment then your doctor can amend post treatment care so that your strict regime includes the use of compression stockings, blood thinners, and a review scan before the flight to make sure that there is no deep vein thrombosis.