Injection sclerotherapy is a treatment that intentionally damages the lining (endothelium) of small veins.  By doing this and then applying pressure the vein walls stick together. The vein can then no longer fill with blood and so it is obliterated.  The compression applied after the injection is an essential part of the therapy. 

Ultrasound guided foam sclerotherapy is a further development in which the foam injection is guided by ultrasound.  The dispersion of the foam is then tracked by ultrasound.

Microinjection sclerotherapy is used for very fine spider veins and uses a very fine needle.

Examples of sclerosants are STD (sodium tetradecyl sulphate), 20% hypertonic saline and polidocanol.  STD and polidocanol can be used as a foam, but hypertonic saline can only be used as a liquid for fine thread veins.

Back to the top

Even if your veins are suitable for injection sclerotherapy, it is important that you have a frank discussion with your surgeon about the potential benefits and limitations of injections.  It is important to be clear from the beginning what will be possible and what will not be possible.  In some patients with very minor thread veins, injections may leave skin pigmentation that is worse than the actual veins themselves.  In these circumstances treatment will not improve the appearance of the veins and the use of false tan and camouflage make-up may be the best way to hide the visible veins.

Take care when reading advertisements offering injection treatments.  Some of the claims are often misleading.  ALL treatments have a failure rate and injection sclerotherapy is no exception.  Injection sclerotherapy may appear to be a cheaper option if you are paying personally for the treatment, but this should not be the only consideration.  In the long run expenses can be greater if a less effective or inappropriate treatment has been used.

Back to the top

It is important after the injections that you do not stand still for long periods.  If you have a job that involves alot of standing it is important to arrange a few days off work after the injections. Avoid committments that will prevent you from resting for the first few days after treatment. 

Back to the top

After your injections you should go for a short walk of approximately 15-20 minutes.  After that time you can carry on normal daily activities.  Try to avoid standing still for long periods.  If you are on your feet it is better to keep walking and if sitting to keep your legs elevated.

If wearing bandages your surgeon will advise how long this is required.  Stockings should be worn at all times day and night for the first two weeks.  You can shower wearing the stockings and then use a hair dryer to dry the legs.

The success of the injection treatment relies upon the pressure that the bandages and stocking apply to the injected area in association with regular exercise.  It is important to take regular walking exercise after your treatment.

Back to the top

The new points in this technique are that the liquid sclerosant is agitated to produce a foam-like mixture which is basically air that is mixed with sclerosant.  When this is injected into the veins it can be traced using an ultrasound scanner.  Using ultrasound should improve accuracy and the use of foam appears to maximise the effect of the injection (Alos et al, 2006).  Because a foam is required only sclerosing agents that can produce a foam can be used such as STD.  In practice it is difficult to actually control the flow of foam around the junction.  The safest technique appears to be to inject with the leg elevated and without pressure applied at the groin.  There is also debate about whether it is safe to use air or whether other gases such as carbon dioxide should be used.  Whether the gas injected should be sterile is also uncertain.

This video shows an ultrasound guided injection

Unfortunately, there are no good trials that have compared surgery with UGFS.  UGFS certainly can be effective initially (Darke SG, Baker SJA, 2006), but its medium to long term results are not reliably known.  There are publications which claim effectiveness for the UGS technique, but frequently more than one session of injections are required for residual veins.  It is also difficult, if not impossible, with UGS to perform a chemical sapheno-femoral ligation that is equivalent to the surgical treatment at this site.  Ineffective treatment at this site is known to cause and to be a predictor for varicose vein recurrence.  In fact for groin reflux there is probably a 20-30% initial failure rate for foam sclerotherapy.  This may at least partly be dependent on the size of the vein - larger veins being more difficult to treat.

Back to the top

Sclerotherapy is also not without complications.  For the vast majority of patients it is very safe, but apart from the complications mentioned above, there is also a small risk of allergy.  There are also rare instances of transient stroke reported (Forlee MV et al 2006).  This is thought to be due to the foam bubbles travelling in the blood vessels to the brain.  In most patients undergoing foam sclerotherapy to major veins, bubbles can be seen travelling in the blood to the heart.  For the majority of patients this does not appear to be a concern but because of these risks I prefer to reserve UGFS for patients without major junctional reflux.

Over the first few weeks following the injection, any slight discomfort, hardness or tenderness at the injection site(s) should gradually subside. If there is excessive redness, swelling or tenderness, this means you should rest more, with the leg raised so that the heel is higher than the hip.  If you are concerned see your surgeon.

Brown staining of the skin around the site of the injection - this is quite common and will quite often remain permanent. Some resolution can occur in the 12 months after the injections.

Ulceration of the skin at the injection site - this is rare but usually means the fluid has been injected around the vein rather than into the vein.  It is much more likely to occur when using higher concentrations of sclerosant.

The injection may fail to obliterate the vein.

Deep venous thrombosis - although the risk of this is low it does occasionally occur.  It may be related to the volume of sclerosant, particularly foam, that is injected.  Larger volumes of foam may present more risk.

         Bookmark this on Delicious      reddit         facebook

References

Last updated Wednesday, 15 July, 2009 7:18 PM