Australian Vein Clinics

Do not cease medications prior to treatment unless otherwise advised.

Do not apply moisturiser on the day of treatment.

Wear slacks or loose trousers and sandals or loose shoes to your appointment to conceal and allow for the thickness of the stockings.

Take two Panadol tablets about one hour before the appointment

Avoid treatment if you intend to fly overseas within the following six weeks.

Multiple injections are given using very fine needles.

A compression stocking is applied to reduce pigmentation, the number of treatment sessions, risk of deep vein thrombosis and risk of recurrence.

Rest for several minutes after the injections with the leg elevated.

If possible, do not drive home yourself. If you have to drive, keep the legs moving.

Wear the stockings continuously for 24 hours. Then wear stockings only through the day, remove them at night and replace them in the morning after the shower for a further two weeks.

Continue with stockings for approximately 2-3 weeks or longer if pain develops after the recommended two weeks.

Walk for 30 minutes each day. Maintain normal daytime activities. Avoid standing still for long periods of time. When sitting, elevate your legs.

Avoid strenuous physical activity such as aerobics for 3-4 weeks after treatment since this increases the risk of blood flow into the treated veins.

Complications can occur even with perfect technique.

Deep vein thrombosis (DVT). Clots can extend into deep veins but this is rare if the protocol of compression and regular daily walking is followed. It is optional to stop hormone preparations as they may increase the risk of DVT.

Allergic reaction. This is rare but can present immediately as an anaphylactic reaction with generalised rash, constriction in the throat or difficulty with breathing. This is immediately treated by injecting cortisone or adrenaline. Allergy may cause a skin rash after treatment requiring antihistamines. Allergy is slightly more common in asthmatics. Patients must stay in the building for 20 minutes after any form of treatment to ensure that no allergic reactions occur.

Pigmentation. Haemosiderin which is a form of iron from the blood can be deposited along the treated veins. This is more frequent with large surface veins but can occur with spider veins. Most disappear within 12 months but there is permanent staining in about 5% and this is of cosmetic significance. Persistent pigmentation may respond to laser treatment.

Matting. This consists of networks of fine dilated capillaries near the injection sites. It appears shortly after treatment in approximately 10% of patients. Most resolve spontaneously, some resolve with injection treatment, and a few persist.

Skin ulceration. This is very uncommon. It occurs because solution has escaped into the surrounding skin or because of an abnormal connection between small veins and arteries. Most injection ulcers are small and heal over a few weeks leaving a small pale scar.

Intra-arterial injection. This has never been encountered in our practice but has been reported resulting in muscle and skin damage.

UGS has been in use for some 25 years. UGS is used to block off smaller diameter saphenous veins or large tributaries by injection using ultrasound to guide the needle to the vein. Our results published in the European Journal of Vascular Surgery show a low risk of complications and good results but with a need to repeat treatment at a later date in some patients. Success rates for UGS compare favourably to published results for surgery. The two sclerosants used are Aethoxysklerol (polidocanol) or Fibrovein (sodium tetradecyl sulphate – STS). Both are detergents and act by washing away the lining of the vein allowing the two walls to stick together.

Worldwide the trend in recent years has been to use sclerosant made up as foam. However, it is now known that this can lead to bubbles passing to the brain and there is a small number of reported strokes. Accordingly, this practice has reverted to liquid sclerotherapy. However this may lead to a need for greater numbers of treatment sessions.

Advantages

Minimal discomfort.

No admission to hospital or anaesthesia.

No time off work nor interference with normal home duties.

Disadvantages

Each leg is usually treated separately.

There is a limit to the dose of sclerosant that can be safely given at a session.

This means that multiple treatment sessions may be required.

Approximately 40% of patients require two sessions and 5-10% require more.

Injected veins may remain inflamed for several weeks and patience is required to allow this to settle.

Advice will have been given about the type and use of stockings.

Do not shave the legs.

Do not apply moisturiser on the day of treatment.

Wear slacks or loose trousers and sandals or loose shoes to allow for the thickness of the bandages and compression garment