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Sclerotheray

Is a technique of injecting a strong solution into the vein that causes the vein to be irritated, makes the lining of the inner vein sticky and with the addition of compression will hopefully cause the vein to close up and heal together. There are several solutions used in SCLEROTHERAPY called sclerosant. This solution is injected with an extremely fine needle into the affected veins.

The principle of SCLEROTHERAPY is to treat the whole patient; that is one tends to treat the larger veins first starting at the top of the leg and working down. The principle of SCLEROTHERAPY is the same for Spider Vein Disease or Varicose Vein Disease. The only real difference is the period of compression. Spider veins can be compressed for a much shorter period of time while varicose veins tend to require longer compression.

After your initial assessments, which will include a history, examination and testing of the veins with a Doppler (ultrasound) Machine, an outline of treatment can be offered to you. This usually requires somewhere between 2-4 sessions lasting 45 minutes each, in this time one leg is usually treated with a sclerosing solution. You will be asked to lie down on the examination table, anywhere from 5 to 30 injections per treatment session is given. This is followed by the application of cotton balls and a bandage or stocking and an immediate return to normal activities. The real advantage of SCLEROTHERAPY is that it causes minimal interruption to your lifestyle, is virtually painless, is extremely safe, has very few complications and can be done out of Hospital without loss of time at work or from social or sporting activities. Most treatments are spaced by a period of 2-4 weeks. One can expect a good result with an 80% - 90% improvement in the cosmetic appearance of the leg. You should be aware that treated veins would look worse before they begin to look better. When the compression dressings are removed, you will notice bruising and reddish areas at the injection sites that last on the average eight weeks, but may be there up to six months.

COMPLICATIONS of SCLEROTHERAPY

Even when a highly experienced physician is performing the treatment, there are a number of possible side effects, including the following:

Aching in the leg for the first day or two following treatment. This is usually relieved by walking, and by keeping the pressure of the bandage or the stocking. You may also take Tylenol (Acetaminophen) to relieve this aching. Avoid Aspirin
Red raised areas at the sites of injection. These should disappear within a day.

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Pigmentation (brown lines or spots) on the skin at the sites of treated blood vessels . These pigmented areas are mainly composed of hemosiderin (a form of iron stored in the blood) and may result when blood escapes from treated veins. They are more likely to occur in patients who have larger veins treated. In most cases, they disappear within a year, but in about 5 per cent of patients they may be permanent. Persistent pigmentation may respond to laser treatment. In order to prevent this side effect do not take any iron supplements (e.g. multivitamins)during the course of treatment, and keep all follow-up appointment with the Doctor. You should not be taking Aspirin as this may increase bleeding.
Matting: This is the development of networks of fine red blood vessels near the sites of injection of larger vessels, especially on the thighs. About 10% of patients develop these. Most resolve spontaneously, some resolve with injection treatment, or laser therapy and a few persist. Matting is more common in patients with extensive surface vein and in obese patients who have poor muscle tone. It is important to walk for at least 30 minutes per day during the treatment to improve leg muscle tone. Other exercise such as cycling, treadmill and low impact aerobics may be substituted.
Ulcers: Rarely there is the formation of small, painful ulcers at treatment sites within 2 weeks of injection. Sometimes these occur because some of the solution has escaped into the surrounding skin. Generally ulcers occur due to sensitivity of the tissues to the concentration of the solution entering the injected vein. They appear to occur more frequently in patients who smoke cigarettes. These ulcers will heal very slowly and may leave a small scar.
Bruises at injected site. These will disappear in a few weeks and are probably related to the fragility of blood vessel walls. Blood trapped in the sclerosed vein may cause the vein to be more noticeable in the first few weeks following treatment, and is early sign that the treatment has been successful.
Allergic reactions: Although on rare occasions such reactions may be serious, they may be treated by immediate injections of adrenaline. Less serious reactions are treated with antihistamines. Minor rashes require no specific treatment but you should inform the doctor if they occur. Rarely, inflammation of the gums (gingivitis) appears to be a reaction to a specific sclerosing solution. If this occurs, a different solution can be used for subsequent treatments.
Phlebitis: This is an inflammation of the treated blood vessels. It is due to the action of the sclerosant on the blood vessel wall. When it occurs it is treated with anti-inflammatory medication, heat packs, compression and regular walking. Most of the time it is caused by lack of compression.
Tender dark lumps may develop in the injected vessels particularly if larger vessels are injected. These are areas where blood has been trapped in the sclerosed vein. The blood may be drained out of these lumps a few weeks after injection. This will lessen the resolution of the tenderness, and help prevent the pigmentation that occurs due to hemosiderin.
Migraine: Some people who have a history of migraine headaches may develop symptoms of migraine within minutes of the injection session. These symptoms generally will include visual disturbances lasting a few minutes followed by a throbbing headache which can be treated by taking the regular medication.

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Other very rare complications

Deep vein thrombosis

Intra-arterial injection.

There are no known long term side effects of sclerotherapy.

Treatment Day

It is important that you wear comfortable clothes which is either a loose fitting dress or shorts, it is also important not to have shaved your legs within the last 48 hours and if you have a superficial skin infection, you should consult your General Practitioner for treatment prior to sclerotherapy. Avoid the application of moisturizers or any other cream to the legs prior to the injections. You will be able to drive home after the treatment, but patients are encouraged to walk for a period of 30-45 minutes immediately following the treatment.

SPIDER VEINS TREATMENT

Firstly for Spider Veins: it is important that the stockings or the bandage are left in place for 48-72 hours day and night. The new trend is to apply cotton balls and tapes few hours, then the patient can use support stockings for daytime hours.

After removing the pressure it is quite common to have a minor ache which is usually a good sign of vein collapse. Tylenol (Acetaminophen) may be taken for minor discomfort. Exercise is an important part of treatment and it is important to walk briskly for at least 30 to 40 minutes every day for one week.

VARICOSE VEINS TREATMENT

After the procedure for varicose veins: it is important to walk immediately for a period of 45 minutes and then it is important to walk at least 45 minutes per day for the next two weeks. The stockings or the bandage need to be left continuously in place for a period of THREE days and night. They may not be removed during that time and must be worn in bed and must not be removed to shower during that time. Again, the trend is to apply compression for shorter periods of time, some keep cotton balls and tapes for few hours, the patient has to put the stockings on once she/he gets home. The commonest causes of complications relate to removing the stockings too early. For your shower you can use a plastic bag ( garbage bag) to cover your leg, and tape it at the top to make it water tight; or sponge bath. Other patients prefer to leave the treated leg ( if only one leg was treated) outside the bathtub.

If you experience pain at night in the foot , or if your toes are numb it may mean the stocking- bandage is too tight, you can remove them and reapply with less pressure.

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