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Ultrasound guided sclerotherapy, also known as echosclerotherapy, is used to treat veins that are difficult to see and reach. By using an ultrasound machine, deeper veins are easier to visualize, dramatically lowering the need for surgery. This technique is appropriate for saphenous veins buried deep below the skin and for veins that recur after surgery
The procedure
begins with a leg examination while the patient is standing. Using a linear
probe, the physician and ultrasound technician identify the anatomy and
competency of the veins. Once mapped out, the patient will be seated
comfortably on the examining table.
A small amount
of local anesthetic will be infiltrated under the skin and then a plastic
coated needle (catheter) is positioned in the saphenous vein. (The procedure is
usually painless, as the area is frozen from the local anesthetic). With the
catheter in place, a medication (sclerosant), which closes the insufficient
vein, will be carefully injected and monitored on the ultrasound screen. A
bandage will be placed over the area injected to provide compression to
collapse the vein network. You will need to leave the bandage on for 5 days
& 5 nights after the procedure and wear a medium strength support hose
or two pairs of regular support hose for the same length of time. Success rates
are high, but in some cases, a second injection will be needed at a later date.
If a second injection does not close the vein, surgery will be recommended.
COSTS:
> There are fees for the ultrasound scan and for the injected medication. Sometimes a portion of these costs can be reimbursed through private (3rd party) medical plans.
> Treatment costs will be discussed with you after the extent of your venous problem has been thoroughly assessed. Before treatment, you will be provided with a written estimate of all treatment fees.
POSSIBLE
SIDE EFFECTS:
> The most common complication is an
inflammation of the injected vein. It usually appears the first week and
consists of a hard, tender cord along the injected site. The pain is usually
minor and is relieved by the application of ice and the use of support
stockings.
> There is always the possibility of an
allergic reaction. This rare complication may range from a slight tingling
sensation with red blotches on the skin to an anaphylactic reaction.
> Rare cases of deep vein thrombosis and
pulmonary embolus can occur.
(< 0.1% and 0.01% respectively)
> There are 2 other rare accidental
complications that may arise from the sclerosing agent spilling into the
subcutaneous tissue, or introduced into an artery. Both will result in an ulcer
that will eventually leave a scar. Permanent muscle damage is remotely possible.
Feel free to call us with any concerns.
RETURN
VISITS:
> You will need to come for a re-assessment
of the vein after approximately four weeks. An ultrasound will determine how
well the veins responded to treatment. There is no fee for this recheck,
however, if a second treatment is required, the usual fee would apply.
PRE-ECHOSCLEROTHERAPY
INFORMATION
1.
Prior to the
echosclerotherapy session, it is necessary to treat smaller veins with a dilute
solution of medication to be sure the patient will not have an allergic
reaction. This set of injections is done on a separate date.
2.
You must
have a medium strength pair of support hose, or two pairs of regular strength
support hose to wear home after the procedure.
3.
The procedure
itself takes 10-15 minutes, however scanning and bandaging add on time, so plan
to be at the clinic for 60 minutes.
4.
You will need
to elevate your legs for four hours
after the procedure, so plan to have the afternoon/night free. You may drive
for a period of 30-45 minutes following the procedure, but a longer drive will
mean that you will need a ride so you can elevate your leg during your travels.
5.
Try to avoid
aspirin for 1 week prior to the procedure.
6.
Eat a good
breakfast!
7.
Stand as much
as you can the day of the procedure so your veins are easier to visualize. (You
may also want to stop wearing your support hose a couple of days before the
procedure).
8.
Bring a pair
of shorts to wear at the clinic, and some comfortable loose clothing for your
travel home.
9.
Long distance
auto or air travel should be avoided for 4 weeks after your treatment.
10.
You must
notify us 48 hours in advance of an appointment change. (Are you traveling any
time close to your procedure date? Please let us know).
POST ECHOSCLEROTHERAPY INSTRUCTIONS
1.
Go directly
home and elevate your legs above your heart for a period of 4 hours. Once
every hour during this period, get up and walk for 5-10 minutes.
2.
Following the
period of leg elevation, exercise your legs for 30 minutes. (ie. A brisk
walk, cycling, swimming).
3.
Any leg
discomfort should respond to leg elevation, leg exercise or ibuprofen.
4.
If there is
localized tenderness or lumpiness in the treated vein, apply ice for 15
minutes, four times a day.
5.
At any time,
if you are having more than mild discomfort, the clinic may be contacted.
6.
Leave the
compression bandage on for 5 days unless it is causing skin irritation or
blistering.
7.
If you have
been asked to wear support stockings over the bandages, you may remove the stockings
while lying in bed at night. If you are wearing two pairs of light compression
support hose, one pair of hose will need to stay on during the night.
8.
Keep your
bandage dry.
9.
Exercise for 30
minutes each day until your next appointment.