Ultrasound-guided Sclerotherapy

Ultrasound guided sclerotherapy, also known as echosclerotherapy, is used to treat veins that are difficult to see and inject. By using an ultrasound machine, deeper veins are easier to visualize, dramatically lowering the need for surgery. This technique can replace surgery and is especially useful for veins that recur after surgery.

The procedure begins with a leg examination while the patient is standing. Using ultrasound, the physician and ultrasound technician identify the anatomy and competency of the veins. Once the veins are mapped out, the patient reclines comfortably on the examining table.

A small amount of local anesthetic is infiltrated under the skin and then a plastic coated needle (catheter) is positioned in the vein. (The procedure is usually painless, as the area is numb 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 compression stocking or two light compression stockings superimposed. Success rates are high, but in some cases, a second injection will be needed at a later date. 

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 after the first week or two 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 compression stockings. 
• As with any medication, there is a small chance of an allergic reaction. This rare complication may range from itching with red blotches on the skin to an anaphylactic reaction.
• Rare cases of deep vein thrombosis (blood clots) 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 being 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.
• Ultrasound guided sclerotherapy with foam medication can occasionally cause temporary (usually a few minutes) dry cough, chest heaviness, visual distubance, numbness or weakness in an extremity or a migraine headache in patients with a history of migraines.

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 medical compression stocking, or two  light medical compression stockings superimposed 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 treatment, 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 traveling time.

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 treatment 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 echoscleroptherapy Instructions

1. Walk for 10 to 15 minutes after leaving the office then 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 10 to 15 minutes.

2. Following the period of leg elevation, exercise your legs for 30 minutes. (ie. A brisk walk, light cycling, swimming).

3. Any leg discomfort should respond to leg elevation, leg exercise or acetaminophen.

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. You may remove the compression stocking while lying in bed at night if it is causing discomfort. If you are wearing two light compression stockings, one will need to stay on during the night.

8. Keep your bandage dry.

9. Exercise for 30 minutes each day until your next appointment.