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.
What are the advantages and disadvantages for UGS?
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.
What should you do before UGS?
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 garments.
What happens during UGS?
- A sonographer may perform a limited ultrasound scan similar to the initial screening scan to familiarise us with the veins.
- One or more injections of the sclerosant are given with you lying flat on a treatment couch.
- The sonographer will then bounce on the vein to enhance the action of the sclerosant
- Compression is then applied by a combination of bandages and compression garments.
What should you do after UGS?
- Walk for 15 minutes immediately after treatment.
- Arrange for someone to drive you home or go home by taxi - it is essential that the patient does not drive or take public transport on the day of treatment. Driving can resume on the following day.
- Walk as much as possible, at least 15 minutes per day. Whenever sitting, elevate the legs if possible.
- Wear the compression garment continuously overnight and remove to have a shower next day. Then wear the compression garment through the day and remove it at night. Continue this for approximately 7 days or longer if pain develops after it is discarded.
- Maintain normal daytime activities and avoid standing still for long periods. Resume normal exercise activities within 24-36 hours.
- Avoid flights of greater than 4 hours duration for 4 weeks after treatment. If travel is unavoidable, then the flight should be covered by subcutaneous heparin injections given before departure and after arrival. Avoid treatment for 2 weeks after returning from a long flight
- A check ultrasound scan will be arranged within a few days after treatment to ensure that the treated vein is occluded, determine whether any further veins require treatment and exclude the small risk of deep vein occlusion.
- Bring your compression garment to every follow-up visit.
What can you expect following UGS?
The following features are expected. They are not a cause for concern although they should be reported at review:
- Mild pain persists for several days and shows that the injections are working. The degree is related to the initial size of the veins. Pain is usually improved by walking or by Panadol or Nurofen. Soreness can occur behind the knee from rubbing by the bandage or compression garments.
- Discolouration and tender lumps over tributaries are usual early on. They usually disappear within 4-6 weeks. This indicates that treatment has been successful. Lumps may need to be pricked to let out "trapped blood".
- Phlebitis or inflammation can occur at any time after treatment due to reaction to the sclerosant. It is treated by further compression and regular walking. It does not represent infection and does not require treatment with antibiotics.
- Migraine symptoms. Patients with a history of migraine headaches occasionally develop prodromal visual symptoms within a few minutes after treatment. Patients may wish to take their usual migraine treatment an hour or so prior to treatment in the hope of preventing this.
- Recurrence. Treated veins can reopen or new veins can develop. For this reason, ultrasound surveillance is offered at yearly intervals so that recurrent veins can be detected and easily treated by UGS before they become too large.
What are the possible complications from UGS?
Complications can occur even with perfect technique.
- Deep vein thrombosis. Clots extending into the deep veins can occur. This potentially serious complication is very uncommon if the protocol of compression and regular daily walking is followed. Minor clots develop in deep calf veins in less than 2% of our patients. If this is demonstrated on the postoperative scan then you may require treatment with daily heparin injections until further scans show the clot is resolving.
- Allergic reaction to the solution. This is rare. It can present immediately as an anaphylactic reaction with generalised rash, constriction in the throat or difficulty with breathing, and this is successfully treated by injecting cortisone or adrenaline. Allergy may cause a skin rash requiring antihistamines. Allergy is slightly more likely in asthmatics. Patients must stay in the building for 20 minutes after any form of treatment to ensure that no allergic reactions occur.
- Pigmentation along the treated veins consists of haemosiderin, a form of iron from the blood. Most disappears within 12 months but there is permanent staining in about 2-3% and this is of cosmetic significance. Persistent pigmentation may be able to be managed by laser treatment.
- Skin ulceration 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 ulcers are small and heal over a few weeks leaving a small pale scar.
- Intra-arterial injection This is a very rare complication that has been reported. It would result in muscle and skin damage.
- Nerve damage We are not aware of any reports of damage to major nerves. Damage of surface sensory nerves can occur but this usually returns to normal within weeks to months.
- Stroke There are a small number of reported cases, all with complete recovery. This is from the hundreds of thousands of patients treated each year worldwide. However, it appears to be more common with sclerosant prepared as foam so that we no longer perform foam Sclerotherapy and only use liquid sclerosant even though this may require more treatment sessions.
Please Note
Your treatment will not be recognized by Medicare if veins are less than 2.5mm in diameter. Even if your treatment is recognized by Medicare, they have restrictions on the item number used for Sclerotherapy (item 32500). A maximum of 6 treatments in a 12 month period is permitted by Medicare. You may require more treatment sessions but there will be no further rebate from Medicare if within the 12 month cycle. Please note if you have had Endovenous Laser Ablation and/or Ultrasound Guided Sclerotherapy the restriction also applies.
We advise you contact Medicare to enquire further - for Medicare General Patient Enquiries phone 132 011
-- Subject to change --