Sclerotherapy for varicose veins in Cairns
Sclerotherapy closes a vein by injecting a solution into it that irritates the vein lining, causing it to seal and, over time, be absorbed. It is used in the treatment of symptomatic varicose veins and their branches.
It is rarely the whole treatment. In most cases it is used alongside closure of the main refluxing vein — by ablation, glue or surgery — to deal with residual branches, or in patterns of recurrent disease where a network of smaller veins is responsible for symptoms.
When it is used
Sclerotherapy is appropriate where duplex ultrasound has demonstrated venous reflux and the veins are causing symptoms — aching, heaviness, swelling, itching, bleeding, phlebitis, skin staining or ulceration.
It is particularly useful for:
- Residual varicosities after the main refluxing vein has been closed
- Recurrent varicose veins where a network of small vessels has developed
- Veins around the ankle where the skin has begun to change
- Veins that have bled or are at risk of bleeding
- Patients for whom a more invasive procedure is not appropriate
Injecting branches while the vein feeding them is still refluxing gives a poor and short-lived result. This is why the duplex comes first.
Where a scan shows no reflux and the veins are not causing symptoms, treatment is a cosmetic procedure rather than a medical one. That is not the work of this practice, and where the assessment finds nothing that warrants medical treatment, we will tell you so.
What is involved
The veins are marked, often with ultrasound guidance for anything that cannot be seen clearly on the surface.
The sclerosant is injected through a fine needle. For larger veins it is mixed with air or gas to make a foam, which displaces blood within the vein and increases contact with the vein wall — this is foam sclerotherapy, and it is used under ultrasound guidance for veins beneath the skin surface.
Several veins are usually treated in one sitting. Most people describe a stinging or cramping sensation lasting a few seconds with each injection.
A compression stocking or bandage is applied immediately afterwards, and compression is an essential part of the treatment rather than an optional extra.
More than one session is commonly required.
Afterwards
Compression is worn as directed — this materially affects the result. Walking is encouraged; thirty minutes a day is the usual advice. Avoid hot baths, saunas and strenuous gym work until reviewed. Avoid prolonged sitting or standing in the first week.
Treated veins typically feel firm and lumpy for some weeks before softening. Trapped blood within a treated vein can sometimes be released with a small needle at a follow-up visit, which speeds the settling process.
Risks
Skin staining — brown discolouration along the line of a treated vein — is the most common unwanted effect. It occurs in a proportion of patients, usually fades over six to twelve months, and occasionally persists.
Bruising and tenderness are expected. Firm, tender lumps along the vein are common and settle over weeks.
Inflammation of the treated vein (phlebitis) occurs in a minority of cases.
Small clusters of fine new vessels can appear at a treated site — matting — and can be difficult to treat.
Skin ulceration at an injection site is uncommon but recognised, and occurs if sclerosant enters a small artery or leaks outside the vein.
Allergic reaction to the sclerosant is rare but can be significant.
Deep vein thrombosis is uncommon. Visual disturbance, migraine and, very rarely, more serious neurological events have been reported following foam sclerotherapy, particularly in people with a history of migraine. This is asked about specifically before treatment.
Veins can recur, and further sessions are sometimes needed. All risks are discussed in full before treatment is agreed, and written information is provided.
Common questions
Do I need an ultrasound first?
Yes. Treating visible veins without knowing what is feeding them produces a poor result and a high rate of early recurrence.
How many sessions will I need?
It varies with the extent of the veins. It is normally more than one, and this is discussed at the consultation rather than estimated in advance.
Can I have it done if I am pregnant or breastfeeding?
Elective venous treatment is generally deferred during pregnancy. Veins that appear in pregnancy frequently improve in the months after delivery, and assessment is usually more useful once that has had time to happen. Breastfeeding should be discussed specifically before any procedure.
Does it hurt?
Each injection produces a brief stinging or cramping sensation. Most people tolerate the sessions without anaesthetic. Local anaesthetic cream is of limited use because the discomfort comes from inside the vein rather than the skin.
Referral and appointments
GPs and referrers: referrals can be sent to the rooms by fax or through the online referral form.
Patients: phone the rooms on (07) 4254 5006. Suite 9, Level 1, 193 Lake Street, Cairns.