Ultrasound Guided Sclerotherapy (UGS) is when an ultrasound machine is used to visualize veins below the surface of the skin and a needle is passed through the skin and is guided into the vein (by watching on the ultrasound screen); the vein can then be treated by injecting a solution through the needle (ie sclerotherapy).
Ultrasound is simply sound whose frequency is above the range of human hearing (hence the term ultra). High frequency sound waves can be transmitted from the skin’s surface into the body and then because different internal structures reflect and scatter sound differently echoes are created which bounce back to the skin’s surface. Diagnostic ultrasounds are machines that are able to transmit ultrasound waves in and collect returning echoes to form an image of internal structures including veins.
The main advantage of UGS is that it allows leg veins that previously required surgery in hospital to be treated non surgically in the clinic environment. Deep veins can be treated without any surgical incisons and the non surgical nature of the procedure means there is no hospital admission and no general anaesthetic. After UGS there is a much more rapid return to normal activity and lower complication rates than after surgery.
UGS is a treatment for underlying deep vein problems and is not used to treat surface veins such as spider veins. These superficial leg veins require either surface injections (sclerotherapy) or surface laser treatment.
Whilst UGS can be used to treat nearly all deep vein problems, the long term results with UGS varies with the degree of the underlying problem. There are certain clinical situations where UGS is the best nonsurgical option and other clinical situations where, whilst UGS can help, better longterm results can be achieved with other nonsurgical options such as the catheter procedures of laser (EVLT) and radiofrequency (VENEFIT).
It is often the case that UGS may be needed after catheter procedures to treat residual varicose veins and it is usually the treatment of choice when patients have recurrent varicose veins after past surgical stripping.
The availability of several treatment options emphasises the need for an accurate initial assessment and mapping scan to determine the best treatment option for an individual clinical situation. Long term results need to be weighed up against cost effectiveness and possible side effects.
Large scale international studies have found UGS to be a remarkably safe method of treating varicose veins.The main complication of significance is the risk of DVT (Deep Vein Thrombosis). The risk is lower than with surgery because of the avoidance of general anaesthesia and time in hospital and also the ability to walk immediately after UGS. If there is a greater risk of DVT, because of factors such as a personal or family history of past thrombosis or an abnormal clotting disorder (called thrombophilia) then preventative anticoagulant injections (Clexane) may be recommended. Any risk of DVT is greatly reduced by daily walking and the use of compression stockings after treatment.
There have been several rare reports of cerebrovascular accidents after UGS and investigation in these cases typically reveal a septal defect in the heart. For patients with a known septal defect (ie ‘hole in the heart’) the risk of this rare complication needs to be discussed.
More common side effects are local reactions such as bruising, tender lumps in the treated veins and pigmentation. These usually resolve over several weeks although the pigmentation may uncommonly be longer lasting in which case laser treatment can be considered.
The Ultrasound part of the treatment simply involves gel on the surface of the skin and is not painful. The injection part of the treatment involves a very fine gauge needle and most patients describe it as only slightly uncomfortable. In fact most patients characterise surface injections as more uncomfortable. UGS only involves a small number of very accurately placed injections.
Varicose veins are best managed conservatively with compression stockings during pregnancy. Treatments such as UGS and catheter procedures are usually undertaken after breastfeeding is completed.
We recommend no waxing or shaving of the legs in the 48 hours before treatment and no moisturiser applied to the legs on the day of treatment. Loose fitting clothing and possibly a loose pair of shorts to wear during the procedure are preferable. Be prepared to be wearing compression stockings after the treatment and allow time for a 30 minute walk immediately after treatment.
Compression stockings will normally be required to be worn for 2 weeks after UGS ( the first week day and night and the second week only during the day). For 2 weeks after UGS a continuous daily walk for at least 30 minutes is recommended and long hot baths, spas or saunas should be avoided. Intense leg exercise (eg aerobics, long runs, stepper and leg weights) should be avoided for at least one week. A general recommendation regarding flying is to avoid any air travel for 2 weeks and any long haul flights ( ie over 4 hours) for 4 weeks after UGS. This recommendation can be varied in certain circumstances and any plans to fly in the 4 weeks after UGS should be discussed with the treating doctor.
The number of treatments varies with each individual case but as a guide the average number of UGS treatments is between 2 or 3. A more accurate indication of the treatment plan will be given after the Mapping Scan assessment.
This will vary with the number of treatments and whether one or both legs need to be treated. Medicare does provide a rebate and Health Insurance funds will usually provide some rebate for the compression stockings but not for the UGS procedure.
UGS can treat the veins that are currently present however it is important to realise that If you have a tendency to get veins in the first instance you will have a tendency to develop more veins in the future. Even with surgical stripping where veins are physically cut out, a significant number of patients develop further varicose veins afterwards (what is termed recurrent varicose veins). If new veins develop after UGS then further treatment may be needed in the future.