Ultrasound Guided Foam Sclerotherapy

No. Although varicose veins carry blood, they are no longer effective in returning blood back to the heart and are the root cause of the troublesome symptoms. After treatment, the blood that used to flow through the faulty veins will be diverted to the many normal veins in the leg, improving circulation and resolving symptoms.

Ultrasound guided foam sclerotherapy is so minimally invasive that most patients return to their usual daily activities right away. We will recommend some mild exercise like walking to ensure good blood flow in your legs and decrease discomfort. Additionally, compression socks will be required to ensure excellent cosmetic outcomes.

• You do not need to stop your medications prior to treatment, unless otherwise advised during your consultation.
• Fasting is not required. If your procedure is scheduled for the morning, be sure to eat breakfast. However, try to avoid caffeinated beverages such as coffee and soda.
• Do not shave your legs immediately prior to your treatment.
• Wear loose clothing to the procedure appointment. Your leg will be wrapped in dressing material and compression stocking placed after the procedure.

• Our patient care specialists will go over the post treatment instructions in detail and provide you with a copy to take home.
• Compression stockings will be worn continuously for the first 48 hours. Following this, the stockings should be worn for a minimum of 14 days during the day. They can be removed for showering and sleeping. The longer you wear them, the fewer the side effects and better the results.
• You may resume normal activities but avoid standing still for long periods of time. Many of our patients even return to work after the procedure.
• You will need to walk a minimum of 30 minutes each day for at least 3-4 weeks after the procedure. This is crucial to obtain the best results, avoid complications and make your leg feel more comfortable.
• You may continue your normal exercise routine, except for strenuous and high impact exercises such as running and jumping for 2 weeks. Walking is highly encouraged.
• Avoid hot baths, hot compresses, whirlpools, saunas for at least 3-4 weeks.
• Avoid direct exposure of the treatment area to sunlight for at least 3-4 weeks to reduce skin staining – high SPF sunscreen is highly encouraged.
• Avoid anti-inflammatory drugs like aspirin, ibuprofen for the initial 48 hours.
• Avoid long distance travel > 5 hours for the first 3 weeks. If this is unavoidable, please let us know.
• A followup evaluation will be performed 2 weeks after the procedure. This is to ensure treatment success and to exclude the very low chance of deep vein thrombosis. 
• We believe in treating patients like family. You will have Dr. Poonawala’s after hours number should you have any questions or concerns.

The common side effects which are a normal response to the treatment, are harmless and transient. They are expected and should not be a cause for concern although they should be reported on follow up. 

• Mild discomfort – expected as a result of vein spasm and the body’s natural inflammatory response to the sclerosant. This may persist for several days with intensity related to the initial size of the veins and their location. Pain is usually improved by walking, cold compresses or by taking acetaminophen in the first 48 hours. Anti-inflammatories such as Ibuprofen or Naproxen may be taken after 48 hours. Discomfort will typically be the worst for the first 1-2 days with gradual decrease and resolution thereafter. There is never a need for prescription strength painkillers.  
• Skin bruising – at the treated areas and is not a cause for concern. This is merely the body’s response to the treatment and typically disappears within two to three weeks and can range from minimal to extensive. Bruising can look quite dramatic though it is not painful.
• Soreness – especially behind the knee and generally related to rubbing by the tight compression stockings and bandages
• Tender lumps –  commonly seen along the treated vein and represent hardened veins; the intention of sclerotherapy. These may present a week to a month after the procedure and can persist for a few months, with gradual spontaneous resolution. They may occasionally be tender and angry appearing when trapped blood has remained with the closed vein. This can be gently drained via a tiny needle prick, resolving tenderness and preventing skin pigmentation. Blood trapping is most common in large varicose veins thus, Dr. Poonawala frequently utilizes a novel technique of tumescent-assisted sclerotherapy with combination exit phlebectomy to reduce this occurrence.
• Pigmentation – Light brown discolouration or dark shadow may occur along the treated veins and is related to skin deposition of hemosiderin from “trapped blood”, an iron containing blood breakdown product. In most cases, complete resolution is seen within 12 months, rarely longer. Above mentioned drainage of trapped blood will prevent prolonged pigmentation.
• Matting – This is the development of fine red veins near the previous injection sites, and occurs shortly after treatment in less than 10% of patients. Matting most commonly presents in patients with extensive surface varicose veins, overweight patients and those with very fair complexion. Typically resolves spontaneously although can persist for many months. Rarely, additional cosmetic sclerotherapy or surface laser therapy can be treatment considerations when persistent. 
• Phlebitis – Spontaneous inflammation of the treated veins after the initial healing process. This presents as red tender areas along the course of treated veins (similar to inflammation from trapped blood) and is treated with anti-inflammatories such as Ibuprofen and Naproxen, compression stockings and frequent walking. This is commonly mistaken for an infection and will not respond to antibiotic therapy. If extensive or progressing, a short course of blood thinners may be recommended.

Sclerotherapy has been proven to be remarkably safe and well tolerated in a large number of clinical studies, although complications can occur even with the best possible technique and attention to detail.

• Deep Vein Thrombosis (DVT) – development of a blood clot in the deep veins of the leg. This is a recognized complication although extremely rare with sclerotherapy, especially if the compression stocking and daily walking regimen is followed. Repeat duplex ultrasound evaluation for blood clots is always performed on the initial follow-up examination. 
• Allergic reaction – Allergic reactions to sclerosing solutions are rare, with generalized rash, airway swelling and difficulty breathing the more common serious and life threatening symptoms. These obviously require immediate treatment with epinephrine and/or steroids. Less serious reactions such as minor rashes are generally treated with antihistamines or careful observation. Allergic reactions are slightly more common in patients with asthma. 
• Intra-arterial injection – rare complication occurring when an artery, rather than a vein, is inadvertently injected with the sclerosant. This can result in severe skin and tissue necrosis in the area the artery supplies. Treatments by a specialist well versed with intricate vascular anatomy will greatly reduce this risk.
• Skin ulcers –  extremely rare complication at the treatment site  (<1%), typically due to too strong a sclerosant concentration and leakage into the surrounding skin.