UGS for venous disease has been in use for many years. This is a very successful therapy, especially used in the treatment of medium to small sized veins. This can be used to treat the great or small saphenous veins and their tributaries depending on their size.
This is performed by injecting a medicine under ultrasound guidance into the vein. Success rates for the procedure compare favourably to published results of surgery. The two products that we use are Polidocanol (Aethoxysklerol) or Fibrovein (Sodium tetradecyl sulphate). Both are detergents and act by washing away the lining of the vein allowing the two walls to stick together.
This is typically performed by mixing the medicine with air or carbon dioxide to form a foam. The regulatory authority requires that each patient sign a consent form for the sclerosant to be given as foam.
What are the advantages and disadvantages for UGS?
UGS is very effective in treating small and medium sized veins. This is can also be performed on veins such as the Great and Small Saphenous Veins and the Anterior Accessory Vein. This does not require admission to hospital or anaesthesia. There is usually no need to take time off work and one is able to continue with ones day to day activities. The Small Saphenous Vein often responds better to EVLA than to Sclerotherapy. There is a dose limit to the amount of sclerosant that can be injected at a single session, and so occasionally several sessions may be needed to effectively treat all the diseased veins. This will vary from patient to patient and whether trying to treat one or both legs in a single session.
Often larger veins are better treated with Endovenous Laser Ablation, Ambulatory Phlebectomy or surgery, alone or in combination.
Does the injection procedure hurt?
This is not a particularly uncomfortable procedure and is well tolerated. The amount of discomfort will vary with the individual. The needles used are extremely fine (similar to acupuncture needles) and many are hardly felt at all. The injected solution can sting slightly for short periods of time. If EVLA is used or Phlebectomy performed, then minimal discomfort is experienced as these are performed under local anaesthetic.
What should you do before UGS?
What happens during UGS?
Prior to the procedure a sonographer performs an ultrasound of the leg similar to the initial screening scan to familiarise us with the veins. Injections will be performed with you lying on a treatment couch, which may be tilted at stages through the treatment.
The needles used are very fine and produce minimal discomfort. Ultrasound is used to track the injected medicine along the veins that are being treated. After completion, a stocking will be applied to the treated leg. Occassionally a subcutaneous injection of the anticoagulant drug Clexane may be given.
What should you do after UGS?
You will be asked to go for a 30-40 minute walk immediately after treatment. It is essential that you arrange for someone to drive you home. Walk or keep the leg elevated as much as possible for the first 24 hours and walk for 30-40 minutes each day for 2 weeks. Maintain normal daytime activities and avoid standing still for long periods. Avoid strenuous physical activity such as aerobics for three to four weeks after treatment since this increases the risk of blood flow returning into the treated veins. You are required to avoid any flights of 2-4 hours duration for 2 weeks and any flights of greater than 4 hours duration for 6 weeks after treatment. If travel is unavoidable, then the flight should be covered by anticoagulation with subcutaneous Clexane injections given before departure and after arrival.
The stocking are typically worn continuously for 48 hours. Stockings are then worn for a further twelve days through the day, removing them at night and replacing them in the morning after the shower (2 weeks in total). It is routine practice to perform a check ultrasound scan at 2 weeks (occasionally earlier) after treatment to determine that the treated vein is occluded and to exclude the small risk of DVT. If residual veins are shown then these may require further UGS at a subsequent appointment. It may be necessary to come back once or twice at weekly/fortnightly intervals to inject further varicosities in each leg.
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:
What are the possible complications from UGS?
Adverse reactions for UGS do not differ much from those for EVLA. Complications can occur even with perfect technique.
These include:
