VARICOSE VEIN TREATMENT

Non-surgical treatments

What are Varicose veins?
The term “Varicose veins” is used to describe veins that have become enlarged and that are causing the patient some type of problem. The problem may be a simple problem with appearance, where the patient does not like visible veins and capillaries on the legs. The problem may, on the other hand, be quite complex with large veins causing pain, swelling and ulceration of the legs.

What types of Varicose veins are there?
Most doctors differentiate between veins that are smaller than 2 millimetres in diameter referring to these veins as telangiectasia, capillaries or spider veins. Larger veins fall under the general umbrella of varicose veins.

What treatments are available for varicose veins?

1. Schlerotherapy involves the injection of medicines into the unwanted veins to cause them to become inflamed and close down. The vein walls stick together and close the veins. This treatment is used on smaller varicose veins, capillaries and spider veins.
2. Lasers can be used to close down fine capillaries which have not responded to multiple treatments with schlerotherapy.
3. Ultrasound-guided schlerotherapy is a technique reserved for larger varicose veins or veins that have not responded to schlerotherapy. Needles are introduced into the veins under ultrasound guidance for accurate placement. With this technique stronger medicines can be used to close down more difficult veins.
4. Endo-venous Laser is the latest technique which is used on larger veins and veins which are difficult to close down.  A laser fibre is introduced into the vein under ultrasound control and the vein is internally burned and closed down.
5. Surgery for varicose veins is being performed less and less. Most patients prefer to avoid hospital. Surgery remains a valid alternative for some very difficult veins.
   This information sheet is devoted to schlerotherapy. If you require information about the other varicose vein treatments, it will be given to you.

What medicines are used for schlerotherapy?
In this practice, three medicines are available for Schlerotherapy. 

1. POLIDOCANOL (Aethoxysclerol)
2. STS (Sodium Tetradecyl Sulphate)
3. Hypertonic Saline (concentrated Saline). 

All these agents are effective in the treatment of varicose veins and each one is indicated for particular types of veins.

Are results guaranteed?
Unfortunately results can not be guaranteed. Repeated treatments are often required and perfect results are rare. Most patients are happy to simply reduce the number of veins on their legs to a more acceptable level.

Is there a risk of HIV or AIDS?
All equipment used is disposable.  There is no risk of HIV.

Possible minor complications of Sclerotherapy
Most people experience some degree of discomfort during the injections. The degree of discomfort varies according to the site of injection.  Injections around the back of the knee, for example, tend to be more painful than on the ouside of the thigh.  Most people develop bruising at the sites of injections.  The bruising usually takes about two weeks to resolve but can sometimes take longer. Clots may develop where a small lake of blood has become trapped inside a vein that has been partially closed. These clots are easily removed.

Injected veins may re-open
Pressure must be applied to injected veins to prevent them from re-opening. Graduated Compression Stockings are used to apply uniform pressure. Stockings should be worn for two weeks after each treatment. Normal activities and sport can be continued during this period.

New vessel formation. (Telangiectatic Matting) 
Occasionally a blush or flare area may appear adjacent to the injected veins. This can be disconserting because the spider veins may look worse then before treatment. This complication may occur with all schlerosant medications. Matting improves in the majority of patients by simply waiting. It can also be improved by changing sclerosant medication or using lasers.

Rare serious complications of Schlerotherapy

1. Deep vein thrombosis – The formation of clots in the deep veins of the legs which can travel to the heat, lungs and brain causing damage. This is the most serious complicaton of schlerotherapy. If you were to develop this complication, you will require urgent medical treatment. Deep venous thrombosis is rare if injections are followed by compression and regular walking. Wearing of stockings and walking should commence immediately after injections and continue for two weeks after each treatment. If you or any member of your immediate family has had a clot, please advise.
2. Anaphylaxis -- This is an extreme allergic reaction which causes shock and collapse.  It is rare and can happen with most drugs in susceptible individuals.
3. Allergic reactions -- These are mainly in the form of minor skin rashes.
4. Skin ulcers -- These tend to be very small and heal rapidly.
5. Pigmentation or brown staining of the skin over the areas injected  -- usually short-term but it can be long-lasting. Usually responds to laser.

How much does treatment cost
The cost of each schlerotherapy treatment is $220.00. A medicare rebate may apply.

What to bring to your schlerotherapy appointment
Come wearing your stockings.  Wear comfortable underwear, a swimming costume or pair of shorts.  Wear loose-fitting trousers or a skirt and bring your walking shoes.  After completion of your injections, you will be required to walk around the block before going home by car.

Graduated Compression Stockings

Stockings
For best results you should wear your stockings for a day or two before schlerotherapy to stretch the stockings around your legs.  The grade of stocking you require is:

Immediately after schlerotherapy please walk for 20 minutes
before getting into your car to drive away.

COMMONLY ASKED QUESTIONS

How many injections will I be given?
The number of injections will vary.  It’s not the number of injections that determines the effectiveness of treatment, it is the type of schlerosing agent, its dosage and the site of injections.

Does the treatment involve any risk?
All medical treatments entail a certain degree of risk.  When scherotherapy is performend by a qualified doctor, complications occur rarely.

Is the treatment painful?
Pain is usually minimal because of the very fine needles used, however, the discomfort perceived by the patient varies with differrent areas being treated.

Can the treated veins come back?
No. The treated veins usually disappear permanently. New ones may develop.

Will I have to rest in bed after each treatment?
No. You will be able to return to your usual activities immediately.

What about exercise after treatments?
You may walk, swim or cycle as much as you please. You can leave your stockings off during exercise.

Will I have to return for review after the treatment program is completed?
You may consider a follow up visit once or twice per year to review any new veins that may appear.

What can I do to prevent varicose and spider veins?

• Avoid wearing girdles
• Wear your graduated compression stockings as often as you can. Especially when flying and during pregnancy.
• Maintain ideal body weight
• Exercise regularly

What can I do to minimise bruising after treatments?

• Do not take Vitamin E
• Avoid Non-Steroidal anti-inflammatory drugs (Feldene, Naprosyn, Orudis ….etc.)
• Do not take Oil of evening primrose
• Minimise alcohol for first day after treatment
• Use Arnica cream to any bruised areas and take Arnica tablets if necessary for the first few days.

What about lasers?
Lasers can be used through the skin, on the outside of the legs, to close down fine capillaries that have not responded to schlerotherapy. Lasers can also be used internally inside the veins to close down large veins.
Lasers used on the outside of the legs work best on fine, red capillaries. They will also help to dispurse pigmentation. Lasers are used to complete what has been achieved with schlerotherapy. Treatments with lasers cost $220 to $440 and no medicare benefits apply.

SCHLEROTHERAPY
POST-TREATMENT INSTRUCTIONS

What will happen?

1. Your veins may be sore for a few days. You may need to take some Padadol.
2. Cotton balls will have been applied to the injection sites and held in position with stick-on dressings.
3. Keep all the dressings intact overnight.
4. The next morning, remove all the dressings, have a cool, short shower and put your graduated compression stockings on.
5. Walk every day for 20 minutes. Walk twice per day if you can.
6. Bruising will appear over the first few days.

What can I do to improve my schlerotherapy result?

1. Keep as active as possible
2. Do not smoke
3. Drink alcohol as little as possible
4. Wear your graduated compression stockings for two weeks after each treatment.

Graduated compression stockings need to be worn during the day only.

What will happen when the schlerotherapy begins to work?

1. The skin bruising will gradually clear
2. The injected veins will decrease in thickness and number

When should I return for review?

1. Return for review two weeks after the first schlerotherapy session.
2. Return monthly thereafter until treatment is completed

Would you like more information about Legs Vein Treatments?
e-mail consultation click here...  enquiry@abccs.com.au
The best way of getting more exact information is to come in for a consultation.
Please make a booking by telephoning 99605400.

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