Sclerotherapy treatment for Varicose veins
Varicose veins are a common surgical problem. It has been estimated the 30% of the adult population will have certain degree of varicose veins. The condition contributes to a significant work load to the surgical departments.
Varicose veins are dilated and tortuous veins commonly seen in lower limbs. There are two superficial venous systems in the lower limb which can get affected by the disease process. With time the vein wall will become weak and the valves will stop functioning properly resulting in varicosities.
These veins can range from tiny thread like veins to gross varicosities.
Common presentations of varicose veins
- Cosmetic blemish
- Dull ache of the leg
- Skin Discolouration, itching
- Bleeding from dilated veins
- Painful and palpable veins with redness (Thrombophlebitis)
With lime certain changes will occur in the skin in a patient having varicose veins. These signs will be commonly seen in the lower part of the leg. Untreated patients may also present with venous ulcers.
During the evaluation of a patient the surgeon will determine which system of the veins are affected and will look for the complication of varicose veins. It is also important to consider patient’s other medical conditions and look for distal pulses in the limbs.
All patients are nowadays further evaluated with a specialized ultrasound test calledduplex scan to accurately map the veins to identify the areas with problems. This will also determine the state of the deep veins in the lower limbs.
Treatment options for Varicose veins
Depending on the severity and the nature of complication the patient is having the surgeon will decide on the specific management for the veins,
- Compression stockings
- Sclerotherapy treatment
- Surgical options (Laser Ablation / Radio frequency Ablation/ Open Surgery)
Sclerotherapy utilizes a special chemical which is an irritant to the vessel wall. Once injected, there will be an inflammatory reaction and this will lead to gradual occlusion of the vessel. Most commonly used agents are Polidocanol and Sodium Tetradecyl Sulphate (STD). This is injected into the vein using a fine needle and compression is applied. Sclerotherapy treatment can be given in two forms as a liquid or as foam. Foam is made by mixing the liquid with air rapidly using two syringes. The special advantage of injecting foam is that large number of varicosities can be ablated with small volume of sclerosant.
Sclerotherapy treatment is indicated for
- Reticular veins
- Primary long veins
- Perforator veins
- Recurrent veins following previous surgery or laser ablation
- As a combined treatment with surgery or laser
Several sessions of treatment may be needed to completely ablate veins under certain situations. Large patient based studies have clearly shown the efficacy of Sclerotherapy treatment especially when injected as foam.
Sclerotherapy treatment is not without complications. But most are minor. Pain following injection can be managed with simple pain medications. Injected veins will feel hard during the first few weeks.
Foam injection may be associated with transient cough or visual disturbances and migraine in certain patients. Allergic reactions may occur but lives threatening allergic reactions are extremely rare.
Dr Udaya Samarajeewa MBBS, MD- Surgery, MRCS (Eng.)
Consultant General Surgeon