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Ultrasound Guided Sclerotherapy

What is UGS?

UGS stands for Ultrasound Guided Sclerotherapy. A high resolution Ultrasound called a DUPLEX Ultrasound Scanner is used to identify abnormal Varicose Veins below the surface of the skin (i.e. where the problem is coming from). The Ultrasound image is then able to guide the treatment of these Varicose Veins below the skins surface using a fine needle injection procedure (Sclerotherapy).

What is Foam Sclerotherapy?

The solution that is used to treat Varicose Veins can be prepared as a Foam solution or as a Liquid solution and when a Foam solution is used it is called Foam Sclerotherapy. Foam Sclerotherapy has been used routinely since 2000 when a simple method of producing Foam was developed by an Italian doctor Lorenzo Tessari. A Foam solution has the advantage of being thicker and more viscous than a liquid solution and subsequently sticks to the lining of Varicose Veins better, making it more effective in sealing off Varicose Veins. In addition Foam solutions have the advantage in Ultrasound Guided Sclerotherapy that the solution can be seen on the Ultrasound scan whereas Liquid solutions cannot. The visualisation of the Sclerotherapy solution on the Ultrasound screen allows for much more accurate treatment of deeper Varicose Veins.

What are the Advantages of UGS

Ultrasound Guided Sclerotherapy is a minimally invasive procedure which can target large Varicose Veins and underlying reflux problems without Surgery. No hospital admission is needed and no anaesthetic is required. It is a walk in walk out procedure with immediate return to normal activity and work. Even patients with very large Varicose Veins can be suitable for Ultrasound Guided Sclerotherapy rather than Surgery. Ultrasound Guided Sclerotherapy is a less expensive procedure than having a surgical operation in hospital and reported side effects and complications are much fewer than with Surgery.

Compared to other non surgical treatments for Varicose Veins such as Ultrasound Guided Radiofrequency (VENEFIT) and Ultrasound Guided Laser (EVLA), Ultrasound Guided Sclerotherapy can be a very cost effective Varicose Vein treatment option. Ultrasound Guided Sclerotherapy does not require the expense of the single use catheters and the cost of expensive Laser and Radiofrequency equipment. Ultrasound Guided Sclerotherapy is often the treatment of choice for Varicose Veins that are branches of the main Leg Veins and residual Varicose Veins that remain after Surgical Stripping, Ultrasound Guided Laser or Ultrasound Guided Radiofrequency.

Are there any requirements before UGS?

All treatments are performed on an outpatient basis in our Leg Vein Clinic. No anaesthetic is necessary and there is no specific preparation required before treatment. We do recommend not shaving or waxing the legs in the 24 hours before any Leg Vein treatment including Ultrasound Guided Sclerotherapy. We do recommend wearing loose fitting clothing and comfortable footwear as patients need to be able to wear compression stockings after treatment and be ready to walk for at least 30 minutes after treatment. We advise not applying any leg moisturiser on the day of treatment as some small dressings may need to be applied to the skin. Patients can elect to bring shorts to wear during the procedure.

What about UGS treatment during pregnancy?

Elective procedures such as Ultrasound Guided Sclerotherapy are avoided during pregnancy and generally not performed until after breast feeding has finished. If Varicose Veins are causing significant symptoms during pregnancy they are best managed conservatively by appropriate compression hosiery.

The main solutions used in Ultrasound Guided Sclerotherapy are classed as Category B3, which means whilst there is no evidence of problems being caused during pregnancy there are no large clinical studies to prove they are definitely safe. In addition the results from Ultrasound Guided Sclerotherapy during pregnancy are likely to be less effective due to the increased blood flow, hormonal changes and pressure in the leg veins during pregnancy.

Is UGS painful?

Ultrasound scans involve gel on the surface of the skin and use of a flat Ultrasound probe so there is no discomfort at all with the Ultrasound aspect of the treatment. The injection side of the treatment does involve a needle so it can be felt but most patients experience only minimal discomfort because the needle used is very fine. The Ultrasound Guided Sclerotherapy procedure typically only requires a few precisely placed injections and patients who have had Surface Injections usually regard the Ultrasound Guided injections as less uncomfortable.

Are there any side effects?

Worldwide clinical trials have found Ultrasound Guided Sclerotherapy to be a remarkably safe method of Varicose Vein treatment. Surface bruising may occur after Ultrasound Guided Sclerotherapy but this typically disappears fairly quickly. Tender cords in the treated Varicose Vein commonly develops in the days after Ultrasound Guided Sclerotherapy, especially when larger Varicose Veins are treated, but these disappear over several weeks as the body breaks the trapped blood. Inflammation (phlebitis) of the treated veins can occur resulting in red, raised areas which can take several weeks to disappear. If post treatment inflammation persists and causes undue discomfort, management includes further compression stockings, Anti inflammatory medications such as Naprosyn, regular walking and if necessary treatment by aspiration in the clinic.

Some skin discolouration is usual early on after Ultrasound Guided Sclerotherapy but uncommonly after treatment the vein may develop a persistent brownish colour due to iron from the blood. It mainly occurs with very large or thick patches of veins and in individuals with darker skin, and can be long lasting. If it is a cosmetic concern medical grade Lasers can break this pigment down.

Deep vein thrombosis (DVT) is a rare complication as are allergic reactions to the sclerotherapy solution but whilst serious side effects are very rare with Ultrasound Guided Sclerotherapy it needs to be remembered that unknown or unpredictable problems can occur with any form of medical treatment.

What is the risk of DVT?

The risk of Deep Vein Thrombosis (DVT) after Ultrasound Guided Sclerotherapy is very low but it is not zero. Some clinical studies put the risk of DVT after Ultrasound Guided Sclerotherapy at 1 in 10,000 but the risk does vary between different individuals. The key to reducing the risk of DVT after Ultrasound Guided Sclerotherapy, is identifying patients at an increased risk of DVT and if necessary using blood thinning injections such as Clexane. Also routine preventative measures such as walking after treatment and compression hosiery can reduce the risk of DVT. The risk of DVT with any Leg Vein treatment is greater if there is a personal or family history of thrombosis (clots) or if there is a history of thrombophilia (abnormal blood clotting). By avoiding General Anaesthesia, time in hospital and the restricted mobility associated with Surgical Stripping the risk of DVT is certainly lower with

What needs to be done after UGS treatment?

Walking immediately after Ultrasound Guided treatment, and daily walks are very important to stimulate blood flow through the deep veins and reduce any risk of Deep Vein Thrombosis. The usual recommendation is a 30 minute walk immediately after treatment and at least 30minutes daily for two weeks. Usual daytime activities can be resumed immediately after treatment.

Compression stockings are usually advised to be worn after Ultrasound Guided treatment continuously for 7 days and then for a further 7 days during the day only. The medical grade compression stockings we recommend are 20-30 mmHg level of compression and usually below knee stockings are adequate.

It is routine to perform a follow up Ultrasound scan after the first Ultrasound Guided Sclerotherapy treatment.

Are there any restrictions after UGS?

It is advised to avoid standing still or sitting for prolonged periods in the first week after Ultrasound Guided Sclerotherapy. Avoid intense leg exercise (aerobics, long runs, leg weights) for one week after Ultrasound Guided treatment. Avoid long hot baths, spas or saunas for two weeks after Ultrasound Guided Sclerotherapy. There is no restriction on sun exposure after Ultrasound Guided Sclerotherapy.

It is the general recommendation that any air travel should be avoided for 2 weeks after Ultrasound Guided Sclerotherapy and long haul flights (over 4 hours) should be avoided for 4 weeks after Ultrasound Guided Sclerotherapy to reduce any added risk of a Deep Vein Thrombosis. If a plane flight is unavoidable then cover with a blood thinning injection (eg Clexane) may be advised. The precise advice for airplane travel after Ultrasound Guided Sclerotherapy does vary depending on the severity of the Varicose Veins being treated and if there are any other risk factors for Deep Vein Thrombosis.

How many UGS treatments are necessary?

This will vary between individuals and depend on the type and extent of the problem and the level of improvement required. A treatment plan will be devised at your first consultation. As a guide the average number is 2-3 treatments for UGS.

Will Leg veins come back after UGS treatment?

Treatment can get rid of the veins that are currently present and these veins do not come back. However treatment cannot prevent new veins developing in the future. If you have a tendency to develop leg veins you will probably develop more in the future. The emphasis in treatment is getting the veins under control with as few treatments as possible. If new veins develop, follow up treatment may be necessary.

What are the costs for UGS?

The cost of the Mapping Scan that needs to be performed before the Ultrasound Guided Sclerotherapy procedure qualifies for a Medicare rebate, with the out of pocket expense to the patient of about $160. The Mapping Scan is performed in our Leg Vein Clinic by the doctor who performs the Ultrasound Guided procedure and not by a radiographer at an outside Ultrasound clinic.

Ultrasound Guided Sclerotherapy does qualify for a Medicare rebate and as a medical procedure with a Medicare rebate GST is not applicable. The Medicare Safety Net can apply when out of pocket medical expenses exceed a certain threshold, however Medicare has placed a cap on the out of pocket expenses for Varicose Vein treatments that can contribute to the Medicare Safety Net. Medicare also places a limit on the total number of injection based Vein treatments that can be claimed in a12 month period to 6 treatments, irrespective of whether the treatment is to surface Varicose Veins or deeper Varicose Veins.

Private Health Insurance does not cover out of Hospital procedures such as Ultrasound Guided Sclerotherapy. In some circumstances an income tax rebate can be claimed for out of pocket health expenses exceeding a certain threshold but this varies with individual circumstances.

The cost of Ultrasound Guided Sclerotherapy does vary depending on whether it is the first treatment to a leg or a follow up treatment. Generally speaking expect the out of pocket expenses with Ultrasound Guided Sclerotherapy to be around $750-$1000 per leg.