Ultrasound Guided Foam Sclerotherapy (UGS)
UGS is one of the least invasive of the varicose vein treatment modalities. The procedure is done in an ultrasound department by Mr Damien Holdaway, an ultra-sonographer and a nurse with the patient fully awake, there is no need for any sedation.
A pre-procedure ultrasound scan identifies the diseased superficial venous segments which are to be treated. The ultrasound also identifies communications between the superficial and deep venous system known as perforators.
The sclerosant is prepared as 5mls of foam and is administered via a small needle, i.e. equivalent to a vaccination, into the target veins which are localized with the US scan. The injection is performed under direct vision in real time to ensure passage of the foam into the diseased vein then the communications between the superficial and deep venous systems are temporarily blocked to retain the foam to achieve maximum affect. The aim is to incite a chemical inflammation within the vein that will ultimately result in it turning into a scar and vanishing.
The second component of the therapy is compression to empty the vein of blood, ensuring the walls stick together, contract and vanish. The patient then goes into a 3 layer compression bandage for the first 24 hours and then uses a compression stocking for the next 10-14 days.
The procedure is walk in/walk out and painless. No surgical incisions are made and there is no requirement for anaesthesia.
Risks of the procedure
DVT (a clot in the deep veins of the leg) at less than 1%, this minimized by;
- The administration of subcutaneous Clexane or a blood thinner during the injections,
- The use of the compression stockings and
- Early mobilization, you will be instructed to walk for 10-15 minutes immediately after the injections.
Other possible side effects
- Severe allergic reactions at 1 in 4000.
- Accidental injection of the sclerosant outside of the vein. If this occurs a chemical inflammation will occur in the soft tissues, much like a insect bite or sun burn which can last anywhere from 10 days to 4 weeks. If a significant amount of foam is injected it can lead to an area of blistering and even ulceration,
- Phlebitis. If the treated venous segments is allowed to fill with blood it will clot and cause a sterile inflammation. This manifests as heat and tenderness. All patients experience this to some degree, which generally resolves in 6 weeks.
- Pigmentation. The treated veins can develop and brownish discoloration in the line of the vein. While this is commonly seen it is generally mild and slowly fades. Most pigmentation has gone within 3 months, although it can persist for up to 12 months. In a small percentage of cases, a smoky hue can be left permanently.
As the procedure does not surgically remove the diseased venous segment, but rather causes them to contract and slowly disappear. Patients need to be mindful this process can take up to 3 months. There is approximately a 20% chance that the treated vein can re-open, for this reason, follow up scanning is arranged for 6 weeks. If this occurs the diseased segment can be re-injected.