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VENUS CENTRE VEIN CLINIC - Dr Chris Lekich

• Veins and Treatment - The Facts
• Making an Appointment
• Micro Sclerotherapy
• Ultrasound Guided Sclerotherapy
• Endovenous Laser Ablation
• Graduated Compression Stockings
• Who should treat your veins

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MICROSCLEROTHERAPY

Sclerotherapy is the treatment used in most cases to treat surface veins. This treatment of veins has been in use for over 75 years. Normal routine activities are encouraged after treatment and time off work is usually not required.

What is involved in this procedure?

Sclerotherapy involves injecting a sclerosing solution with a very fine needle directly into the blood vessel. The solution causes a reaction along the wall of the vein, causing it to swell and stick together. As a result the vein no longer fills with blood and will gradually fade over a period of weeks until it becomes barely visible. Depending on size, some veins require several injections for optimal results, but in any one treatment session numerous veins can be injected. Larger underlying veins must be treated first to reduce the chance of recurrence of surface spider veins. An ultrasound will be used to rule out incompetent veins that lead to superficial spider vein development. This procedure requires specialized skills.

What solution is used?

Many solutions are available however, "Fibrovein" is the solution of choice preferred by Dr Lekich. This solution is specifically manufactured for sclerotherapy. "Fibrovein" is rapidly broken down after contact with the vein wall and does not circulate through the body as an active solution. The effects of Fibrovein are isolated in its action.

Don't I need all of my Veins as part of my Circulation?

There are definitely certain veins that are required for healthy blood flow in the legs. Abnormal veins though, are unhealthy veins that do not function properly and usually (sometimes for years) haven't been relied upon by the body as part of normal blood circulation. These abnormal veins contain poorly oxygenated blood and subsequent free radicals that cause tissue damage. To compensate for this lack of function, more stress is placed on the deeper veins which can, in certain cases, also become abnormal. Once treated, circulation usually improves in the affected limb.

As abnormal veins do not return blood to the heart competently, they cannot be used in heart by-pass grafts.

Will the injections hurt?

Although many vessels are injected each treatment session, discomfort is minimal because of the tiny diameter of the needle. The ankle, foot and high thigh region may be a little more sensitive, although the pain experienced is easily tolerable. Some larger injections give a feeling like a dull ant bite, while most small injections into the veins feel slightly warm and tingly. You will be lying on the examination table during this time and changing positions to your side, back and stomach as needed to access the affected areas.

What is the usual treatment regime?

Often larger incompetent vessels underlie superficial veins - this will be assessed using an ultrasound in the initial consultation. If this is the case then the larger veins will be treated first. The smaller, superficial veins are then usually treated 4 weeks later.

Will I have any bruising?

Bruising in the treated area is quite normal and to be expected. Often legs can initially look worse, but this is only temporary. Blood may be trapped in the vein after treatment, forming a lump that becomes tender. Relieved by small needle aspirates as a routine procedure on your next visit, these lumps are not blood clots, but are a sign that treatment has been successful. The bruises will disappear within 2 to 3 weeks.

How successful is Sclerotherapy?

Generally, after the recommended number of treatments as per your assessment most patients can expect up to an 80% improvement in treated vessels. Legs may look worse initially from bruising, but this is only temporary. Treated veins will start to fade a few weeks after treatment and continue to fade for up to three months after the last treatment. Sclerotherapy is highly effective in treating abnormal veins however, absolute cosmetic perfection may not be achieved as a result of the progression of new abnormal veins.

Do treated veins recur?

Generally, the veins that are treated will not recur. Over time however, previously normal veins may progress and develop new varicosities. If there is an inherent tendency for vein walls to weaken, then these previously normal veins may require treatment in the future. Keeping to a healthy diet and weight, regular exercise and limiting time spent in high heel shoes can help minimize the development of new veins.

Are there any Side Effects of Sclerotherapy Treatment?

As with all treatments it is important to be aware of the possible side effects of Sclerotherapy treatment:

• Mild to moderate ache in the legs in the first day or two after treatment (relieved by walking and panadol)
• Some redness at the injection sites: disappears within a day or two
• Brown spots or lines on the skin: these pigmented areas occur due to blood escaping from the treated veins. The brown pigmentation is mostly haemosiderin, a form of iron that is stored in the body and in most cases disappears within a year. Around 5% of patients find that the pigmentation can persist for more than a year - laser can be used to minimize this effect. To reduce this side effect it is advisable not to take iron supplements during the course of treatment and to have trapped blood removed at your follow up appointment.
• Tender lumps in the treated vein: this is caused by the trapping of some blood in the injected vessel. These lumps are not blood clots but are a sign that treatment has been effective. They can be alleviated instantly by fine needle aspiration (which is part of the routine treatment) on your next visit.
• Matting: this is the formation of fine, closely grouped red blood vessels close to the injection sites of larger vessels. Approximately 16% of patients develop these and they either spontaneously resolve or disappear with injection. Occasionally, some may persist. Poor muscle tone or inability to exercise can increase the prevalence of matting as can a large number of surface veins pre-treatment. This effect can be greatly minimized by walking for 45mins daily or substitution low impact aerobics or cycling.
• Rarely, small ulcerations can occur at the injection site within 2 weeks of treatment. These can be painful and can be due to either the escape of the sclerosing agent into the surrounding tissues or sensitivity of the tissues to the concentrate of the agent used. Although they can be easily treated, please inform the doctor immediately. These ulcers tens to heal slowly and can leave a small scar. This side effect is more commonly observed in patients who smoke.
• Allergic Reaction: rarely an allergic reaction to a certain sclerosing agent can occur. Although serious, they can be treated instantly by adrenaline injection and antihistamine therapy. Hospitalization in this instance is uncommon. Minor rashes can occur and requires no specific treatment however, please inform the doctor so an alternative solution can be used in your subsequent treatments.
• Phlebitis (pronounced "Fle-bite-us"): Inflammation of the treated blood vessels can occur in 1% of patients undergoing sclerotherapy. This condition can be painful but resolves quickly with anti-inflammatory treatment, compression and walking.
• Migraine: Patients may experience migraine headache following sclerotherapy. Often migraine symptoms also include visual disturbances. This can be treated with Pannadol or Panadeine.
• Deep Vein Thrombosis: This formation of a clot in a deep vein is a rare occurrence (1 in 5000). This can be minimized by walking and using compression stockings. (SEE POST TREATMENT INFO SHEET)
• Intra-Arterial Injection: Resulting in muscle and skin damage, this complication is extremely uncommon. Use of through ultrasound examination will reduce complications.
• Infection: As the Fibrovein solution used is antibacterial, infection is very rare.
• There are no known long-term side effects of sclerosing solution

Is there any after treatment care?

Yes, and it is easy to follow:

1. Medical Grade Compression Stockings
   Following treatment sessions you will be required to wear a medical venous compression stocking to assist in sealing off the abnormal veins. The length of time that the stocking will be required to be worn varies from 7 - 14 days. The medical stockings offered at the VenusCentre have come a long way from the hot and thick stockings that were used years ago. Today, medical stockings are comfortable and reasonably light. Although autumn, winter and spring are ideal times for treatment; summer is comfortable with access to air conditioning for those who feel the heat.
   
   Why is Compression necessary?
   Compression minimizes:
   • Dark pigmentation of the treated areas
   • The risk of deep venous thrombosis
   • The number of treatments necessary
   • The possibility of recurrence.
     
2. Walking
   One 45 minute session or two 25 minute sessions of walking are required each day once treatment begins. Immediately after your first treatment session, you will need to walk for a minimum of 20 minutes. This greatly increases comfort by increasing blood flow to the leg and enhances treatment results. Walking also helps reduce complications.
3. Attend Follow up Appointments
   Attending all follow up appointments ensures the best possible results.