Sclerotherapy for Varicose Veins
There are very specific indications for utilizing sclerotherapy for varicose veins to increase success rates and limit the rate of recurrence from our experience at The Vein Institute of Toronto™.
The Indications for Sclerotherapy are as follows:
- As an ancillary or adjunctive treatment for branch varicose veins when treating superficial (axial) saphenous vein reflux with endovenous thermal ablation (laser or radiofrequency). We perform branch vein sclerotherapy in all patients when performing endovenous thermal ablation for axial superficial saphenous vein reflux in order to obtain optimal results. We will also perform delayed branch vein sclerotherapy at the 6 and 12-week follow-ups as necessary. Treating the branch varicose veins with sclerotherapy is critical to the overall success of endovenous endothermal ablation (laser or radiofrequency) procedures.
- For treatment of isolated branch varicose veins with no underlying superficial axial saphenous vein reflux.
- For treatment of branch varicose veins secondary to an incompetent perforator vein. Our protocol at The Vein Institute of Toronto™ is to treat the branch varicose vein and incompetent perforator with sclerotherapy.
- For treatment of recurrent branch varicose veins post-surgical stripping or ligation, with no underlying superficial axial saphenous vein reflux.
Sclerotherapy for Varicose Veins is Not Indicated:
When there is underlying, untreated superficial axial saphenous vein reflux. Sclerotherapy in this situation leads to a high recurrence rate of branch varicose veins, with persistent or permanent bruising or discolouration. Therefore, is it is critical to have a proper physician venous consultation, including ultrasound, to determine your underlying problem, and an optimal personalized treatment plan for you? Many vein clinics will engage in this kind of treatment, as it is a “quick fix” requiring minimal equipment, and ensuring the patient returns for multiple follow-up treatments.
The Vein Institute of Toronto™ Technique for Varicose Vein Sclerotherapy:
Our primary sclerotherapy agent for varicose vein sclerotherapy is Sotadecrol® (Trombojet™). This medication has been used in different medical applications for over 40 years, and has been demonstrated to be very safe, with a very low rate (<1%) of allergic reactions. We prefer to use the “foam sclerotherapy” method, which combines air with the sclerotherapy agent, to increase the effectiveness, and decrease the chances of bruising. Dr. Kundu, our medical director, performs all varicose vein sclerotherapy at our clinic and gives a number of lectures internationally on his “technique of performing sclerotherapy to optimize success”.
Dr. Kundu performs sclerotherapy using either light guidance (transillumination) or ultrasound guidance, depending on the depth, type and source of the varicose vein. As a fellowship trained Interventional Radiologist, Dr. Kundu is an expert at performing image-guided procedures, including sclerotherapy. We typically will only require one to three injections per varicose vein using imaging guidance and our foam sclerotherapy technique.
If you would like to have a consultation please contact the Vein Institute, Toronto’s premier clinic for leading edge, state of the art treatments for leg varicose, spider and facial veins.
Patient Procedure Instructions:
WHAT SHOULD I DO BEFORE MY APPOINTMENT?
- Do not shave your legs or apply cream for one day prior to and the day of your follow-up appointments. No tanning within two weeks of the treatment date. Do not take aspirin or blood thinners 3 days prior to the procedure. Do not take Tetracycline or Minocin 10 days before or after sclerotherapy. Eat a snack one hour prior to your treatment. Bring shorts to wear during the procedure and slacks to wear out of the office. Sclerotherapy will only be performed if deemed necessary by the attending physician.
- Keep stockings on continuously for the first 72 hours. Only take off stockings to go to the washroom or for showers. After the first 72 hours, wear your stockings from morning to night for another 7 days (ideally, take a quick 5-minute shower and then put them on before continuing with the rest of your morning routine). Compression stockings help decrease bruising at the sclerotherapy sites.
- To Prevent Pain, Bruising and Persistent Discolouration.
- Please continue to take 5 pellets of Arnica™, 3 times per day, and one 500 mg Bromelain tablet twice per day for 11 days after the procedure in order to reduce pain, swelling and bruising. Also, drink at least 2 liters of water each day to promote healing, reduce bruising and prevent discolouration.
- Elevate your leg on a couch or stool and apply a gel pack for 10 minutes at a time to the bruised and painful areas, three times daily. After each application of the gel pack, apply the Arnica Gel™ on the bruised areas.
- Please purchase generic Ibuprofen tablets (not Advil™) and take 600 mg three times daily orally for seven days after the procedure date. Ibuprofen may be purchased at any pharmacy.
- It is preferable to avoid sun exposure after the procedure. It is mandatory to apply a strong sunblock SPF 40 to 50 (available here) at sites of bruising or discolouration if there is any sun exposure.
- Apply Creamy Cleanser for sensitive skin twice per day to site of varicose veins and rinse off. Apply Complex Cu3 Intensive Tissue Repair Cream 3 to 5 times per day, to treated areas. If itchy, then apply more often than five times per day. If any irritation occurs, discontinue use and call our office
- You can resume normal daily activities, excluding exercise, today. You can resume exercising in 2 days. You can shower in the morning but no hot baths, hot tub, sauna, and Jacuzzi for 2 weeks after sclerotherapy.
- Bruising, local swelling and some tenderness are normal after treatment, but please feel free to call the office if you have any questions or concerns.
- You will not notice an immediate improvement. Clearance of varicose veins and discolouration usually occurs within 2 to 10 weeks and, in some cases, may take up to 12 weeks.
Call 416-929-0834 for a physician consultation (Referral letter required from a physician)