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Varithena™ (polidocanol injectable foam) is used for the treatment of problems with the great saphenous vein and other saphenous veins and varicose veins of the great saphenous vein system. It is for the treatment of veins above and below the knee. It is only for use in adults with significant venous reflux that was diagnosed by a duplex ultrasound.
During the treatment procedure, Varithena™ is injected directly into the failed veins and varicose veins. It pushes the blood out of the vein and the active ingredient (polidocanol) irritates the lining of the vein. This causes the vein to go into spasm destroying the lining of the vein, which is then closed. Over several months the vein is slowly resorbed by the body and eventually turns into a thin string of scar tissue. The blood is redirected to healthy veins.
In clinical trials, Varithena™ reduced patients’ varicose vein symptoms including heaviness, achiness, swelling, throbbing, and itching (HASTI™ symptoms). Varithena™ also improved vein appearance in assessments by both patients and doctors.
About Varithena™
Your doctor has suggested treatment with Varithena™ (polidocanol injectable foam) because you have varicose veins. Varicose veins are enlarged, bulging veins usually found in the legs. They can cause uncomfortable symptoms such as swelling and achiness. Untreated varicose veins tend to get worse over time and can lead to serious problems that might require hospitalization.
Varithena™ is for the treatment of problems with the great saphenous vein and other saphenous veins and varicose veins of the great saphenous vein system. It is for the treatment of veins above and below the knee. It is only for use in adults with signifi cant venous refl ux that was diagnosed by a duplex ultrasound.
How Varithena™ Works
Varithena™ is injected directly into the failed veins and varicose veins. It pushes the blood out of the vein and the active ingredient (polidocanol) irritates the lining of the vein. This causes the vein to go into spasm destroying the lining of the vein, which is then closed. Over several months the vein is slowly resorbed by the body and eventually turns into a thin string of scar tissue.
How Varithena™ is Given
Treatment with Varithena™ is a nonsurgical procedure (no incision is required). Your doctor will inject a small amount of Varithena™ into the affected veins (a local anesthetic may be used to numb the injection site). The amount of Varithena™ injected is carefully controlled by your doctor by using ultrasound to see that the foam has fi lled the veins being treated. When the veins are fi lled, the treatment is complete (this will depend on the size and extent of your varicose veins).
You may require several injections during one treatment session, and may require several treatment sessions to completely treat all veins. Each treatment session will be separated from the next by at least 5 days.
After You Go Home
  • Bandages and a compression stocking will be applied and should be worn without taking them off for 48 hours
  • The compression stockings should be worn for the first 2 weeks
  • You should walk for at least 10 minutes each day after treatment
Your doctor will probably schedule a follow-up visit to see how you are doing. Some patients need only a single treatment with Varithena™. Additional treatments may be needed depending on the number and size of veins to be treated.
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.
What are varicose veins?
Varicose veins are enlarged, bulging veins that are most common in the legs and ankles. They can cause uncomfortable symptoms, such as achiness, swelling, throbbing, heaviness, and itching.
Who gets varicose veins?
Varicose veins occur in 10–20% of the population, with women being twice as likely to get varicose veins as men. They usually appear between 30 and 70 years of age, often getting worse over time. You may be more likely to get varicose veins if other members of your family have them, if you are overweight, or if you work at a job that requires you to stand for long periods of time.
Why do varicose veins occur?
Varicose veins occur when the tiny valves inside the veins become weaker, causing blood to back up and make the veins swell.
Tiny valves help the leg veins work against
gravity to push blood back to the heart.
But if valves weaken, blood can leak backwards
and pool, resulting in varicose veins.
There are many things that contribute to getting varicose veins, including:
  • Getting older
  • Being a woman
  • A family history of vein problems
  • Being overweight
  • Pregnancy
  • Sitting or standing for a long time
What are common symptoms of varicose veins?
Varicose veins may not cause any problems, or they may make you feel so bad that you miss work or become unable to do the things you enjoy. Symptoms of varicose veins include:
  • Leg pain, aching, or burning
  • A feeling of heaviness
  • Restless legs
  • Cramps
  • Feeling tired
  • Itchiness
  • Tingling
  • Swelling
  • Skin changes
  • Ulcers (open sores)
What happens if varicose veins are not treated?
Most varicose veins are not a serious medical issue. However, left untreated, varicose veins can sometimes lead to complications, such as bleeding from the varicose veins, blood clots, open sores, and infection, which may arise from skin problems due to fluid buildup. Untreated, varicose veins tend to get worse over time and can lead to serious problems, such as chronic venous insufficiency.
How are varicose veins treated?
Talk with your doctor about taking care of your legs. Managing the symptoms of varicose veins may be as easy as using compression stockings and avoiding long periods without moving around.
However, there are other options for the treatment of varicose veins. The newest option, Varithena™ (polidocanol injectable foam), is the first and only minimally invasive microfoam procedure that treats both the symptoms and appearance of the widest range of varicose veins above and below the knee. Other options include liquid sclerotherapy, laser treatment, vein stripping, and surgery. If you think the symptoms you are having may be related to varicose veins, it is important to talk to your healthcare provider. He or she can diagnose your condition and determine which treatment plan may be right for you.
  1. At The Vein Institute of Toronto™, you will undergo a comprehensive venous consultation by a physician. This comprises your venous history and physical examination, followed by a venous duplex ultrasound in order to assess for superficial venous reflux, rule out deep venous thrombosis and map out the anatomy of your superficial venous system. This allows us to develop a personalized treatment plan for you.
  2. If you decide to proceed with the procedure, please follow the pre-procedure instructions (page 6) and medication protocol comprised of Arnica™ and Bromelain to minimize post-procedure discomfort, bruising and pigmentation, thus optimizing results. An EVA kit, including Arnica™ tablets/gel, Bromelain tablets and gel pack, may be obtained from The Vein Institute of Toronto™.
  3. The EVA procedure is performed according to our own tested and proven protocol, which was developed by physicians from around the world (page 7). EVA is a minimally invasive, ultrasound-guided procedure involving endovenous ablation of the affected saphenous vein. At The Vein Institute of Toronto™, our EVA protocol using our unique micropuncture technique has produced a 99% technical success rate and 92% clinical success rate in over 2200 procedures to date.
  4. After the procedure, a physician assistant will assist you to put on the required compression stockings. Please wear the Class II (30-40 mm Hg) compression stockings for the first 72 hours and then from first thing in the morning to before bedtime for another 10 days. For optimal results, please follow the post-procedure instructions (page 8).
  5. You will be seen in follow-up at one and twelve weeks after the procedure or as per your personal schedule and individual requirements. At each follow-up, a venous ultrasound will be performed to confirm the treated saphenous vein is closed. Foam sclerotherapy injections (which are included as part of your procedure) will be performed for any residual branch varicose veins (page 9) at your discretion or if clinically necessary. Please bring your stockings for all follow-up appointments. All post-EVA follow-ups are included as part of the procedure.
  6. At your 1 and 12-week follow-up appointments, you will be instructed on our Leg Wellness Program to improve the conditioning of your legs.
EVA Pre-Procedure Instructions
  1. Take 5 pellets of Arnica™, 3 times per day, for 5 days prior to the procedure. Place pellets under the tongue and allow them to dissolve in your mouth. Arnica™ is a homeopathic medicine which has been shown to reduce pain, bruising and swelling after the EVA procedure.
  2. Take one 500 mg Bromelain tablet twice per day, for 5 days prior to the procedure. DO NOT TAKE Bromelain, if you have a sulfa allergy.
  3. Your normal medications may be taken on the morning of your procedure along with a light breakfast. You may eat and drink normally before the procedure. However, please avoid products containing alcohol and/or caffeine.
  4. Please do not take blood thinners for 1 week prior to the procedure. Please check with the physician who prescribed your medication to verify that you may discontinue this medication for this period of time. Please inform the physician performing the EVA procedure of any health problems, allergies experienced and/or medication you are currently taking. Tetracycline or Minocin should be discontinued for 10 days before and after the procedure.
  5. Wear loose, comfortable clothing that can be worn over the stockings after the procedure. Please bring a warm pair of socks with you to keep your feet warm prior to the procedure. Please do not wear sandals to the procedure.
  6. We have a compression stocking service onsite to ensure that you are measured and fitted with the correct type and size of stockings. Accurately fitted stockings are essential to ensure the success of the procedure.
  7. Please read the enclosed post-procedure instructions (page 8) prior to your procedure. Please bring your stockings to your follow-up appointments. Have someone accompany and drive you home after the procedure.
The EVA Procedure
  1. Please arrive AT LEAST 60 MINUTES before your procedure time, to allow for proper preparation before the procedure. On arrival, you will be asked to change into a procedure gown and to remove your trousers or shorts, leaving your undergarments and socks on.
  2. A local anesthetic cream will be applied to the area to be treated. This should be applied at least 60 minutes before your procedure to maximize effectiveness. You will also be given an oral sedative (Ativan) and pain killer (Oxycodone) at your discretion to minimize discomfort during the procedure.
  3. A pre-treatment photograph will be taken to act as a baseline for your chart. A repeat mapping venous ultrasound will be performed. A tourniquet will be applied to your leg, in a standing position.
  4. You will then lie down on the treatment table and a cleaning solution will be applied on the leg(s) to create a sterile field for treatment. Sterile drapes will be placed around the treatment area (All materials used are sterile and disposed of after a single use).
  5. Local anesthetic (“freezing”) will be injected at the vein entry site. A needle is placed through the skin using ultrasound guidance into the vein to be treated. At The Vein Institute of Toronto™, we utilize a unique micropuncture technique to maximize success and minimize your discomfort. A guidewire will be placed through the needle into the vein. You may feel mild discomfort as the wire is being positioned. A vascular sheath (tube) will be placed over the guidewire and positioned at the junction of the superficial and deep venous system using ultrasound guidance. The ablation device will be placed through the sheath to the correct position.
  6. Branch vein sclerotherapy for your enlarged varicose veins will also be performed at the same sitting with a foam Sotadecrol® solution under light or ultrasound guidance. Pigmentation can occur after sclerotherapy in 2 to 4% of patients. The pigmentation usually resolves in 6 to 10 weeks with our post-treatment protocol.
  7. Tumescent anesthetic, using a special mechanical pump, will be applied around the vein to increase the effectiveness of the ablation and minimize your discomfort (only for laser or radiofrequency). The ablation device is then activated and pulled back along the vein. The ablation device is activated for a period of approximately 5 minutes. For the safety of patients and staff, we utilize and fully adhere to ablation safety protocols. After the catheter is removed, a small antibiotic dressing is placed on the skin, in order to prevent infection and promote healing.
  8. Immediately after the treatment, dressings and support stockings will be applied to the treated area on your leg(s). We suggest you walk for five minutes after the procedure, before leaving the clinic to promote deep venous circulation.
EVA Post-Procedure Instructions
  1. Keep support hose and Comprilan® bandage on for the first 72 hours continuously. After the first 72 hours, please wear the stockings from first thing in the morning (after a short 10-minute shower), until bedtime at night for another ten days. If bleeding occurs from the puncture site, apply pressure for five minutes. Remove the gauze dressing/bandages on your leg 72 hours following the procedure.
  2. You can go back to work the following day. You can resume daily activities the same day of the procedure (excluding exercise). You can resume exercising the following day (no lifting weights, sit-ups or push-ups for 2 weeks after the procedure). It is mandatory to walk at least 10 minutes every hour for the first 6 hours after the procedure. We strongly encourage walking at least 30 minutes per day from the day after the procedure for two weeks. You can shower immediately after the procedure (if you wear a leg bag) but no hot baths, hot tub, Jacuzzi, sauna or tanning for 6 weeks after the procedure.
  3. Bruising, localized swelling, some tenderness, tightness, and pain are normal along the inner thigh or behind the calf after treatment. Bruising may occur the same or following day. In most cases, it will be gone after 2 weeks but could remain longer. You may develop “lumpy” areas in your groin, which are tender and part of the normal healing process. Apply a gel pack (part of EVA kit) three times daily and Arnica Gel™ twice per day from day 3 to day 5 after the procedure to reduce the bruising. From day 5 to day 14 after the procedure, please apply warm compresses to the bruised and lumpy areas. Redness, tenderness and swelling around the point of entry may remain longer than 2 weeks. If you have pain and leg swelling involving the entire leg or calf, please call our office immediately.
  4. To Decrease Pain, Bruising and Persistent Discolouration/Pigmentation
    • Please continue to take 5 pellets of Arnica™, 3 times per day, and one 500 mg Bromelain tablet twice per day for 14 days after the procedure in order to reduce pain, swelling and bruising. Also, drink at least 2 liters of water per day to decrease discolouration/pigmentation at the sites of treatment.
    • Elevate your leg on a couch or chair and please apply a cold gel pack for 10 minutes at a time three times daily to the bruised and painful areas from day 3 to day 5 after the procedure. Then apply a warm gel pack to the bruised/painful or lumpy areas from day 5 to day 14 after the procedure. After each application of the gel pack or warm compress, apply Arnica Gel™ to the bruised areas. Apply Hiruval 35™ cream three times daily to discoloured areas from day 3 after the procedure for at least 6 weeks or until discolouration/brownish pigmentation disappears.
    • 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 essential to try to avoid sun exposure after the procedure. It is mandatory to apply a strong medical grade sunblock SPF 40 to 50 (available here) at sites of bruising or discolouration if there is any sun exposure.
What Should I Do Before My Follow-Up Appointment?
  1. Do not shave your legs or apply cream for one day prior to and on the day of your follow-up appointments. No tanning within two weeks of the treatment date. 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 necessary.
What Should I Do After My Sclerotherapy Treatment?
  1. 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 doing the rest of your morning routine). Compression stockings help decrease bruising at the sclerotherapy sites.
  2. To decrease Pain, Bruising and Persistent Discolouration/Pigmentation
    • Please 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 per day to promote healing, reduce bruising and prevent discolouration or pigmentation.
    • Elevate your leg on a couch or chair and please apply gel pack for 10 minutes at a time three times daily to the bruised and painful areas from day 3 to day 7 after the procedure. Then apply a warm compress to the bruised/painful or lumpy areas from day 7 to 14 after the procedure. After each application of the gel pack or warm compress, apply Arnica Gel™ to the bruised areas. Apply Hiruval 35™ cream three times daily to discoloured areas from day 3 after the procedure for at least 6 weeks or until discolouration disappears.
    • 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 critical to avoid sun exposure after sclerotherapy. It is mandatory to apply a strong sunblock SPF 40 to 50 (available here) at sites of bruising, discolouration or pigmentation if there is any sun exposure.
  3. You can resume normal daily activities, excluding exercise today. You can resume exercising in 2 days. You can shower in the morning but no weight lifting, sit-ups, push-ups, hot baths, hot tub, sauna, and Jacuzzi for 6 weeks after sclerotherapy.
  4. Bruising, local swelling, areas of bumpiness, lumps, and some tenderness are normal after treatment, but please feel free to call the office if you have any questions or concerns.
  5. You will not notice an immediate improvement. Clearance of varicose veins and discolouration usually occurs over a 4 to 12-week period and, in some instances, may take longer.
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.
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