For many years sclerotherapy has been used to treat certain lower limb varicose forms – intradermal, reticular varicose and recently also bigger varices.
All over the world different sclerosants varying in strength (concentration) and form (foam or liquid) are used with one aim – to cause a vein to stick together and close as a result of vein wall damage so that the vein would not be visible any more.
In Estonia Aethoxysclerol or Polidocanol (1%, 3 %) is mainly used. The advantages of Aethoxysclerol over other sclerosants include relatively painless intravenous injection and fewer allergic reactions. In addition, the medicament does not cause hemolysis which is an important factor in the occurrence of hyperpigmentation. The problem with Aehtoxysclerol is that the medicament produces tissue necrosis when it gets out of the blood vessel – however, this complication can be prevented and occurs rarely if the medicament is used in lower concentrations.
There are certain nuances accompanying sclerotherapy which one should be aware of prior to going to the procedure:
– The skin, where sclrotherapy is performed, must be undamaged.
– It is a procedure consisting of needle sticks – it is not the most painful procedure, but the intensity of the pain syndrome is connected with the sensitivity of the patient. If a patient is very fearful of pain, it is wise to inform the doctor about it prior to the procedure – there are various methods that can be used on an outpatient basis for decreasing the pain syndrome.
– A sclerosant may cause allergic reactions – although this has been described rarely all over the world.
– A sclerosant with the least concentration and in as small amount as possible is used in the first procedure keeping in mind an allergic reaction. This, in turn, means that varicose might not disappear completely after the first procedure and multiple procedures may be necessary.
– Not all the varicoses can be corrected by sclerotherapy – it becomes clear after 1-3 procedures whether the specific varicose responds to the sclerosant used or not.
– After the procedure discoloration of the skin in the sclerosed spot (hyperpigmentation) can be expected. As a rule, it is a phenomenon that will disappear soon, but skin discoloration is permanent in case of up to 1 % of the patients. Hyperpigmentation worsens in sunlight, which is why it is not recommended to sunbathe the treated areas for 1 month after sclerotherapy.
– Immediately after sclerotherapy support stockings need to be worn – II class 30-40 mmHG, which are recommended to be used for 2 weeks after the procedure – continuously in the first 24 hours and daily after that.
– A person can continue his or her usual routine after sclerotherapy – a certificate for sick leave is not needed.
– A haematoma may occur at the injection site that needs to be corrected at a repeat consultation. The aim of a repeat consultation is also to give patients the opportunity to express their satisfaction and ask specifying questions in addition to repeat sclerotherapy.
– At the end of the procedure the patient will be given the time for repeat appointment and the contact number to be used in case of problems. What should a patient know, if he or she has varicose veins and wishes correction.