Ultrasound Guided Sclerotherapy (UGS) is a method of treating varicose veins of any size and it has now mostly superseded older traditional forms of injecting varicose veins under direct vision. Ultrasound is used to guide injections of sclerosant foam by directing the needle tip into the target vein. There is no sedation used with this procedure.
The principle sclerosants now used in Australia and overseas are Polidocanol and Sodium Tetradecyl Sulphate. Both these agents are detergents and because of this property, they can be agitated into a foam. The first published reports on the use of sclerosant foams appeared in 2000 and since then they have come into routine use around the world today. The properties of foam have specific advantages over the use of solutions.
UGS is the optimal form of treatment for the majority of patients with varicose veins. Endovenous Laser Therapy (ELT) is the preferred method if the varicose vein is larger than 6mm in diameter but ELT is only feasible if the vein is straight and deep to the skin.
The source of lumpy varicose veins almost invariably arises from a leakage point from the deep veins into the superficial veins higher up the leg and this position is usually not obvious on the surface of the skin. Therefore the initial ultrasound assessment is imperative in determining the location of the source of this “leak”. Direct treatment at the sight of visible lumpy veins is usually a futile exercise if a primary leak point higher up the leg has not been identified and eliminated.
The initial treatment is directed towards this source with subsequent injections made in a distal direction. The injections can vary from 2 to 10 in number. The duration of treatment is usually less than 30 minutes. A medical grade compression stocking is then applied to the leg and patients then go off for a half hour walk. The stocking needs to be worn for 1 to 2 weeks depending on the severity of the case.