ULTRASOUND GUIDED SCLEROTHERAPY

 Anew method treating varicose veins – without operation – has been gained increased practice for the last ten years.

This ambulatoric treatment is based on injecting alcoholic foam solution –Polidocanol-inravenously under ultrasonic guidance.

The treatment lasts 20 minutes  at the outpatient Clinique with elastic bandages dressing for 36 hours.

The treatment is repeated 2-3 times with intervals of 10-15  days for the same leg.

Scientific background

The role of venous circulation is to return blood from the periphery – feet and hands- to the heart.

Venous circulation of the legs,  contains unidirectional valves which directs blood flow towards the heart, and prevents venous blood to regurgitate back to the legs.

As a result of pregnancies, long standing or genetic aberration of venous valves- the valves tend to separate from each other and cause venous incompetence leading to varicose veins formation.

Blood in the superficial venous system is supposed to flow from distal to proximal ,and from superficial to the deep venous system.

As a result of venous valve incompetence , the venous blood stays in the legs and causes venous congestion.

The increased venous pressure in the superficial venous system tends to develop the following manifestations

1. Superficial long and short saphenous varicose veins
2. Superficial veinou phlebitis
3. Varicose veins bleedindg
4. Stasis dermatitis due to leak of blood through venous capillaries with distraction of hemoglobin and browny degeneration of the ankle skin.
5. Venous ulcer –which develops after 5-10 yearf of venous .disease

TREATMENT

1.  Conservative treatment – Elastic stockings during the day and leg elevation at night.
2.  Venous surgery –Sripping of Long or Short Saphnous veins and evulsion of varicose veins under general or spinal anesthesia
3. Hybrid treatment by minimal invasive treatment with Endolaser Radiofrequency or endosopic steam treatment causing obliteration of the Long and Short Saphena with injecting or evulsion of residual varicose veins.
4. Ultrasound guided sclerotherapy-with foam injection to Long and short Saphena and varicose viens.

ULTRASOUND GUIDED SCLEROTHERAPY

Aim of treatment-closing the superficial incompetent veins by sclerotherapy to reduce high retrograde venous pressure.

Method of treatment

Ambulatory treatment of the varicose veins by  foam sclerotherapy guided by ultrasound.

The foam causes damage to the intimal layer of internal venous surface, and so causing obstruction of the vein.
Biological degredation of treated vein ,take place gradually in  3 months time ,in which the vein disappears.

Material

Polidocanol 1%-3 Injected as foam solution,  by mixing two thirds of air with third polidocanol .

This solution contains air bubles which is detected by ultrasound, while injected intravenousely .

After insertion of the needle intravenously by ultrasound,Polidocanol as foam solution is injected slowly  for about 10-15 minutes.

The venous lumen as detedted by ultrasound, change from black to white , which results in venous occlusion.

In order to prevent Deep vein thrombosis, the patient lies in prone position with the treated vein in the upperborder.

As a result , the foam polidocanol stays in the upper superficial vein and does not accumulate in the deep vein.

The needle is withdrewn out , and the leg is dressed with elastic bandage for 36 hours.

Next treatment can be continued 2 weeks later.

Sice effects

Ultreasound guided sclerotherapy is performed for the last 12 years , with growing experience throughout the world

It is a safe treatment with minimal- less then 1%  major complication.

Major complications-are :deep vein thrombosis ,pulmonary emboli, arterial occlusion and leg ulcers.

Minor complication-are: superficial phlebitis casing pain,treated by unti inflamatoric tablets.Pain in treated veins due to thrombotic veins, which  is treated by needle aspiration of the thrombosed vein.

Some times there is pigmentation of the teated veins especially of white skin patients . the pigmentation should resolve in one year.

Recurrent veins could occure in 5%-8%  In 5 years post treatment.

All most 90% of varicose veins and incompetent veins should be successfully treated by foam sclerotherapy.

Conclusion

Ultrasound guided sclerotherapy is a safe and effective treatment with minimal side effects

3 sessions of 30 minutes each , is usually sufficient to treat each leg of varicose veins.

This ambulatory procedure enables the patient to continue in his daily activities ,with minimal disturbance.

The varicose veins are supposed to disappear in the average of 3 month.

Key words

Varicose veins treatment, foam sclerotherapy.
ultrasound guided sclerotherapy.