Patient Information Ultrasound-guided Foam Sclerotherapy

Vascular Surgical Unit Derriford Hospital Derriford Road Plymouth PL6 8DH Tel: 01752 439228 www.plymouthhospitals.nhs.uk

Varicose veins are swollen, irregular shaped veins that often develop in the legs. They occur when the vein wall weakens, causing the vein to dilate (bulge). If this happens, valves in the veins that prevent blood flowing in the wrong direction (back down your legs) may stop working properly and affect circulation. Symptoms can include heaviness, aching, throbbing, itching and cramps or fatigue in the legs. Some patients might have skin discolouration, skin inflammation or ulcers on the skin.

Treatment options Ultrasound-guided foam sclerotherapy is one of the modern treatments for varicose veins. They have been traditionally been treated with surgery or injection sclerotherapy. Sclerotherapy involves injecting a chemical into the affected vein that inflames the lining and causes it to block. This chemical is called a sclerosant, which is transformed into foam by being forcibly mixed with a gas (carbon dioxide and oxygen). The National Institute for Health and Clinical Excellence (NICE 2013) have stated that foam sclerotherapy can be offered routinely as a treatment option. The current evidence shows that foam sclerotherapy is an effective treatment for varicose veins and it works well in the short to medium term. Studies have shown that 84% of veins are successfully blocked using foam sclerotherapy. The rate of symptomatic varicose vein recurrence ranges from 4-22% at 5-year follow-up. Current evidence suggests no significant difference between foam sclerotherapy and other treatment modalities for varicose veins in the short to medium term. However, current research does not provide clear evidence of the efficacy of this treatment in the long-term. Website address: www.nice.org.uk/guidance/IPG440 2

Advantages of foam sclerotherapy The advantages of this procedure are:  It involves no general anaesthetic  There is no need for hospital admission  It results in none of the incisions and scars associated with surgery  The recovery time is shorter compared to the surgical option and allows a faster return to normal activities

Possible complications The potential complications/side effects of this procedure include:  hard lumps and some bruising may develop a few weeks post-procedure where the veins used to run  brown pigmentation may develop over the treated veins. This tends to fade with time, but may not resolve completely  thrombophlebitis: inflammation of the treated vein  deep vein thrombosis or DVT (0.5% risk)  an extremely rare risk of serious problems such as heart attack, fits and stroke (including transient ischaemic attacks, known as ‘mini-strokes’)  an allergy to the chemical used  headache  visual disturbances or chest discomfort immediately after the treatment (this is very rare and does not last)  there remains a possibility of recurrence of varicose veins in the future 3

Before the procedure If you are taking an oestrogen-based contraceptive pill, we would advise stopping this 4-6 weeks prior to your treatment, to reduce the risk of DVT. It would be helpful to depilate/shave your leg and wash your leg with ordinary soap, but please do not apply any lotions or creams. Eat a light meal before attending for your procedure. Be prepared to stay in the unit for 20-30 minutes after your treatment while we make sure that you are OK before going home. It is probably most comfortable and convenient to wear loose trousers and soft shoes. Please ask someone to come with you and to take you home afterwards. We do not recommend that you travel by aeroplane within one month of treatment.

Treatment After a local anaesthetic, a needle is inserted into the main affected superficial (surface) vein. Sclerosant foam is then injected and monitored with an ultrasound probe. Once foam has filled the entire vein, the top end may be compressed to keep the foam in the superficial veins. After the vein has been filled with foam, a compression stocking is put on the leg to wear for one week. Further injections may be given during the same session to make sure that all the varicose veins have been completely filled. If any vein is incompletely treated, further injections can be given in a second session.

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Immediately After Treatment Please have a brisk walk for 15 minutes and return to the day case unit prior to going home. We do not advise that you drive immediately following treatment. You may drive once you feel able to do so and your insurance company is happy to cover you.

During the next five days For the first week, at least, you should walk around for a minimum of 5 minutes every hour. Avoid standing still for long periods of time. We recommend that you remain active. When sitting down, please elevate your leg to help your circulation. These actions will help to prevent a DVT post-treatment. Avoid vigorous exercise and excessive kneeling or squatting for a week. You should be able to return to normal activities the next day, including returning to work. The stocking is an important part of the treatment and must remain in place for five days to keep the vein closed. During the first five days, bathing/showering is difficult and you may need to strip wash to avoid getting the stocking wet. Once removed after five days, you may have a bath or shower. You can purchase a plastic leg cover from some pharmacies to enable showering. If you do get some pain or tenderness we would advise pain-killing tablets, such as Paracetamol, and to keep active. Some discomfort is expected after the third day or so. If your whole leg swells, or becomes excessively painful, you should contact your GP for advice. If you have any 5

further concerns, please contact the Vascular Nurse Specialist on 01752 439245. Avoid travelling in confined circumstances for long periods. Try to break the journey into short sections and have a good brisk walk for 5 minutes every hour or so.

After five days After five days, you can remove any bandages and the compression at home. Please wash and keep your stocking. Usually the veins become lumpy and occasionally tender under the skin. The overlying skin may become faintly brown and discoloured. This is normal and should resolve: it indicates that the treatment has worked. If the veins are still tender, then we recommend wearing your stocking during the day only until this settles. Antiinflammatory tablets or gels such as ibuprofen are sometimes useful for local tenderness. You will receive a follow-up outpatient appointment with the Vascular Nurse to check the treated veins. In most cases, a single treatment is sufficient. In about 10% of patients, a second treatment is required to deal with any remaining veins. After five days in the thigh length stocking, you should then return to wearing your usual compression socks or stockings.

Consultant Vascular Surgeon

Mr Simon Ashley Secretary: 01752 431822 6

Consultant Vascular & Transplant Surgeon

Mr Jamie Barwell Secretary: 01752 431809

Consultant Vascular Surgeon

Mr Francis Dix Secretary: 01752 431822

Consultant Vascular Surgeon

Surgeon Commander Cris Parry Secretary: 01752 431809

Vascular Scientists

Mrs J George Mr A Ellison Mr R Craven 01752 439228

Vascular Nurse Specialist

Mr A Elstone 01752 431805

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This leaflet is available in large print and other formats and languages. Contact: Vascular Surgical Unit Tel. 01752 439228

Date issued: November 2014 For review: November 2016 Ref: A-93/S/V/CC/Ultrasound sclerotherapy V5

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