Ultrasound Guided Sclerotherapy (UGS)

Ultrasound Guided Sclerotherapy (UGS) is a method of treating the source of varicose veins which lie deep beneath the skin. The doctor views the image on the Ultrasound monitor to guide insertion of the needle and injection of a sclerosant solution into the target vein.  The earliest publications regarding UGS appeared in the early 1990's.  The application of improved Ultrasound technology has now led to a great refinement in Ultrasound Guided Sclerotherapy.  Very accurate injection of varicose veins deep to the skin can now be undertaken. A varicose vein visible on the skin always has a deeper source under the skin and effective treatment requires treatment at this source. UGS has this capability of targeting treatment at the source of the varicose vein. UGS can be used to treat varicose veins of all sizes but Endothermal ablation using Endovenous Laser or Radiofrequency devices is now the preferred method for treating large refluxing Saphenous Veins. 

The principle sclerosants now used in Australia and overseas are Polidocanol and Sodium Tetradecyl Sulphate.  Both these agents are surfactant 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 appeared in the late 1990's and since then they have come into routine use around the world today.  The properties of foam have specific advantages over the use of liquids. 

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 has a large diameter ( > 6mm).  However ELT has limitations because it is not possible to insert the fibre around the corners of a very tortuous veins.   

During the initial consultation, Ultrasound examination provides an accurate means of mapping the “leaking” or “incompetent” vein through its invisible descent beneath the skin before it appears as lumpy varicose veins on the surface of the skin lower down the leg.

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.

Following UGS the veins undergo a sclerotic process over the next few months.  During this period it is not unusual for lumps to become palpable beneath the skin. This is often a sign of successful treatment and simply reflects the vein walls transition to scar tissue. The lumps will eventually disappear over time. 
On occasions areas of trapped blood can develop and these areas can sometimes be tender and uncomfortable. Release of this trapped blood provides immediate relief.  Less common is inflammation of the vein wall itself- called superficial thrombophlebitis. This condition is usually well managed by compression with the stockings and non steroidal anti inflammatory medications.

Reassessment of patients following UGS is routinely undertaken at six weeks, three months and twelve months following the initial treatment. Ultrasound examination is used to detect any evidence of recurrence. Re treatment is undertaken at the time, so we urge you to return with your stockings for every follow up visit.

UGS is a particularly suitable method of treatment for Recurrent Varicose Veins After Surgery (REVAS).  
Varicose veins recurring after surgery are often complex and can be very extensive causing patients a great deal of distress because they unfortunately have the belief that nothing further can be done, particularly if they have had surgery on more than one occasion.  

Click here for further information about Recurrent Varicose Veins After Surgery.