 Vein Services > Ultrasound-Guided Sclerotherapy (Echosclerotherapy)
Ultrasound-Guided Sclerotherapy
(Echosclerotherapy)
Questions and Answers
What is echosclerotherapy?
Echosclerotherapy is a technique for the permanent elimination of veins that involves the injection of various fluids directly into veins under ultrasound guidance. The use of the ultrasound machine makes it possible to inject veins that are otherwise undetectable and previously required surgical treatment.
This technique was developed in France and the USA in the late 1980s. There are vein clinics in Montreal, Vancouver, and Calgary offering this service. There are very few clinics in Ontario doing echosclerotherapy.
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What kinds of veins can be treated?
There are several areas of the superficial venous system that are inaccessible to injections by touch or sight. These large veins are frequently the source of pressure that produces dilated varicose veins and even clusters of spider veins. These large veins must be treated before smaller vessels are treated, otherwise the small vessels will recur.
The most commonly injected area is the saphenofemoral junction. This is the junction between the largest superficial vein in the leg (greater saphenous vein) and the largest deep vein of the leg (common femoral vein). It is located in the groin.
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What are the alternatives to echosclerotherapy?
Prior to the introduction of ultrasound-guided sclerotherapy, surgery (ligation and stripping) was the only option for elimination of large deep veins. Ultrasound-guided sclerotherapy eliminates the need for surgery in most cases.
Laser surgery (endovenous laser ablation of the saphenous vein) can be done. This is a minor surgical procedure requiring local anesthetic only. A fiber optic wire is fed up the vein and a laser beam is applied to the inside of the vein to destroy it. This technique works very well, but it is expensive and not readily available.
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What are the risks of echosclerotherapy?
The risks of echosclerotherapy are the same as those for sclerotherapy.
Sclerotherapy is an extremely safe technique. Serious complications are rare.
Bruising around the injection sites is normal following sclerotherapy. These bruises resolve within ten days.
Increased pigmentation along the course of the vein is fairly common. This may take a few months to resolve.
Marked inflammation may occur in the area injected. This may take several weeks to resolve.
Clots always form in the treated vessels. These are really just scabs forming on the injured vein lining. When varicose veins are large and close to the surface, these clots may be felt or even seen as lumps under the skin. These may be tender but are otherwise of no significance. They will resolve in a few months.
Matting is a phenomenon in which your body builds numerous tiny blood vessels in or near the area injected. These tiny blood vessels have the appearance of a bruise or a flush. They usually resolve over several months, but they are sometimes permanent. They may be treated with further injections or laser.
Exceedingly rarely, the sclerosing agent may be inadvertently injected into an artery. This will produce severe pain and damage to the tissue fed by this artery. This requires immediate hospitalization for treatment.
Allergic reactions can occur to the injected agents. These reactions are extremely rare. This may simply involve local swelling and itching, but in its worst form, allergic reactions can lead to anaphylactic shock. This involves a severe drop in blood pressure that is potentially fatal.
Very rarely, blood clots can form in untreated veins of the legs. Clots of this type may break loose and travel to the lungs (pulmonary embolism). Small clots would go unnoticed. Larger clots can lead to chest pain and shortness of breath. Even larger clots can be fatal. This is most likely to occur in people with a genetic predisposition to clotting.
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How many treatments will be required?
There is no simple answer to this. It depends on the extent of the vein problem. Frequently, only one injection is required at each site, but there may be numerous sites that require injections. Sometimes, more than one injection is required to treat the same vein, particularly at the saphenofemoral junction.
If disease is extensive, treatment may require numerous visits over several months.
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At what intervals are treatments provided?
Treatments are usually spaced at weekly intervals.
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What should I do to prepare for treatment?
Do not shave your legs the day of treatment.
Do not apply lotion or cream to your legs (tape will not stick).
Bring a pair of loose shorts to allow us access to your veins and allow you some dignity. Bring long pants or a long skirt to wear afterwards. You will have dressings to cover up.
Purchase support hose and bring it with you to wear after treatment. We stock support hose for sale.
Eat well before you come to avoid hypoglycemia and fainting.
Drink lots of fluids before your treatment to fill up your veins and to prevent fainting.
Avoid exercise (even walking) prior to treatment. This may drain your veins and make injections more difficult. It is preferable to stand for a prolonged time to fill your veins.
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What should I expect following treatment?
A compression bandage will be applied that needs to be maintained for five days. It must be kept dry.
You will be required to wear support hose or tensor bandages for two weeks.
You must elevate your legs above the level of your heart for 4 hours following the injection. You may therefore need time off work or the assistance of a babysitter.
Following the period of leg elevation you should go for a 20 minute walk. For the next few days, you should continue to walk. There is no such thing as too much exercise following sclerotherapy. You are encouraged to be as active as possible, except in the first 24 hours when vigorous exercise should be avoided.
Except for the insertion of the needle, this is usually a painless procedure. Occasionally you will feel some discomfort when the vein goes into spasm almost immediately following the injection. This can be quite intense, but it only lasts a few minutes.
Inflammation around the injection site and along the course of vein can occur, and it may be extremely tender. This is fairly common (about 5%). Ice, elevation, and ibuprofen may be used. It will resolve in one to two weeks.
Scabs form internally on the inside of the injured veins following every tretament. These scabs may be felt as lumps under the skin. Your body will break them down slowly (weeks to months). As these scabs are broken down by the body, they release byproducts that are irritating and pigmented. These substances may cause tenderness and staining of the skin. Large vessels with large scabs in them will cause persistent tenderness and staining for a few months.
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Do I really need to wear support hose?
When large veins are treated, support hose is required. It is an important part of the treatment. Use of support hose decreases the rate of complications (lumps and blood clots).
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Does OHIP cover the cost of echosclerotherapy?
Treatment of varicose veins that are larger than 5 mm and symptomatic is covered by OHIP. This applies to most cases where echosclerotherapy is required.
There may be additional charges for materials such as tensor bandages and support hose.
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How much does it cost?
If OHIP does not cover the cost (the veins are too small or you have no symptoms), each echosclerotherapy session costs $450 (four hundred and fifty dollars). This includes assessment, injections, ultrasound time, and medication cost.
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What is your cancellation policy?
We appreciate 48 hours notice for cancellation of your consultation or treatment. If sufficient notice is not received, you may be billed a minimum of $80 up to a maximum of the value of the service that was to be provided.
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Photos
 
Before and after foam sclerotherapy
Case #2
 
Before and after foam sclerotherapy
Case #3
 
Before and after foam sclerotherapy
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