What are the other Names for the Procedure?
- Injection of Sclerosing Agent in Varicose Vein
- Sclerotherapy of Varicose Vein
What is the Varicose Vein Sclerotherapy surgical procedure?
- Varicose Vein Sclerotherapy is a non-invasive procedure to treat varicose veins; a condition in which veins become enlarged, due to various factors
- Normally, the procedure lasts about an hour and the patient is treated in an outpatient setting
What part of the Body does the Procedure involve?
Varicose veins are often observed in the lower limbs (legs); however, other parts of the body maybe affected too. The Varicose Vein Sclerotherapy procedure is confined to the affected parts of the body.
Why is the Varicose Vein Sclerotherapy surgical procedure Performed?
There are two reasons why Varicose Vein Sclerotherapy is performed:
- If the varicose veins become painful, cause discomfort while walking or sitting, and are swollen
- If varicose ulcerate and bleed
- For cosmetic purposes, because varicose veins are definitely not visually appealing
What are some Alternative Choices for the Procedure?
Alternatives for this procedure are broadly classified as surgical or non-surgical:
- In a surgical procedure, an incision is made where the varicose veins are observed and these may be removed completely. Depending on the method used they are variously known as Stripping, Cryosurgery, Ambulatory Phlebectomy, etc.
- Non-surgical procedures include Endovenous Laser Ablation, the use of Compression Stockings, etc.
What are the Recent Advances in the Procedure?
Recent advances include the use of a foam based sclerosant and this technique is called Foam Sclerotherapy.
What is the Cost of performing the Varicose Vein Sclerotherapy surgical procedure?
The cost of Varicose Vein Sclerotherapy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused by the information regarding Varicose Vein Sclerotherapy and on what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
- They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one
What are some Helpful Resources?
Prior to Varicose Vein Sclerotherapy surgical procedure:
How is the Varicose Vein Sclerotherapy surgical procedure Performed?
- During a Varicose Vein Sclerotherapy, the dilated vein is injected with a sclerosant (a solution used to treat the vein), which usually is either Sodium Tetradecyl Sulfate (STS) or 5 Tetradecyl sulphate and Polidocanol
- The injection leads to dissolution of the vein and causes it to collapse and scar (a process called sclerosis). This is then absorbed by the neighboring muscle tissues over a period of 2-3 weeks
- Immediately after administering the injection, a compression bandage is applied to the area so as to prevent the flow of blood into the treated vein. The patient has to wear the compression bandage for a couple of weeks after the injection
- The whole procedure takes about a few minutes and often the patient can resume their regular activity, almost immediately
- However, vigorous activities are not advised and exposure to sun or application of other chemicals on the injected area has to be avoided.
Where is the Procedure Performed?
A Varicose Vein Sclerotherapy is usually performed in an out-patient surgery center facility, a physician’s clinic/office, or a hospital. Normally, the person can go home once the procedure is completed.
Who Performs the Procedure?
Varicose Vein Sclerotherapy could be performed by a trained physician who has an expertise in blood vessels or by a vascular surgeon.
How long will the Procedure take?
- The procedure to treat a single varicose vein generally takes about an hour
- However, depending on how large and complicated the formation is, or in case of multiple varicose veins the treatment may take longer
- Your surgeon can best advise you on questions related to these
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- Before a Varicose Vein Sclerotherapy is performed, the physician studies your medical history and checks to see if any varicose vein treatment has been done earlier and if you are currently under any medication
- In some cases these may have to be completely stopped for a particular period of time, under advice of the physician
- Any medication which leads to thinning of the blood, or that which delays its normal clotting time like Aspirin; or non-steroidal anti-inflammatory drugs like Ibuprofen, have to be discontinued
- Similarly any medication (such as steroids, oral contraceptives, etc.) that alters the normal human body hormonal balance must be stopped, as they tend to relax the blood vessels
- Avoid application of any cosmetic or medical chemicals before the procedure is to commence
- A physician will request your consent for Varicose Vein Sclerotherapy procedure using an Informed Consent Form.
What is the Consent Process before the Procedure?
A physician will request your consent for the Varicose Vein Sclerotherapy procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Varicose Vein Sclerotherapy surgical procedure?
- No particular preparations are needed prior to an Varicose Vein Sclerotherapy
- However, the physician may suggest certain routine tests if the patient is known to suffer from any significant illnesses, like a heart disease, etc.
- Normally for a healthy person, a simple medical examination is all that is necessary, before the procedure is performed
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What causes varicose veins?
- What is a Varicose Vein Sclerotherapy?
- What choices do I have, apart from Sclerotherapy?
- (If your varicose veins are not causing any discomfort) Is it essential to get a Sclerotherapy done?
- Can oral medications solve the problem?
- What is the cost of the procedure?
- What are the costs involved pre- and post- Sclerotherapy?
- Am I required to undergo any routine or specific tests prior to the procedure?
- These are the medicines I am taking regularly/now; can I continue them before, during or after a sclerotherapy?
- Are there any specialists, or is there a particular hospital for varicose vein treatment that you would recommend?
- When will I be able to resume my regular activities after the procedure?
During the Varicose Vein Sclerotherapy surgical procedure:
What kind of Anesthesia is given, during the Procedure?
The procedure does not require the administration of any anesthesia.
How much Blood will you lose, during the Procedure?
Since Varicose Vein Sclerotherapy is a non-invasive procedure (no incision or cut is made), there is no blood loss involved.
What are the possible Risks and Complications during the Varicose Vein Sclerotherapy surgical procedure?
There are general factors that increase the risk of complications during the procedure, which include:
- Obesity: Generally greater the degree of obesity, greater is the surgical risk
- Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders, chronic infections
- Poor immune system due to a variety of causes
- Taking some prescription or non-prescription medication: It is very important to inform your healthcare provider the complete list of all such medications. This will help assess the surgical risk for complications
The possible risks or complications that may arise during the surgery are:
- Injury to the neighboring structures
- Anesthetic complications
What Post-Operative Care is needed at the Healthcare Facility after the Varicose Vein Sclerotherapy surgical procedure?
At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.
After the Varicose Vein Sclerotherapy surgical procedure:
What are the possible Risks and Complications after the Varicose Vein Sclerotherapy surgical procedure?
The possibilities of developing any risks or complications are rare. Yet, in some cases inflammation, allergic reactions, air bubble, and blood clot formations, have been observed:
- In case of an inflammation or an allergic reaction to the sclerosant (the solution injected in the vein during Sclerotherapy), a course of antibiotics or anti-allergens, are respectively recommended
- If blood clot formation occurs; the clot is surgically drained, or treated using suitable drugs
- Air bubbles in the blood stream may cause symptoms like nausea, unclear vision, and headaches. Sometimes, this might cause difficulty in moving one’s arms or legs
What is the Prognosis after the Surgery?
- Varicose Vein Sclerotherapy almost every time offers definite results and has the best cosmetic effect amongst all available treatments for varicose veins
- Dark coloration is usually observed around the injected area; but, this is normal and it heals in a couple of weeks
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Inflammation, redness, loss of sensation around the injected area
- Difficulty moving your limbs
What Post-Operative Care is needed at Home after the Varicose Vein Sclerotherapy surgical procedure?
At home, the following post-operative care is recommended, after a Varicose Vein Sclerotherapy procedure:
- Avoid all activities that are physically strenuous
- Continue wearing the compression bandages or stockings, as advised by the physician
- Avoid direct sun contact with the injected area, and any exposure to chemicals
How long does it normally take to fully recover, from the Procedure?
- Procedures on small varicose veins may take anywhere between 3-6 weeks to heal
- However, larger and more complex varicose vein formations may take 3-4 months for a full recovery
What happens to tissue (if any), taken out during the Procedure?
Varicose Vein Sclerotherapy does not involve the surgical removal of any tissue.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.
Who will you receive a Bill from, after the Varicose Vein Sclerotherapy surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- The outpatient facility, physician’s office or hospital
- A family physician or a vascular surgeon
The patient is advised to inquire and confirm the type of billing, before Varicose Vein Sclerotherapy procedure is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA