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Sclerotherapy

Overview

Sclerotherapy is a medical procedure for the treatment of abnormal veins (spider veins, varicose veins, or vascular malformations). Sclerotherapy involves injecting a solution or foam (sclerosant) directly into the blood vessel, causing it to shrink and over time, the vessel fades from view.  
 
Vascular malformations are uncommon benign vascular lesions that often don’t present in patients until their teens or early twenties. MRI and ultrasound are the best way to image vascular malformations. Historically vascular malformations have been treated mostly by surgery, however more recently interventional radiology using image guided sclerotherapy has become the first treatment option for many patients.
 

How is Sclerotherapy Performed?

The procedure is conducted in an angiography suite at Mercy Angiography, which is in the Mercy Hospital at 98 Mountain Road, Epsom in Auckland. Your Interventional Radiologist will be assisted by nurses and other highly trained staff during the procedure.
 
  • The procedure is often performed under sedation but occasionally general aneasthetic is recommended.
  • The area to be treated will often be numbed with topical anaesthetic before the treatment starts.
  • The abnormal vein(s) or malformation are treated using x-ray and ultrasound guidance.
  • Using microinjection techniques, small amounts of the sclerosant are injected into the vein. This process may be repeated several times, depending on the treatment area.
  • On confirmation of success treatment, the needle is removed.
  • Firm pressure is applied on the entry point for several minutes, to prevent any bleeding.
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What will I experience during the procedure?

  • An intravenous catheter (IV line) for administration of fluids and medication will be inserted into a vein on the back of your hand or in your arm.
  • Devices to monitor your heart rate and blood pressure will be attached to your body.
  • You may also be given oxygen.
  • You will feel a slight pin prick when the needle is inserted into your vein for the intravenous line (IV) and sometimes when small butterfly needles are placed at the treatment site.
  • You will be given sedation and pain relief through your IV to help you feel relaxed.
  • You may feel some discomfort when the sclerosant is injected into the blood vessel, such as burning or cramping.
  • As the contrast material passes through your body, you may get a warm feeling.
 
While you are in the hospital, any pain you might have post procedure will be well-controlled with medications infused through your IV line.
 
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Why do I need Sclerotherapy?

Vascular malformations may have debilitating symptoms such as pain and swelling; these in turn may cause restrictions in movement. The blood flow through these vessels is slow-moving and it may be so slow that the blood can clot and this can cause a local phlebitis (inflammation of the vein) that is often painful. Symptoms are usually responsive to simple analgesia (ibuprofen and paracetamol). Some vascular malformations may bleed, particularly if they are close to the surface of the skin. In the most severe cases symptoms can include skin breakdown over the veins (ulceration).
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How should I prepare for the procedure?

  • Fasting: You will likely be instructed not to eat or drink anything two hours before your procedure. Your doctor will tell you which medications you may take in the morning.
  • Medications: Please inform your doctor about all the medication you are taking. You doctor may advise you to stop taking some medications temporarily few days prior to your procedure e.g. blood thinners.
  • Allergies or previous reactions to contrast (x-ray dye): Please inform Mercy Angiography staff at the time of booking your procedure if you have any known history of allergies, particularly allergies to x-ray contrast and seafood.
  • Diabetes: If you are a diabetic you should inform your doctor at the time of booking. You may need to discuss your insulin dose with your radiologist.
 
Please bring with you any medication and any recent blood tests, ultrasound results or x-rays.
 
You may bring a favourite music CD as this can be played during the procedure. You are also encouraged to bring a friend or family member.

On the day of your procedure, please make your way to the Mercy Hospital Reception where they will be expecting you. You will be admitted to a hospital ward and transferred to Mercy Angiography for your procedure.

For directions to the Mercy Hospital, click here.
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What happens after the procedure?

  • A compression stocking or banadage may be applied following treatment of the legs and sometimes the arms.
  • You will be transferred to the hospital ward on a bed and depending on the area that has been treated you will be able to sit up.
  • The nurses in the ward will do routine examinations e.g. taking your pulse and blood pressure and also ensuring that the entry site is healing well.
  • You will stay in bed for few hours until you have recovered, after which you can be discharged.
  • Your interventional radiologist will discuss the findings with you following the procedure or at a follow-up appointment.
 Some more extensive procedures might require an overnight stay. You will be advised of this beforehand.
 
You are advised to avoid doing any heavy lifting or vigorous exercise for at least five days to allow healing time.
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What are the risks or complications?

The risks associated with sclerotherapy depend on the local anatomy, volume of tissue being treated and agents used. The most significant complications include skin ulceration, tissue necrosis and neuro-vascular injury. These can occur at the minor end of the spectrum in up to 30% of patients but tend to be well managed with symptomatic care.
 
Generally the procedure is very safe and carried out with no significant side effects.
 
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