Ultrasound Guided Sclerotherapy (UGS)

What is UGS?

UGS stands for ultrasound guided sclerotherapy.  A high resolution ultrasound is used to identify abnormal veins below the surface (i.e. where the problem is coming from).  The ultrasound is then able to guide the treatment of these veins below the skin surface using a fine needle injection procedure (sclerotherapy).

Advantages of UGS

UGS is a minimally invasive procedure which can target large varicose veins and underlying reflux problems without surgery.  No hospital admission is needed and no anaesthetic is required.  It is a walk in walk out procedure with immediate return to normal activity and work.  Even patients with very large veins are suitable for UGS rather than surgery.  UGS is a less expensive procedure than having a surgical operation in hospital.

Are there any requirements before treatment?

All treatments are performed on an outpatient basis in the clinic.  No anaesthetic is necessary and there is no preparation required before treatment.  We do recommend wearing loose fitting clothing and not applying any leg moisturizer on the day of attendance.  You may wish to bring shorts to wear during the procedure.

What about treatment during pregnancy?

Leg veins are best managed conservatively during pregnancy by compression stockings.  Definitive treatment is usually undertaken after breastfeeding is completed.

Are treatments painful?

Ultrasound scans involve gel on the surface of the skin so there is no discomfort at all.  Only minimal discomfort may be experienced with UGS because the needle used is very, very fine.

Are there any side effects?

World wide clinical trials have found UGS to be a remarkably safe method of leg vein treatment.  Surface bruising may occur which usually disappears quickly.  Tender cords can occasionally develop after treatment of larger veins but these disappear over several weeks as the body breaks down these sealed veins.  Uncommonly after treatment the vein may develop a brownish colour (hyperpigmentation).  This is similar to how an area of skin can go a brown colour after bruising.  It mainly occurs with very large or thick patches of veins and in individuals with darker skin, and usually resolves over several weeks although rarely it may be long lasting.  Deep vein thrombosis (DVT) is a very rare complication as are allergic reactions.  Another possible rare complication is the development of a small skin ulcer.  If this occurs it is mainly in the elderly, but is very rare and typically heals quickly.  Whilst side effects are very rare, unknown or unpredictable problems can occur with any form of medical treatment.

What is the risk of DVT?

The risk of deep vein thrombosis (DVT) is very low but it is not zero (1 in 10,000).  By avoiding anaesthesia and time in hospital the risk of DVT is significantly reduced compared to surgery.  The risk of DVT is greater if there is a personal or family history of thrombosis (clots) or you have a condition called thrombophilia (abnormal blood clotting).

The risk of DVT is greatly reduced by daily walking and the use of compression stockings.

Do I need to wear compression stockings?

Generally the larger the veins treated the more important the need for compression stockings.  For large or deep veins treated by UGS, compression stockings are usually necessary for 2 weeks.

Are there any restrictions after treatment?

Walking immediately after treatment, and daily walks are very important.  Avoid intense leg exercise (aerobics, long runs, leg weights) for one week.  Avoid long hot baths/spa/sauna for two weeks.  After UGS avoid any air travel for two weeks and overseas travel (greater than 5 hours) for four weeks.

How many treatments are necessary?

This will vary between individuals and depend on the type and extent of the problem and the level of improvement required.  A treatment plan will be devised at your first consultation.  As a guide the average number is 2-3 treatments for UGS.

Will the veins come back after treatment?

Treatment can get rid of the veins that are currently present and these veins do not come back.  However treatment cannot prevent new veins developing in the future.  If you have a tendency to develop leg veins you will probably develop more in the future.  The emphasis in treatment is getting the veins under control with as few treatments as possible.  If new veins develop, follow up treatment may be necessary.