(1) Injection microsclerotherapy: reserved for the treatment of small veins including spider veins.

(2) Ultrasound Guided Sclerotherapy: reserved for the treatment of medium sized veins and bulging varicose veins and some hidden veins.

(3) Endovenous Laser Therapy (EVLT™): for large hidden varicose veins previously treated with surgical stripping. Many patients will require combinations of the above treatment modalities to achieve the best results.

1. Microsclerotherapy of surface veins: Surface veins are often numerous, widespread and usually require several treatments. Sclerotherapy is considered the first choice method for the treatment of small reticular and spider veins(2,5,23). This involves the injection of a sclerosant detergent solution via a tiny needle into the diseased vein, which causes the vein wall to collapse. The veins dissolve and disappear as the body gradually absorbs them(2,3). For most patients with spider veins the underlying blue reticular veins need to be treated first.

2. Ultrasound Guided Sclerotherapy (UGS) and the treatment of varicose veins UGS is a safe and effective method for the eradication of varicose veins(7,8,9,10,11,31,32,33,34,35). Unlike surgery there is no need for hospitalization or an anaesthetic. There is no surgical scarring and virtually no downtime. Most patients with varicose veins are suitable for UGS. Your consulting doctor will determine your individual suitability during the course of the assessment. Some patients will require follow-up treatments to achieve the best results. Prior to treatment a duplex ultrasound scan(4,3,28) is performed to establish and map out the exact nature of the vein problem. The UGS procedure is performed using ultrasound technology to locate the abnormal veins and allow the doctor to accurately and safely inject sclerosant detergent solution(34,36) or more recently with sclerosant detergent foam (36,37,38) directly into the veins that are hidden below the skin. Once injected the veins collapse and the body’s process of absorption begins. Numerous injections may be required and can be associated with a slight burning sensation that usually only lasts for a few minutes. The sclerosant becomes diluted within a short distance from the injection site and therefore is unlikely to damage normal veins. The appearance of the treated veins rapidly improves over a few weeks with continued improvement still occurring for about three months.

Recent Advances in Sclerotherapy-namely the use of “sclerosant foam”. Detergent sclerosant SOLUTION can be converted into FOAM with the addition of a small amount of air. The use of foam has proved to be advantageous in patients with varicose veins. In Germany a meeting of European specialists in 2003 concluded “Foam sclerotherapy…is a powerful tool in experienced hands and in general more powerful than conventional sclerosant solution”. It was stated in 2003 at the UIP World Congress meeting that the use of foam “marked a new era in treatment of primary venous disease with the advent and universal acceptance of foam sclerotherapy”. Studies from Australia and New Zealand have been published to support the safety and efficacy of foamed sclerosants. The Australasian College of Phlebology in 2004 has developed guidelines for the use of both sclerosant solution and foam. The Therapeutics and Goods Administration (TGA) have approved the use of sclerosant solution for clinical use in Australia several years ago. However, this approval was granted before foam sclerotherapy was introduced and properly evaluated. Applications have been made to the TGA for the use of foam but this approval process takes time. Until then, the use of foam does not have formal TGA approval. However, foam can be used as an “off label “product provided consent has been obtained and if there is a benefit to the patient. Should you have varicose veins then using foam is now considered a more effective option.

3. Endovenous Laser Therapy (EVLT™) for large varicose veins. EVLT™ is the latest method for the treatment of major veins previously treated by stripping surgery under general anaesthetic. The procedure involves the placement of a laser fiber with ultrasound guidance into the abnormal vein via a tiny incision. The vein is then anaesthetized with local anaesthetic. The laser fiber is removed slowly whilst the laser is activated which destroys the vein wall along the treated length. The procedure involves minimal discomfort. The published success of EVLT™ treatment is between 95-98% with far fewer complications as compared to surgery. With the addition of EVLT™ to Ultrasound Guided Sclerotherapy it is expected that varicose vein surgical stripping will be performed less frequently.

Compression: Following each treatment you will be required to wear a Class 2 compression stocking(2,17,19,29) to assist closure of the treated veins and protect against deep vein thrombosis (DVT)(45). The length of time the stocking needs to be worn varies from three days to three weeks depending on the size of the veins injected and the treatment method provided(4,28,30). It is important to follow the provided compression instructions carefully to achieve the best results.