Injection revascularisation (sclerotherapy)

During sclerotherapy, the vascular surgeon uses a small needle to puncture the dilated varicose vein, and the sclerosing agent (polydocanol, aethoxysclerol) is injected through the needle into the vein. The substance injected causes sterile inflammation in the vein, damaging the vessel wall and triggering its scarring, which causes the vein walls to stick together, thus excluding the vein segment from the circulation, which is absorbed over time, making it invisible.

Sclerotherapy treatments take place in several stages. In one session, the patient is given 2 ml (1 ampoule) of active substance per limb. This is usually enough to cover an area the size of a fingertip. The concentration of the solution administered is chosen individually according to the patient's skin type and the diameter of the varicose veins to be treated. In the case of pronounced, thick, „finger-thick” dilatations, the substance to be administered is foamed, so-called foam sclerotherapy.

During the treatment, a balloon compress (also known as a bucit) is placed over the needle punctures and the treated vascular sections, and at the end of the treatment, a compression bandage or elastic bandage is applied to the leg, which should be left on until the next morning to keep the vein walls compressed (for at least 10-12 hours).

After sclerotherapy, it is recommended to walk for at least 15-20 minutes and avoid passive standing or sitting. Exercise (light physical activity) is allowed even after the treatment. In the morning after the treatment, the bandage should be removed and the treated area should be cooled and iced for about 10-15 minutes. Compression stockings up to the knee or thigh should be worn during the day for the entire duration of the treatment and for two weeks afterwards. The type of compression stocking or sock is chosen individually: for milder dilatations of the saphenous vein, the 140DEN compression stocking or sock I, available without prescription from medical shops, is sufficient, while for more severe dilatations, a compression stocking II, available without prescription, is prescribed and worn during the treatment period.

From the evening of the day after the treatment, it is recommended to apply Lioton or Dimovena gel to the affected area every evening for 3-5 days. If the treated area becomes sensitive, hot, red, the use of the above gels should be supplemented by local cooling or icing of the affected area (e.g. ice gel available from pharmacies). The effectiveness of sclerotherapy can be increased by taking Detralex 2×1 or Dimotec 1×1 venotonic drugs.

After sclerotherapy, avoid hot baths and saunas for at least 2 weeks and sunbathing and/or tanning beds for at least 4-6 weeks!

After the treatment, small haemorrhages - bluish-purple patches may appear at the site of the needle punctures or in the treated venous dilatations, which disappear without a trace in about 2-4 weeks. The area treated with sclerotherapy may become red, but may also feel burning and painful. All this is not actually a complication and will disappear with mild cooling and icing (do not apply compresses!). In some cases, sensitivity to the substance administered may cause an allergic reaction or a permanent brown discolouration, typically corresponding to the needle puncture, possibly according to the course of the treated vascular segment, which usually disappears spontaneously within 6-12 months, becoming permanent only in exceptional cases (1-5%). If the brownish discoloration does not fade over time, Skinoren (prescription) cream treatment of the affected area is recommended. The sclerosing agent placed close to the skin surface on the sclerotherapy-treated area may cause a small amount of skin necrosis, resulting in a small epithelial defect, which may later heal with scarring or redness.

In rare cases (frequency in thousands of units), the vaccine can cause an ascending type of superficial venous inflammation in the main trunks of the saphenous vein (Latin: saphena magna, parva), which can be treated with LMWH, i.e. heparin containing blood thinners (Clexane) or a new type of anticoagulant drug (NOAC: Xarelto or Eliquis) for an appropriate period of time (until the inflammation is gone!) for a prolonged period of time (until the inflammation stops) to prevent deep vein thrombosis (deep vein thrombosis) and possibly pulmonary embolism. Rarely found in the literature, the vaccine may enter the deep venous system and cause deep venous thrombosis, possibly resulting in pulmonary embolism, and in the case of treatment with foam sclerotherapy, cerebral embolism, which may require hospitalisation!