Recommendations to the patient before sclerotherapy

Recommendations for a patient who is scheduled to undergo sclerotherapy

Please read this sheet very carefully. If you have any doubts or questions, ask your doctor. It is important to strictly follow the instructions before and after treatment.

Patients with varicose veins of the lower extremities know about the existence of a special method of treating their disease. Colloquially, it sounds like ""treatment with injections"". The correct name is compression sclerotherapy. The first term emphasizes a mandatory and quite important component of treatment - elastic compression. The second shows the nature of the healing process in the veins that are subject to treatment.

Today, sclerotherapy is a popular and fairly effective method of treating varicose veins, especially in the initial stages of the disease. Relative ease of execution, cheapness compared to surgery in hospital conditions, lack of need for hospitalization, possibility to perform work during treatment, good cosmetic results have ensured trust in sclerotherapy all over the world.

About 70% of all patients with varicose veins of the lower extremities are treated with sclerotherapy in Europe.

This method is not competitive either for conservative treatment or for surgical interventions for varicose veins. Each of them has its own indications. They often complement each other. Sclerosis therapy only prevents the progression of varicose veins. With the help of this method, those veins that are already dilated are ""closed"", but the mechanisms that caused the disease are not eliminated. Therefore, after treatment, patients must follow certain measures to prevent recurrence of varicose veins. Doctors and patients should be warned against unnecessarily wide use of drugs that cause obliteration of varicose veins. Sclerosis therapy is a very effective method in a rather limited number of patients, as long as the disease is localized only in the tributaries of the main subcutaneous veins or after previously performed operations. The use of this method in the presence of pathological blood flow in the system of large and small subcutaneous veins can cause early relapses or ascending thrombophlebitis, which is dangerous for the patient. Therefore, before using sclerosing drugs, the patient should be thoroughly examined using instrumental methods (ultrasound, dopplerography, occlusion plethysmography).

The basis of the method is the possibility of some drugs, when administered intravenously, to interact with the venous wall in a special way. Thanks to this, its ""gluing"" occurs in the future, and the blood flow stops. In the place of the vein, a mild pain remains at first, and then this sensitivity passes. Despite its apparent simplicity (a seemingly simple intravenous injection), the method requires extensive knowledge and professional skills. The positive effect of the procedure directly depends on the qualification and experience of the doctor.

In what cases is sclerotherapy used? It is 100% indicated for telangiectasias and reticular varicose veins. To understand these terms, you should simply measure the diameter of the veins. Telangiectasias are dilated venous capillaries of the skin. Sometimes these capillaries are connected with arterial ones, which leads to a sharp increase in intracapillary pressure. The diameter of telangiectasias, or, as they are also called, vascular stars, is no more than 0.5 mm. The size of the reticular veins is from 0.6 to 2 mm. Both types of these vessels are located in the skin, in its different layers. The aforementioned veins are not always sclerosed - in some cases, due to arterial capillaries, the effect will be insufficient.

In the case of varicose veins, in which deeper, subcutaneous veins are affected, the question of the possibility of performing sclerotherapy is decided individually. Anatomical and functional features of the patient's venous system, the prevalence of varicose veins, the state of deep and perforating veins, as well as the form of the disease play a role here. As a rule, in such cases, the patient first undergoes an examination - a duplex scan of the veins, which clarifies the possibility and necessity of performing sclerotherapy.

Theoretically, most veins are susceptible to sclerosing, but it would be wrong to treat any varicose vein in this way.

Firstly, when a certain lesion of the veins is detected, with valve damage and the formation of ""wrong"" or pathological connections between different veins and the presence of backflow of blood in them, treatment by the method of sclerotherapy by means of other Ections are contraindicated due to the high risk of developing complications.

Secondly, no one guarantees that pathological changes in the vein will not occur again after some time, that is, there may be a relapse. This directly depends on the size of the veins to be obliterated, to a lesser extent on the drug used and the technique, as well as due to the fact that varicose veins are a chronic disease prone to progression. In the areas where sclerotherapy is performed, new veins do not appear, but they may appear in other places. Any known method of treating varicose veins that exists today is symptomatic, that is, it treats the symptoms, not the cause. The true causes of varicose veins have not yet been fully elucidated and are probably in the area of ​​genetic disorders.

Thirdly, with the relative safety of the method, complications exist, and the more advanced the lesion, the more pronounced they will be. Although it is more correct to call them side effects of treatment, since these are known and predicted phenomena after sclerotherapy. When the sclerosant gets under the skin at the injection site, a focus of inflammation (infiltrate), occasionally skin necrosis (black ""crusts"" of dead skin) may appear. In almost 60-70% of cases, hematomas (bruises) appear along the course of sclerosed vessels. This happens due to the partial filling of the capillaries with blood after sclerosing due to the high pressure in these vessels. In a number of cases, pigmentation of the skin occurs along the course of a sclerosed vein, most often this happens as a result of local thrombophlebitis, provoked by insufficient emptying of the vessel during injection or resorption of the hematoma. In addition, hyperpigmentation is most often found in people with dark skin and hair, as well as with increased iron content in the body, taking certain antibiotics. Of course, after performing a venipuncture, there is a partial passive outflow of sclerosant and blood through the puncture of the wall at the point of needle insertion, which causes the formation of hematomas and hyperpigmentation. In addition, sclerosants cause a decrease in blood clotting at the injection site, as well as increased permeability of the vessel wall for formed blood elements. Hyperpigmentation occurs in 20-40% of cases with varying severity. Darkening of the skin within 4-8 weeks is considered a normal reaction to treatment. In the next 3-6, sometimes up to 12 months, there is a gradual restoration of the normal color of the skin. These complications are reversible and pass either independently or after the use of special ointments. No one is immune from allergic reactions either, although the probability is minimal. The patient must inform the doctor about concomitant diseases, special attention is paid to thrombotic episodes, dyshormonal conditions. The presence of thrombophilic conditions (congenital disorders of blood coagulation) seriously limits the performance of sclerotherapy.

When administered correctly, the injection of drugs into a vein does not cause pain, the injection feels like a mosquito bite, which is tolerated by the absolute majority of patients. If the patient has a low pain threshold, local anesthesia can be used. Sometimes there is a slight heartburn along the vein, which passes within a few seconds. This is due to the action of the sclerosant on the inner wall of the vein, which it chemically burns. Immediately after the injection, the patient's leg is bandaged with an elastic bandage. At subsequent visits to the patient, the doctor decides whether repeated injections should be performed and prescribes a further regimen of bandaging or wearing a compression jersey, depending on the effect and treatment plan.

It is far from always possible to do everything at once. The required number of procedures depends on the specifics of the vein damage - it may require from 1 to 5 (on average 2-3) depending on each specific case. During one procedure, from 3 to 10 injections can be made, depending on the form of the disease and the sclerosing drug used, its concentration, as well as the amount of medicine used for treatment.

In our practice, we use only modern sclerosing drugs, which are recognized and used by specialists all over the world. There are two of them - Fibro-Vain and Etoxyklerod. Both drugs belong to the group of detergents, that is, they are the safest and most effective of all known for sclerotherapy. These drugs are not equivalent in effectiveness and differ in their mechanisms of action based on their chemical structure. Therefore, a qualified phlebologist must thoroughly understand the mechanisms of their action in order to adequately choose both the drug and its concentration depending on the situation. The efficiency of the procedure and the number of its side effects directly depend on this.

Also, we use the original technique of microsclerotherapy with the use of special accessories that increase the effectiveness of the procedure. In order to gain such experience, a specialist must undergo special training, as well as constantly engage in self-improvement.

Sclerotherapy is an almost painless procedure. For its implementation, special thin needles or microcatheters (thin tubes with needles thinner than a human hair) are used. Modern sclerosants are absolutely safe and have an anesthetic effect, so their administration is accompanied by only a slight burning sensation. If during the treatment you have any unpleasant sensations (pain, nausea, dizziness, etc.), inform the doctor immediately. The duration of the procedure is from 15 to 45 minutes.

Sclerotherapy allows not only to achieve a therapeutic and cosmetic effect, but also to prevent the development of varicose veins.

What the patient needs to know about sclerotherapy

Before sclerotherapy:

• in women, sclerotherapy should preferably be performed during the menstrual cycle;
• it is necessary to inform the doctor about the medications you are taking, especially anticoagulants and hormonal drugs;
• you should warn the doctor about cases of transferred allergies;
• A week before the procedure, it is necessary to stop taking aspirin and other anticoagulants, as well as anti-inflammatory drugs (diclofenac, ibuprofen, meloxicam). These medications can increase tissue bleeding and increase the risk of bruising;
• you should not drink alcohol and smoke for 2 days before and after sclerotherapy.

On the eve of sclerotherapy:

• you should not perform hair removal, use lotions, creams;
• take a hygienic shower, wash your feet with regular or antibacterial soap;
• you should come to the treatment in comfortable, roomy clothes and shoes that are one size larger than yours (so as not to feel discomfort and so that the leg that will be bandaged fits);
• it is advisable to eat 1.5 hours before sclerotherapy.

After a sclerotherapy session:

• it is necessary to walk for 10-30 minutes;
• it should be remembered that the composition of the drug includes alcohol, so after sclerotherapy you should not get behind the wheel;
• do not limit physical activity, walk for at least an hour every day, for example, it should be 2 walks a day at a regular pace of 30-40 minutes (walk the dog, walk with the child);
• avoid standing or sitting for a long time;
• do not take hot baths for 2 weeks and do not visit saunas and baths for 1.5-2 months, and do not perform any type of hair removal during this time;
• in the first 2 weeks after sclerotherapy, you should not do aerobics and gymnastics or exercise on an exercise bike.

Attention!

At the end of the procedure, a special elastic bandage is applied to the leg or a compression bandage is put on, which should be worn around the clock during the entire course of treatment and which cannot be removed without the doctor's permission.

Often, patients ask when it is better to do scleroderma. It is possible at any time of the year, but preference is given to the cold season. Because in the heat it is difficult to maintain a hygienic regime of the skin of the leg under the bandage, especially with round-the-clock wearing, obvious physical and aesthetic discomfort from an elastic bandage in the summer.

What are the possible side effects?

Injection treatment is a necessary component of modern complex treatment of manifestations of chronic venous insufficiency. Sclerotherapy is a popular, effective, safe and painless method of treating varicose veins and vascular ""stars"". However, like any other method, it has a number of side effects.

1. Itching and burning of the skin depend on the type of sclerosing drug and usually pass 1.5-2 hours after the procedure. In some cases, it can occur episodically during the day or longer.
2. Temporary darkening of the skin (hyperpigmentation) along the course of a sclerosed vein is observed in 5-8% of patients. In some cases, light brown strips of skin can persist for up to a year.
3. Skin peeling is noted in less than 1% of cases. At the same time, a small superficial wound is noted at the injection site, which heals without a trace after 2-4 weeks.
4. Allergic reactions to modern sclerosants are noted very rarely, since during the preparation of the drugs are subject to special thorough cleaning. The risk of allergy is highest in patients who have a reaction to other types of medications.
5. Pain at injection sites or along the course of a sclerosed vein is noted in a small number of cases. Pulling pain at the injection sites usually occurs when walking, physical exertion and can last for 3-9 days.
6. In some cases, 2-4 weeks after treatment, a reddish vascular network may appear along the course of the sclerosed vein, which usually disappears on its own within 4-6 months. Sometimes additional procedures may be required to remove such meshes or use laser therapy.
7. Short-term swelling in the area of ​​the ankle can be observed during the treatment of varicose veins and vascular stars located in this area, as well as when wearing shoes with high heels or narrow soles during the treatment. In addition, swelling appears if the bandage is applied without gripping the feet. Such swelling is functional and disappears immediately after removing the bandage.
8. Inflammation of a vein - thrombophlebitis - is an infrequent complication of sclerotherapy, which occurs in one case per 1000 patients. Thrombophlebitis occurs when a doctor's prescription is violated and an independent decision to remove an elastic bandage is made.
9. Hematomas and bruises at injection sites or along the course of sclerosed veins are noted in 10% of patients who underwent sclerotherapy and in 30% who underwent microsclerotherapy. These defects pass independently or with the use of special drugs within 2 weeks.
10. Local urticaria is observed when using any sclerosants, is temporary and passes after 30 minutes. It is related to the direct action of the sclerosant on the inner lining of the vein. Various ointment applications are used to reduce the severity of this reaction.
11. Vasovaginal reactions (dizziness, nausea, sweating, shortness of breath) are observed in 1-3% of patients and are associated with the patient's emotional state.
12. Post-injection skin necrosis is a consequence of leakage of the sclerosant from the vein and is observed in 0.5-3% of patients. The treatment does not require the use of special means, it is enough to apply an aseptic bandage with hormonal ointment or alcohol for 3-5 days, after which a crust forms, which falls off on its own over time.

Keep in mind that sclerotherapy does not always guarantee a lifelong effect, and repeated treatment may be required in the future. The best way to prevent relapse is to constantly wear special medical prophylactic or therapeutic tights.

Remember that the best way to prevent possible complications and side effects is the use of modern sclerosants, strict adherence to doctor's prescriptions, and treatment by specially trained and certified specialists.

Way of life after a course of treatment

• Go through preventive medical examinations at least 1-2 times a year
• Take the drugs of conservative therapy recommended by the doctor
• Exercise regularly (walking, jogging, cycling, skiing, swimming); wear compression underwear for gym sessions; avoid sports related to heavy load on the legs (tennis, weightlifting, high jump)
• Eliminate or minimize prolonged standing or sitting
• If you are forced to stay in a standing position for a long time, switch from one leg to another, and if you are forced to sit for a long time (in a train, plane, car), stomp with your feet with your heels fixed to the floor
• Don't sit cross-legged
• When sitting for a long time (at the table, in front of the TV), put your feet on a small riser (pouf)
• During night rest, keep your feet 15 cm above heart level (put a book under the soft end of the bed or a pillow under the mattress)
• Do not wear tight shoes and tight clothes
• Do ""venous"" gymnastics exercises in the evenings
• Wear shoes with medium heels (4-6 cm), do not wear shoes with flat soles
• Control your weight
• Avoid taking too hot baths, visiting saunas
• Limit exposure to the sun, sunbathe at a safe time, rest more in the shade
• Walk up the stairs more often
• Finish the water procedures with a cold shower, pouring water on the lower legs from the bottom up
• Eat more vegetables and fruits, foods rich in fiber
• Drink at least two liters of water a day, especially in the heat
• Be sure to find out from your doctor the regulations for elastic compression, what type of elastic compression knitwear (tights, knee highs, stockings) you need to wear and at what level of compression
• Take a course of pneumolymphoma massage at least twice a year

To receive information about treatment and make an appointment, call the contact center of MM ""Dobrobut"":
044 495 2 888 or 097 495 2 888 .



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