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Post-Op Information

Post-Operative Information: For Ultrasound-Guided Sclerotherapy Patients

The Technique
Involves several injections into the veins to destroy the lining of the veins followed by compression to squash the veins flat to minimise bruising. Your body will then remove the destroyed vein and the bruising and inflammation will settle.

Frequently Asked Questions

Q. Do I need to wear compression stockings?
A. Yes. It is an essential part of the mechanism of injection of veins (sclerotherapy), whether the veins are small or large. Typically you will need to wear a bandage for 3-4 days followed by stockings every day for several weeks.

Q. When do I wear my stockings?
A. We suggest you put them on in the morning and take them off in the evening after dinner. It is probably better to have a brief shower in the evening rather than in the morning. Stockings can be hand-washed and will dry overnight. If you want another pair, please contact the rooms. We don’t recommend wearing them in bed, although occasionally this is advised in specific cases.

Q. What activities should I do?
A. You should resume all your normal activities e.g. walking, work. You should also try to avoid prolonged immobile standing and sitting. If sitting, elevate you foot and if you experience pain (usually minimal) in the leg, take some Panadol (2 daily).

Q. What activities shouldn’t I do?
A. We don’t recommend swimming or a long hot bath/spa/sauna. All these cause intense relaxation and expansion of the surface veins, and are liable to work against the mechanism which we are trying to use to remove your varicose veins. Gym and aerobics can be performed with support stockings after 2 weeks. We also don’t recommend contact sports or jogging/cycling for the first couple of weeks after sclerotherapy.

Q. Can I travel interstate/overseas?
A. Air travel involves prolonged sitting in one spot and is a known risk factor for deep venous thrombosis. No sclerotherapy should not be performed within 6 weeks of such planned travel.

Q. My stockings don’t fit/have I got faulty stockings?
A. Please call the Rooms and we will arrange another pair and discuss your case with the manufacturer’s representative on your behalf.

Q. Should I expect much pain or bruising?
A. This can vary dramatically, but a small to moderate amount of pain/bruising is to be expected. The injections cause inflammation in the veins and this starts off as a mild inflammation but reaches its maximum about 7-14 days after injection and then settles down. This means that patients actually experience more pain towards the end of the second week than they do in the first week. The pain should be relieved by Panadol, and your activities shouldn’t be minimised.

Q. What if I notice red hard lumps under the skin?(Thrombophlebitis/“Phlebitis”)
A. An earlier review maybe needed as sometimes this indicates that the vein has relaxed and a larger blood clot has formed than we had anticipated. This can sometimes be removed.

Q. What are the follow up arrangements?
A. We arrange an ultrasound at 1-2 weeks to show which veins have been blocked off. A review appointment should occur then or a week later. You should then wear your stockings until the end of the month and then a further appointment relating to more treatment if needed will be arranged. Patients having microsclerotherapy may only need a review at 6 weeks.

Q. What if I need to see my doctor after UGS – should I let him know about the injections?
A. If you need to consult a doctor for any reason after injections and before your review appointment please make sure the doctor calls me. There are some significant issues regarding ultrasound guided sclerotherapy management that are not widely known. During office hours call my rooms and after hours call my mobile. If I am away or unavailable the answerphone in the rooms will have details of how I may be contacted.

Q. What do I do when I finish wearing my post-sclerotherapy stockings?
If you wish you can return to no stockings. Many patients find they need to wear them for an extra couple of weeks for comfort. You may well benefit from trying non-medical support stockings, e.g. Kolotex Sheer Relief (about $8 at supermarkets).

Q. Should I put anything on my skin?
A. We recommend a light application of moisturiser, e.g. Sorbolene, in the evening after your shower or before bed on a daily basis while you are wearing support stockings.

Q. Is there anything I should do long term?
A. We recommend you review the appearance of your legs in February each year. If there are some recurrent veins that are concerning you, come to the practice for a consult in February or March. It is then hot and we won’t be tempted to do sclerotherapy and we have all year to arrange investigations or treatment.

Recurrent varicose veins that are flat and visible are a cosmetic concern, i.e. no medical risk. They can be injected. No Medicare or Private Health Insurance rebate applies.

Recurrent varicose veins which are lumpy can be injected if they are less than 5mm in diameter. You might require an ultrasound arranged by our office prior to your appointment if that is the case. Veins less than 5mm in diameter in most people would be veins looking similar to those on the back of your hand.

Q. What can I do to minimise “phlebitis”?
A. The mechanism of sclerotherapy is to cause an injury to the vein. The reaction by the body is inflammation which is hopefully severe enough to destroy the vein but not severe enough to cause very severe pain, redness or swelling. The larger the vein, the more chance of a more severe reaction.

Continue wearing your support stockings. Apply Hirudoid or Arnica in the evenings before bed to tender inflamed areas. Cover the limb with a sheet of Gladwrap wrapped around the leg and secured with a couple of pieces of sticky tape. The Gladwrap will aid sweating in the cream overnight and after three to five nights the inflammation will be much improved. The third option for treatment is to take Nurofen, 2 in the morning and 2 at night for 3 days, or Voltaren 25-50mg one tablet twice a day for three days. (Nurofen can be obtained over the counter while Voltaren is prescription only.) For those whom Nurofen or Voltaren is contra-indicated take Panadol or Panadeine or your usual analgesic. Take it at night to aid sleep. The additional benefit of Nurofen or Voltaren is their anti-inflammatory action.

If the areas remain very inflamed you will need to attend the surgery because sometimes percutaneous release of the “trapped blood” is required. This is a brief procedure and it is used in less than one in ten patients.

Hirudoid or Arnica can be applied earlier before inflammation develops to some good effect especially if the veins are larger or the patient has a prior experience of phlebitis. Both are available over the counter from the pharmacy without a prescription. Hirudoid is a medical preparation and Arnica is a naturopathic preparation. Both seem very effective.