ULTRASOUND GUIDED SCLEROTHERAPY (UGS) has been in use for some 25 years. UGS is used to block off smaller diameter saphenous veins or large tributaries by injection using ultrasound to guide the needle to the vein.

Our results show a low risk of complications and good results but with a need to repeat treatment at a later date in some patients. Success rates for UGS compare favourably to published results for surgery in our hands, with a low complication rate. Occassionally the procedure may need to be repeated.  The two sclerosants used are Aethoxysklerol (polidocanol) or Fibrovein (sodium tetradecyl sulphate - STS). Both are detergents and act by washing away the lining of the vein allowing the two walls to stick together. Results have improved following introduction of techniques to prepare the sclerosant as a foam.

What are the advantages and disadvantages for UGS?


  • Minimal discomfort.
  • No admission to hospital or anaesthesia.
  • No time off work nor interference with normal home duties.


  • Each leg is usually treated separately.
  • There is a limit to the dose of sclerosant that can be safely given at a session.
  • This means that multiple treatment sessions may be required.
  • Approximately 10-15% of patients require two sessions and less than 5% of patients require more.
  • Injected veins may remain inflamed for several weeks and patience is required to allow this to settle.


What should you do before UGS?

  • Do not shave the legs.
  • Do not apply moisturiser on the day of treatment.
  • Wear slacks or loose trousers and sandals or loose shoes to allow for the thickness of the stockings.


What happens during UGS?

  • A sonographer performs a ultrasound scan similar to the initial screening scan to familiarise us with the veins.
  • One or more injections of foamed sclerosant are given with you lying flat on a treatment couch.
  • Ultrasound follows the foam along the veins to the upper end of the vein.
  • Compression is then applied by wearing a compression stocking.


What should you do after UGS?

  • Walk for 15 minutes immediately after treatment.
  • Arrange for someone to drive you home or go by public transport – it is essential that the patient does not drive on the day of treatment. Driving can resume on the following day.
  • Walk or keep the leg elevated as much as possible for the first 24 hours and walk for 30 minutes each day.
  • Wear the stocking continuously for 48 hours. Then wear stockings only through the day, remove them at night and replace them in the morning after showering. Continue this for approximately 7-10 days or longer if pain develops after they are discarded.
  • Maintain normal daytime activities and avoid standing still for long periods.
  • Avoid strenuous physical activity such as aerobics for three weeks after treatment although swimming is acceptable from about 3 days after treatment.
  • Avoid flights of greater than 4 hours duration for 6 weeks after treatment. If travel is unavoidable, then discuss this with your doctor before treatment.
  • Return for a check ultrasound scan a week after treatment to ensure that the treated vein is occluded, determine whether any further veins require treatment, and exclude the small risk of deep vein occlusion.
  • Bring your stockings to every follow-up visit.


What can you expect following UGS?

The following features are expected. They are not a cause for concern although they should be reported at review:

  • Mild painpersists for several days and shows that the injections are working. The degree is related to the initial size of the veins. Pain is usually improved by walking or by Panadol or any non steroidal antiinflammatory agents such as aspirin, voltaren or nurofen. Soreness can occur behind the knee from rubbing by the bandage or stocking.
  • Discolouration and tender lumpsover tributaries are usual early on. They usually disappear within 4-6 weeks. This indicates that treatment has been successful. Lumps may need to be pricked to let out “trapped blood”.
  • Phlebitis or inflammationcan occur at any time after treatment due to reaction to the sclerosant. It is treated by further compression and regular walking. It does not represent infection and does not require treatment with antibiotics.
  • Migraine symptoms.Patients with a history of migraine headaches occasionally develop prodromal visual symptoms within a few minutes after treatment. Patients may wish to take their usual migraine treatment an hour or so prior to treatment in the hope of preventing this.
  • Recurrence.Treated veins can reopen or new veins can develop. For this reason, ultrasound surveillance is offered at yearly intervals so that recurrent veins can be detected and easily treated by UGS before they become too large.


What are the possible complications from UGS?

Complications can occur even with perfect technique.

  • Deep vein thrombosis.Clots extending into the deep veins can occur. This potentially serious complication is very uncommon if the protocol of compression and regular daily walking is followed. Minor clots develop in deep calf veins in less than 2% of our patients. If this is demonstrated on the postoperative scan then you may require treatment with daily heparin injections until further scans show the clot is resolving.
  • Allergic reaction to the solution.This is rare. It can present immediately as an anaphylactic reaction with generalised rash, constriction in the throat or difficulty with breathing, and this is successfully treated by injecting cortisone or adrenaline. Allergy may cause a skin rash requiring antihistamines. Allergy is slightly more likely in asthmatics.
  • Pigmentation or brown staining along the treated veins consists of haemosiderin, a form of iron from the blood. Most disappears within 12 months. Permanent staining can rarely occur which may respond to laser treatment.
  • Skin ulcerationis very uncommon with foam. It occurs because solution has escaped into the surrounding skin or because of an abnormal connection between small veins and arteries. Most ulcers are small and heal over a few weeks leaving a small pale scar.
  • Intra-arterial injection.This is a very rare complication that has been reported but never encountered in our practice. It would result in muscle and skin damage.
  • Nerve damage.We are not aware of any reports of damage to major nerves. Irritation of surface sensory nerves can occur rarely and this will always disappear within a few weeks.