Compression Sclerotherapy

During your first visit, you will meet with Dr. Jane Burk-Vassallo and a member of the aspireMD health care team for a complimentary consultation.     After reviewing your medical history, Dr. Burk-Vassallo will assess your current concerns integrating her 20+ year professional expertise to your care. A detailed conversation and assessment will formulate your diagnosis. Dr. Jane will then develop the best treatment approach for you.

Dr. Jane believes knowledge is empowering, and to that end will fully explain each recommendation. When all of your questions are answered, Dr. Jane Burk-Vassallo will work with you to create your treatment plan which encompasses your personal objectives and desired outcomes.

TREATMENT OPTIONS

Varicose veins are treated with lifestyle changes and medical interventions to:

• Relieve symptoms
• Prevent complications
• Improve appearance

Dr. Jane Burk-Vassallo and her healthcare team will discuss your individualized assessment and treatment strategies. Considering only 10-15% of the venous flow of your legs is visible at the surface level, Dr. Jane will often send you for a Duplex Ultrasound of the venous system of your legs to obtain full visualization of any underlying issues contributing to your concerns.

Your individualized treatment plan will be reviewed with you. Your Venous Ultrasound will aid in determining whether closure of the major valves at the groin or behind the knees is warranted and referral may be made to a specialist to perform this step if needed.  

Once all your questions have been answered and you are comfortable with the treatment plan, your informed consent will be obtained. Expect to have your photograph taken to record your baseline image and celebrate your improvement. Your photographs will be kept in your file with the same strict confidentiality as the rest of your medical records.

Your optimal leg health will involve a combination of steps one through three outlined below. As previously mentioned, the need for step two is determined by a Duplex Venous Ultrasound of the legs.

STEP 1:

Medical Graduated Compression Support Socks and Stockings

Support socks and hosiery are the foundation for your best leg support.

The graduated compression is greatest at the ankle reducing as it goes up the leg, to naturally encourage blood flow up the leg and back to the heart improving your body’s overall circulation.

Support socks will:

• Cause your legs to feel immediately more rested and energized
• Reduce swelling
• Optimize the results of varicose vein treatments
• Prevent varicose and spider vein recurrences

Anticipate customized measurements for your individualized prescription to suit your preferences and lifestyle.

A prescription for private insurance coverage will be provided at your consultation.

STEP 2:

CLOSURE OF MAJOR VALVES AT THE GROIN OR BEHIND KNEES

Dr. Jane Burk-Vassallo will discuss if this second, more invasive step is required in your specific case. If so, your options for leaky (refluxing) valve closure are:

Traditional Surgical Stripping or Ligation

• Performed in the hospital
• Recovery 4-6 weeks
• Recurrence: 40-60% within 10 years
• Covered by OHIP only if certain criteria met

Non-Surgical Closure with Laser (EVLA) or Sealant (VenaSeal™)

• Performed in a private clinic with minimal recovery (resume normal activities immediately)
• Recurrence: 6% within 10 years
• Never covered by OHIP. Private insurance plans with extended health spending account will cover

Further information may be obtained on the following websites:

• Venacure
• Angiodynamics
• Venaseal

STEP 3:

INJECTION COMPRESSION SCLEROTHERAPY

Following the closure of the major contributing malfunctioning valves (step two – if necessary), the smaller varicose and spider veins may be improved with injection compression sclerotherapy. By injecting a solution directly into a vein, the inner wall of the vein is irritated and subsequently collapses and seals, to be gradually absorbed by your body. When varicose veins are injected, the blood is re-routed through healthier veins. Varicosities and spider veins usually require repeated injections for resolution.

Compression bandages are subsequently applied to facilitate vein obliteration. Medical studies worldwide support that compression sclerotherapy is the gold standard for treating non-surgical veins (as opposed to external laser).

What to expect:

Immediate:          

• Pin prick and burning for 10 to 15 minutes.
• Occasional dull ache for one to two days.

Short Term:        

• Bruising, which disappears in one to two weeks.
• Occasional tender, red, hard lumps after treatment of large veins.  These may be uncomfortable but they are not dangerous and should be treated with cool compresses and ibuprofen (if able to tolerate) for symptomatic relief. Contact the clinic for alternate treatment if they are troublesome. Extension of these lumps/clots into the deep venous system is exceedingly rare. Unusual pain and swelling should be reported immediately.

Infrequently:       

• Discolouration or staining of the skin under injection sites. Most areas will fade gradually, but some areas may persist.
• After injection of large veins, spider veins may appear over the injected areas.
• These may also be resolved with injections.   

Rarely:                 

Allergic reaction to the solution or the tape. This ranges from tingling/itching of the skin to more severe reaction of hives and/or swelling. In extreme cases anaphylaxis may be fatal. Ulceration of the skin from sclerosing solution leaking outside the vein.

Special Instructions for Sclerotherapy:

Compression bandages will be applied over the injection sites. Compression enhances the effectiveness of your treatment and minimizes bruising. Patients with varicose veins should wear their support hose over these bandages. You will be instructed to remove these bandages in one to two days. Please keep them dry. At times there may be residual adhesive from the compression bandages. We will recommend products to aid in its removal if it is an issue for you. Softening the residue with coconut oil for 15 minutes prior to brisk rubbing with a facecloth is often effective.

On the day of treatment we suggest:

• Wear loose, comfortable clothes (shorts are suggested).
• Have proper nutrition and hydration.
• Do not put oil or cream on your legs the day of the treatment, as it prevents proper compression from our bandages, and may promote bruising.
• Resume normal activities. Moderate exercise is encouraged. Avoid strenuous strength training for 48 hours after sclerotherapy.
• Do not fly within 2-4 weeks after sclerotherapy. Discuss the particular deciding factors with the doctor.
• Advise the doctor if you are pregnant, breastfeeding or prone to fainting.

To Minimize Bruising:

Be aware of medications and vitamins that may promote bruising. If possible, refrain from: Vitamin E, Omega 3, ASA and anti-inflammatory products for a few days prior to treatment. Herbal supplements such as Bromelain and Arnica during the treatment course may reduce bruising. Avoid saunas, steams, and hot baths.

• Compression sclerotherapy is designed to fit in with your active lifestyle. You are able to step back into the stride of your schedule immediately after treatment.
• There may be temporary aching or bruising.
• Light to medium activity (brisk walks, yoga etc.) is encouraged.
• It is advised to avoid strenuous activity or workouts (10+ km runs, spinning, leg weights) for at least 48 hours after sclerotherapy to allow you treatment to take effect where it was placed.
• You will be individually instructed in the removal time of your compression bandages, typically 24 hours for spider veins and 48 hours when varicose veins are treated.
• It is recommended to sponge bathe during the time you are wearing your compression bandages to aid in keeping them dry and effective.
• Some find the removal of the bandages easier by soaking in a tub, others prefer to dry rip them off.
• Frequently, small spots of residual adhesive remain. We recommend softening with coconut oil for 15 minutes followed by a brisk rub with a facecloth. Failing that, speak to us about other products to aid with stubborn areas.
• Due to the hydrostatic pressure of standing, and the deeper connectors involved with varicose and spider veins, multiple injection sessions spaced a few weeks apart will be required for resolution.

MAINTENANCE AND PREVENTION OF VENOUS CONDITIONS

• Varicose veins and spider veins are a progressive condition. They can be controlled, but often are not cured. Due to the high pressures on our legs especially when we stand, and genetic predisposition, varicose and spider veins may return and new varicosities will likely develop.
• To impede the progression of varicose veins we suggest:
• Avoid non-prescription knee-highs.
• Wear prescription graduated compression hose or socks. Our trained staff will recommend a strength and style to suit your health requirements and lifestyle. Custom fitting is performed at aspireMD. Prescriptions for private insurance coverage are provided upon evaluation by Dr. Jane Burk-Vassallo.
• Avoid standing for prolonged periods of time; at least, move your legs and wear compression socks if you must stand for extended periods.
• Avoid excessive heat exposure.
• Remain physically active and maintain a healthy weight.
• Some find relief of venous congestion symptoms with the herbal agent Horsechestnut.
• We recommend intermittent follow-up in 1-2 years for maintenance of healthy legs.

LONG TERM COMPLICATIONS OF UNTREATED VEINS

• Progressively worsening severity of varicose and spider veins
• Pain, ache, throbbing, tired, heavy, cramps and/or restless legs
• Phlebitis – both superficial and deep
• Skin discolouration with altered texture of legs
• Itchy rash (stasis dermatitis)
• Spontaneous rupture and bleeding of weakened vessels
• Ankle swelling
• Thinning of skin leading to ulceration, especially at the ankle area