SCLEROTHERAPY INFORMED
CONSENT AND BEFORE AND AFTER TREATMENT INSTRUCTIONS
WHAT IS SCLEROTHERAPY?
Sclerotherapy is an injection treatment used to eliminate small to medium size
varicose veins and "spider" veins. "Spider" veins are
superficial telangiectasias, tiny vessels that are red, blue or purple in
color. The majority of these veins present as a cosmetic problem.
HOW DOES SCLEROTHERAPY WORK?
A very small needle is used to inject a sclerosing solution into a varicose or
"spider" vein. Different solutions are used depending on the type of
vein. Different strengths of the solutions are used based on the size of the
vessel. Once injected the cells that line the vein wall (endothelium) will
become irritated, inflamed and damaged. External compression is applied using
cotton balls, tape and support hose. The compression causes the vein walls to
seal together and the vein no longer can transport blood. Your body will then
break down and absorb the damaged vein. When healing is complete the vein is no
longer visible. The process is very similar to how your body heals a bad
bruise. "Spider" veins do not have any useful function and
eliminating them will not affect your circulation. Reducing or eliminating
varicose veins can improve your circulation and symptoms of heaviness, aching
and fatigue.
HOW MANY TREATMENTS ARE NEEDED?
The number of treatments needed varies from patient to patient depending on the
type, size and quantity of veins to be treated. Varicose veins and
"spider" veins may require multiple injection sessions. Subsequent
treatments are usually scheduled every four to six weeks to allow time for the
body to respond to the treatment. It is important to realize that the best
results require patience. It takes time for your body to respond to the
injections. It is important to follow the post-treatment instructions to
optimize your results. Your body will continue to heal and "fade"
injection sites for months after treatment.
After your initial screening exam your doctor will give you an estimate as to
the number of treatments that may be required. This is based on the doctor's
assessment, your history and expectations. You may end up needing fewer or more
treatments than the surgeon estimated. It is important to discuss your expected
outcomes with your doctor and to keep them realistic. Your doctor will do
everything possible to meet or exceed your expectations.
WHAT TO EXPECT:
Photographs will be taken before treatment is initiated. This helps to monitor
your progress. Your legs will look worse before they look better. After the
vein is damaged the body needs time to heal. Most people will notice a dramatic
improvement approximately four weeks after their initial treatment. Maximal
improvement often takes several months and several treatments. There is no
guarantee sclerotherapy will be effective in every case. Some veins and areas
will need to be retreated. Recurrence of the same vein treated rarely occurs
with proper injection technique and compliance with post treatment
instructions. New varicose veins or "spider" veins may form requiring
subsequent treatment. Periodic re-evaluations are encouraged so that any new
veins that develop can be injected before they become too large or too
numerous.
COMMON SIDE EFFECTS:
ITCHING-you may experience itching around the area
injected. If this occurs, it is usually mild and lasts for one to two days.
HYPERPIGMENTATION-a light brown discoloration of the
skin may develop along the vein in the area injected. Approximately 20-30% of
patients treated note the discoloration, which is lighter and less obvious than
the vein being treated. The hyperpigmentation usually fades in a couple weeks,
but may take several months to a year to totally resolve. There is a
one-percent incidence of hyperpigmentation continuing after one year.
A small amount of blood may become trapped and hardened in the vein when
injecting varicose veins or some "spider" vein complexes. This may
feel like a knot or cord and it may look dark blue or bruised. This is a common
occurrence. You may need to return before your next treatment so this area can
be drained to remove the trapped blood. This will reduce the hyperpigmentation
that can occur. The chance of this occurring can be decreased with proper
compression of the vein and use of compression hose after your treatment.
TELANGIECTATIC MATTING-the formation of new, fine
"spider" veins in the area injected occurs in less than 1% of
patients injected. The exact reason for this occurring is unknown. If
untreated, the matting usually resolves in three to twelve months, but very
rarely it can be permanent. If the matting does not fade it can be re-injected
or treated with a laser/light source.
PAIN-it is common to have some tenderness or stinging
at the injection site. Injection of the sclerosing agent can be uncomfortable,
but is usually well tolerated by most patients. The discomfort is temporary,
lasting one to at most seven days. Acetaminophen (Tylenol) can be used if
needed, according to product directions.
BRUISING-may occur at the injection site. Bruising may
be minimized by avoiding Aspirin and Ibuprofen products for ten days before and
after each treatment session.
RARE SIDE EFFECTS:
ULCERATION AT INJECTION SITE-very rarely a small ulcer
will occur at the site where the vein is injected. An ulcer can take four to
six weeks to completely heal. A small scar may result.
ALLERGIC REACTION-there is a very rare incidence of an
allergic reaction to the solution injected. You will be observed for such
reaction and will be treated appropriately should it occur. Please inform us of
any allergic history.
PULMONARY EMBOLUS/DEEP VEIN THROMBOSIS-a blood clot to
the lungs/a blood clot in the deep vein. In the medical literature there is an
extraordinarily low incidence of this complication.
ALTERNATIVES TO SCLEROTHERAPY:
You may choose no therapy. The existing varicose and "spider" veins
may progress and new veins may form. You should be re-evaluated periodically to
monitor your condition for changes.
You may choose to only wear compression support hose (if this is an appropriate
treatment for your problem). Compression hose promote venous blood return to
the heart. If support hose are worn faithfully symptoms such as aching,
heaviness and tiredness are often alleviated. They also may help prevent the
progression and formation of varicose and "spider veins".
Vein stripping and/or ligation may be appropriate to treat some patients with
larger varicose veins. Laser/light source therapy may be an option if you have
spider veins. Your doctor will discuss these alternative choices with you.
SCLEROTHERAPY PRE TREATMENT INSTRUCTIONS:
COMPRESSION HOSE-are required to be worn immediately
after each injection treatment or if you have had aspiration of trapped blood
from an injected vein. Hose can be purchased from our office or you may request
a prescription to purchase at a pharmacy or medical supply store. You cannot be
injected without your compression hose. The hose must be worn continuously for
48 hours after your treatment. Then they may be removed and worn daily, during
the waking hours, for seven more days. Your doctor may adjust the length of
time to wear your hose. The compression hose are critical to the success of the
treatment.
LEG PREPARATION-do not apply oil, lotion or powder to
your legs the night before or the day of your injections. Use of these
toiletries will not allow the cotton balls and tape to adhere to your skin.
CLOTHING-bring a pair of loose, comfortable shorts to
wear during your treatment. Dress in loose clothes and comfortable shoes to
accommodate the cotton balls, tape and hose after your treatment.
MEDICATIONS-discontinue Aspirin (Bufferin, Anacin etc.)
and Ibuprofen (Motrin, Advil, Aleve etc.) for 10 days before and after
injections to reduce bruising. Acetaminophen (Tylenol) is allowed.
TIME ALLOTTMENT-a sclerotherapy treatment should last
approximately 30 minutes. You should arrive 10-15 minutes early for your first
sclerotherapy treatment to allow time for photographs and to sign your
consents. You should then allow 15 to 30 additional minutes to apply your
support hose, get dressed and to check out of the office. If you need to cancel
or reschedule your sclerotherapy treatment, please give our office at least 72
hours notice.
PHOTOGRAPHS-photographs will be taken before your first
treatment to document progress and/or for the purpose of medical education,
research, scientific publication or educational presentations. You will not be
identified in your photographs and informed consent will be obtained before you
are photographed.
SCLEROTHERAPY POST TREATMENT INSTRUCTIONS:
COMPRESSION-cotton balls and tape provide local
compression over each area injected. Before standing, you will put on your
compression hose. Proper compression is very important because it minimizes the
blood re-entering the injected vein, decreases the incidence of post
sclerotherapy hyperpigmentation and telangiectatic matting and improves venous
blood flow. The cotton balls and tape can be very uncomfortable and may even
irritate and blister sensitive skin. After the first 48 hours the hose, cotton
balls and tape may be removed. If tape blisters occur, keep clean with soap and
water, use Neosporin or Bacitracin ointment and cover with a dry non-adhering
dressing. These heal within seven to ten days. After the initial 48 hours you
should continue to wear your hose for one week, during the waking hours. If
larger varicose veins are injected, you may be advised by your doctor to wear
them for two to three weeks.
BATHING-a shower is allowed after the first 48 hours.
Hot baths, hot tubs and saunas should be avoided for two weeks after
sclerotherapy to avoid venous dilatation.
HYPERPIGMENTATION-if you develop hyperpigmentation
after sclerotherapy you should apply sun block to those areas when sun exposure
is anticipated to avoid increasing the hyperpigmentation. Continue to use sun
block until the hyperpigmentation has resolved.
DRIVING-you may drive immediately after your treatment.
If your trip home is longer than an hour we recommend you stop hourly to
stretch your legs.
ACTIVITY-in most cases, you may return to work and
resume normal activity after treatment. Please take a 15-minute walk
immediately following your treatment. This will help circulate the solution
that was injected. Walking is encouraged; it promotes efficient venous
circulation. Avoid sitting and standing for extended periods and elevate your
leg(s) above the level of your heart when possible for the next two to three
days. If large varicose veins were injected, your doctor may recommend you stay
off your feet with your leg(s) elevated for the rest of the day. Avoid high
impact aerobics, jogging, running, leg weight lifting and sit-ups for one to
two weeks after each injection treatment.
MEDICATIONS-do not use Aspirin or Ibuprofen products
for ten days after each treatment to reduce bruising. Acetaminophen (Tylenol)
can be used if you experience any discomfort from sclerotherapy.
FOLLOW-UP-subsequent treatments are usually every two
to four weeks. Your doctor will advise you when you should return. If you
notice dark knots or cords at your injection sites please call our office; you
may need to return sooner to have these areas aspirated. Remember it is
important to call our office if you have any questions or concerns before or
after your sclerotherapy treatment. Please keep your follow up appointment
after treatment. It is important for the physician to assess the results you
achieved from each treatment. If you need to cancel or reschedule your sclerotherapy treatment or follow up appointment, please
give our office at least 72 hours notice.
I have read and understood
all information presented to me before signing this consent.