We may suggest ultrasound guided sclerotherapy for treatment of damaged branch veins, especially those that lie below the surface and cannot be directly seen. This treatment is often used together with other methods that treat either large or small varicose veins.
Ultrasound guided sclerotherapy uses agents identical to those used in conventional sclerotherapy but rather than injected as a liquid form, a foam may be used. Using ultrasound, the foam is injected into the veins that often lie hidden beneath the surface. Alternatively it may be used to inject larger superficial veins with more control. By using foam the sclerosing agent is less likely to be washed away in larger veins (as liquid would be) and will more likely cause the desired local damage to vein walls. As for conventional sclerotherapy, compression is applied after injection to cause the vein walls to stick together. By injecting the damaged larger or deeper veins, the smaller or more superficial visible veins will either disappear or respond better to conventional sclerotherapy. Ultrasound guided sclerotherapy has been used with considerable reported success in Europe, but is relatively new to North America. This technique requires more experience and skill than conventional sclerotherapy and does have the potential to cause staining, blood clots and allergic reactions. It does offer promise and will likely be a preferred treatment in the future for many people.
Following ultrasound guided sclerotherapy you should wear your compression bandage or stocking for 48 hours, but can resume regular activities immediately. Repeated sessions may be necessary to inject veins that remain open or to release trapped blood in damaged veins. Following successful treatment of the deeper veins, further treatment of superficial branches that may remain may be performed with techniques such as conventional sclerotherapy or ambulatory phlebectomy.