Having Sclerotherapy for Vascular Malformations Department of Radiology Information for Patients i Radiology Leaflet No. 74 University Hospitals of Leicester NHS Trust
Contents 1 Introduction... 3 2. Referral and consent... 3 3. What is sclerotherapy for vascular malformation?... 4 4. Important information... 4 5. How do I prepare for the procedure?... 5 6. What happens during the procedure?... 5 7. How long will the procedure take?... 6 8. What happens after the procedure and when I go home?... 6 9. Are there any risks or complications?... 7 10. How do I get the results?... 8 11. Background radiation... 9 12. What if I need to talk to someone?... 9 13. Other sources of information... 10 14. Additional hospital information... 10 2
What is a Hickman line? This information tells you about the procedure called sclerotherapy for vascular malformations. It contains an explanation of how the procedure is carried out and what the possible risks are. This will help you to decide whether or not to go ahead with the procedure. Referral and consent Before attending for sclerotherapy, you will have been assessed by a vascular surgeon and radiologist in the vascular malformations clinic. At this time they should have discussed with you the reasons for this procedure, any alternatives, any risks involved and the success rates. You should make sure that you understand these. You have been referred to a radiologist for this procedure. Radiologists are doctors who have specialised in imaging and X-ray treatments. They will confirm that you understand why the procedure is being done, its potential risks, and what the chances of success are. You will then be asked to sign a consent form. When you sign this it means you have agreed to have the procedure done and that you understand why it is needed. You will have a copy of the consent form to take away. If after discussion with your hospital doctor or radiologist you do not want the procedure carried out, then you can decide against it. If the radiologist feels that your condition has changed or that your symptoms do not indicate the procedure is necessary then they will explain this to you and arrange for you to return to the vascular malformation clinic. The radiologist will let the surgeon who referred you know, so that they can see you again to review your condition. At all times the radiologist and surgeon will be acting in your best interests. 3
What is sclerotherapy for vascular malformation? A vascular malformation (VM) is an abnormality of your blood vessels present since birth. Although you will have been born with this you may not have noticed it until more recently. Following consultation with your doctor, you have been referred for sclerotherapy as your VM is of a type thought to be best treated by this method. Sclerotherapy involves injecting the abnormal blood vessels with a liquid (called a sclerosant) to block and destroy them. This process is good at reducing the pain caused by your VM. It is important to be aware that this is not a cosmetic procedure. If your VM causes skin discolouration or swelling then this may not change. In fact swelling and discomfort is likely to increase for a week or two following the procedure before getting better. If your VM is large, repeated sessions of sclerotherapy may be required. In addition if the VM is deep under your skin, on your palms or the soles of your feet, then you may have been advised to have the procedure performed under general anaesthetic. Important information Please tell the doctor who is doing the procedure if: You have any allergies, in particular to iodine. You have previously reacted to an intravenous contrast medium, the dye used for kidney X-rays and CT scanning. You are diabetic. 4
How do I prepare for the procedure? Sclerotherapy for VM is done as a day-case procedure and you should follow the information sent to you about the appointment. Your length of stay will be approximately 2-3 hours. On the day of your appointment please have a light breakfast before 6am (cereal or toast with a cup of tea or coffee). It is important that you continue to drink until one hour before your appointment time. Have a bath/shower in the morning, or the night before. Take all your usual morning medications and bring all your usual medications with you. What happens during the procedure? The procedure is performed in the radiology department, or sometimes the operating theatre if you are having a general anaesthetic. You will lie on the X-ray table. Everything will be kept sterile, and the radiologist will wear a theatre gown and sterile gloves. Your skin will be cleaned with antiseptic and some of your body will be covered with sterile sheets. An injection of local anaesthetic may be given to numb the area. The radiologist will place a thin needle (the size of a blood test needle) into the VM. Contrast medium (a colourless liquid that shows up on X-rays) will be injected through the needle and X-rays will be taken to see the VM. The contrast medium may give you a warm sensation but this will only last a few seconds. 5
What happens during the procedure? (continued) Once the needle is in the correct position the sclerosant is injected. The procedure may be uncomfortable but it is not usually painful. There will be a nurse or another member of staff looking after you. If the procedure does become uncomfortable for you, they will be able to arrange for you to have some painkillers. Once the radiologist is satisfied that the procedure is complete, the needle will be removed and the radiologist will then press firmly on the skin entry point for several minutes, to prevent any bleeding. An elasticated bandage may be applied if your VM is on your arm or leg. How long will the procedure take? Every patient s situation is different. It is not always easy to predict how complex or how straightforward the procedure will be. It may be over in 10 minutes or, very occasionally, it may take longer - up to 30 minutes. What happens after the procedure and when I go home? Nurses will carry out routine observations, such as taking your pulse and blood pressure, to make sure that there are no problems. They will also look at the skin entry point to make sure there is no bleeding from it. You will be asked to rest in bed for approximately 1 hour. The nurse will discuss important aspects of your post-procedure care including how to look after yourself at home. 6
After the procedure and when I go home (continued) Do not drive for 24 hours. You are advised to relax and take things easy for the rest of the day. If your VM is in your leg, then keep that leg raised when you sit down. If a dressing or bandage has been applied, you can remove this approximately 24 hours after the procedure. You should expect to have some swelling and tenderness which may be worse than your initial symptoms. This will settle down after a week or two. If you have any pain this can be relieved by taking your usual painkiller, and you may find a non-steroidal anti-inflammatory drug (such as ibuprofen) most effective, if you can take this. Should your usual painkiller be ineffective, you should see your GP. After 24 hours you can return to normal activities. Are there any risks or complications? As with any procedure or operation, complications are possible. We have included the most common risks and complications in this leaflet. The possibility of these complications occurring will vary for each patient and the possibility of these complications happening to you will be discussed with you before you sign the consent form. The main risk is that the sclerosant spreads outside the VM. This may cause: Numbness or tingling - if a nerve is involved. Skin necrosis - a blister or a small ulcer may form if the skin is involved. The risk of these complications happening is about 15%. With time these are likely to get better without further treatment. 7
Are there any risks or complications? (continued) Swelling and pain - You are likely to get an increase in any swelling or pain that you had before the treatment. This is part of the normal healing process and you should not be alarmed. Take some pain killers (as described in section 8) if you have to. The symptoms should get better in a week or two. However, if the treatment area becomes hot and red or you feel unwell with flu-like symptoms, this might mean you have an infection and you should see your GP. Alternatively you can call the angiography suite for advice using the telephone number on your appointment letter. Contrast medium - Some patients may be allergic to the contrast agent and may have symptoms such as nausea, vomiting or a rash. You will have been asked questions to see if you are likely to be allergic to the contrast media. If you develop symptoms at home you should contact your GP. As described above VMs may be extensive and require repeated injections to fully treat. In addition they may have a tendency to recur. If this happens at a later date further injection is usually possible. How do I get the results? You will be told straightaway if the treatment session has been successful. However, it is unlikely that the entire VM will be treated in one session. If you still have symptoms you may be offered further injections or referred back to the vascular malformations clinic. 8
Background radiation The risk from having X-rays is very small indeed. We are all exposed to natural background radiation every day of our lives. This comes from the sun, food we eat, and the ground. Each examination gives a dose on top of this natural background radiation. The risks from radiation are slightly higher for the unborn child so we must ask female patients aged 10 to 55 years about their menstrual history. The benefits of this examination outweigh any potential risk and the risk from not having the examination could be greater. We will take all safeguards to minimise the amount of X-rays you receive. What if I need to talk to someone? Before the procedure you can contact the radiology nursing staff or your consultant. After the procedure you can contact your GP for advice. You can also obtain advice from the angiography department at the hospital where you had your treatment. Alternatively you can contact NHS Direct on 0845 46 47 for health advice or information. 9
Support for people with learning disabilities There is support available in our hospitals for patients with learning disabilities. Please contact the learning disability specialist nursing team on (0116) 258 4382 telling them when the appointment is and what examination has been booked. Other sources of information Websites For general information about radiology departments visit the Royal College of Radiologists website: www.goingfora.com For information about the effects of x-rays read the NRPB publication: X-rays how safe are they, on the Health Protection Agency website: www.hpa.org.uk Please note that the views expressed in these websites, do not necessarily reflect the views of UHL or the NHS. University Hospitals of Leicester website: www.leicestershospitals.nhs.uk NHS Direct: For health advice or information you can call NHS on: 111. 10
Additional hospital information How was it for you? If you wish to make any comments or suggestions regarding your visit to the Radiology Department please fill in a suggestion form or speak to a member of staff. Suggestion forms are located in all waiting areas within the department. University Hospitals of Leicester NHS Trust also has a Patient Information and Liaison Service (PILS), and you are welcome to contact them on: Freephone: 08081 788337 email: pils.complaints.compliments@uhl-tr.nhs.uk We review our information leaflets on a regular basis. If you have any comments about how we can improve these leaflets please speak to a member of staff. Directions and car parking Hospital car parking is available to all hospital patients and visitors. Spaces are limited so please allow plenty of time to find a car parking space. Parking charges are payable, please check tariff boards or the hospital website for full details. As well as the hourly rates there are a range of saver tickets available for patients and prime carers. Dedicated disabled parking bays are also available. Marked disabled bays exist outside of the public car parks for which there is no charge. If you park in the car parks the fee will apply. Drop off bays exist at the main entrances, these bays have a 20 minutes maximum stay. Certain qualifying benefits as notified by the Department of Social Security entitle the patient to free or reduced parking. For more information contact the Cashiers office. 11
Additional hospital information (continued) Bus services to the hospital Our aim is to ensure that there are car parking spaces available for those who really need to use them. We encourage you to use public transport or walk to the hospital if you are fit and well. For information on bus routes and times contact Traveline on 0871 200 2233. Our Hospital Hopper shuttle bus service links our three hospitals with Beaumont Leys Centre, Hamilton Centre, the Railway station and St Nicolas Place (Park and Ride hub). The buses run from 6:30am until 7pm every 30 minutes from Monday to Friday. The nationally recognised concessions are valid on buses in Leicester including the Hospital Hopper. Contact the UHL Travelwise Manager on 0116 258 3796 for more information on the Hospital Hopper. Relatives and escorts You may wish to bring a friend or relative to accompany you to and from the Radiology Department when you have your examination although they may not always be allowed into the examination room. This may be useful if you do not understand English very well or if you have any special needs. Children Baby changing facilities are available. Please ask to be shown to them if you wish to use them. We are unable to offer childcare facilities. If you need to bring your children with you, please bring along an adult who can supervise them whilst your examination is being carried out. Radiology staff are not able to supervise your children. 12
Additional hospital information (continued) Facilities available Refreshments: Refreshments including hot and cold drinks are available in the hospital. Please ask a member of staff for directions. Shops: Each hospital contains a shop selling magazines, newspapers, sweets and drinks. Please ask a member of staff for directions. 13
Any questions? If you have any questions write them down here to remind you what to ask when you speak to your consultant or radiologist. 14
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Today s research is tomorrow s care We all benefit from research. Leicester s Hospitals is a research active Trust so you may find that research is happening when you visit the hospital or your clinic. If you are interested in finding out how you can become involved in a clinical trial or to find out more about taking part in research, please speak to your clinician or GP. If you would like this information in another language or format, please contact the service equality manager on 0116 250 2959 Produced by: Imaging Patient Information Group. Edition 3. Printed: June 2011 Reviewed: October 2014 Review: October 2018 (Mear)10148449KR IMA021-1014