This article refers specifically to foam sclerotherapy treatment
of medium-sized tributary veins during
duplex
ultrasound guidance. Sclerotherapy and foam sclerotherapy can also be used
to treat
spider
veins.
In this technique, liquid sclerosant is agitated with air to
produce a foamed mixture. The ultrasound probe is used to
locate the damaged vein and the position of the needle is
carefully monitored using ultrasound imaging so that it is in
exactly the right place when the foam is injected.The bubbles
in the foam push the blood out of the way and this maximizes the
amount of sclerosant which contacts the blood vessel lining,
leading to a better outcome. More than one session of
injections is usually required for complete treatment.
Who is suitable for foam sclerotherapy?
Patients with very extensive large varicose veins are usually
best treated with
endovenous laser ablation
(EVLA). The endovenous laser successfully closes the
main source of venous reflux over 98% of the time using only
local anesthesia.
After the larger veins are closed with EVLA, small or moderate
size varicose veins can be treated with foam sclerotherapy.
Who performs this treatment?
At present only a limited number of phlebologists in the U.S.
are experienced in this treatment. It requires a specialist who
is skilled at ultrasound imaging as well as injecting foam
sclerosant.
Where is the procedure done?
Foam sclerotherapy is done in the physician's office while the
patient rests comfortably on a bed with their legs slightly
elevated. No anesthesia is required but the patient feels a few
small needle pricks. Injecting the foam causes little or no
discomfort, although the leg may ache slightly afterwards. The
varicose veins in the leg are checked with
ultrasound to see if foam has entered them. The
entire treatment takes about 30 minutes. After the procedure,
compression stockings are applied to the legs before the patient
goes home. These should be worn for at least 3 weeks.
Is foam sclerotherapy effective at closing varicose veins?
Yes, several detailed clinical studies have been published that
suggest that 80-90% of veins are permanently closed by this
treatment when examined 1-2 years later using ultrasound
imaging.
Are there any side effects?
The treated varicose veins can sometimes be felt as small lumps
under the skin. These slowly resolve over several months. There
may be minor bruising after the procedure. For the vast majority
of patients foam sclerotherapy is safe but there is also a small
risk of allergy. There are also rare instances of transient
stroke or visual impairment reported due to the foamed air
bubbles reaching the brain or eye.
When will I be able to go back to work?
Most people go back to work the same day.There is minimal, if
any, discomfort after this procedure.
Will my spider veins go away too?
While spider veins are not specifically targeted with foam
sclerotherapy, some will improve after treatment of the deeper
tributary veins. Patients who desire cosmetic treatment of
spider
veins may need additional
sclerotherapy for smaller and recurrent or residual
veins
