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Foam Sclerotherapy

Foam sclerotherapy (video)

What is foam sclerotherapy?

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.        




 
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