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Ultrasound-Guided Foam Sclerotherapy
Also known as just "Sclerotherapy"
Injection treatments for varicose vein removal have been used for many years to treat varicose veins. Two recent developments now allow us to use an injection technique to treat varicose veins that were previously only treatable by surgery. These are the use of ultrasound to guide the injections and the preparation of the chemical as a foam.
Over the last 20 years or so, the use of foam injections has spread widely in France, Spain and Italy and more recently the technique is being used in the USA. The treatment can be performed as a “walk in, walk out” or “lunch hour” procedure.
Key features of Ultrasound-Guided Foam Sclerotherapy
- There is no need for an operation under general anaesthetic
- The treatment involves injections under local anaesthetic
- A treatment session is complete in about 45 minutes
- The treatment is carefully monitored using ultrasound
- A firm compression bandage must be worn for 2-7 days afterwards
- The costs of treatment are much lower than for surgical methods
- No time off work (if compatible with wearing a bandage and stocking)
What is foam?
The solutions that are injected are exactly the same as those which are already used to treat varicose veins. At The VeinCare Centre, we use Fibrovein® which has a UK product licence for Ultrasound-Guided Foam Sclerotherapy from the MHRA.
The prescription medicine is mixed with air to create a foam which looks a little like hair mousse or shaving foam. Many scientific studies have shown that this foam is perfectly safe to inject into veins.
What does the foam do?
Foam pushes the blood out of the way and completely fills the vein. The lining of the vein is removed by the foam and the treatment starts a healing process. The vein walls stick together and the channel is closed off. With time the vein is completely absorbed by the body.
Treatment is performed in a treatment room and not an operating theatre. The patient rests comfortably on an examination couch. A small amount of local anaesthetic is used to numb the skin of the leg and a small needle is inserted into the refluxing vein that is feeding the varicose veins. The position of the needle is carefully monitored using ultrasound so that the feeder veins are closed.
Foam is then injected and its progress into the feeder veins and varicose veins is carefully monitored with ultrasound. The whole treatment usually takes no more than 45 minutes.
Finally a firm bandage is applied to the leg. The aim of this is to keep the veins compressed so that they do not fill with blood when the patient stands up.
When the bandages are removed at the follow-up appointment it is usual to find that all the varicose veins have been sealed. The leg may be a little bruised at this stage, although this is usually fairly minor. If any varicose veins have not been completely treated in the first session, they are injected and bandaged to complete removal of all veins.
If varicose veins are present in both legs, the treatment is given to one leg at a time with an interval of 1 or 2 weeks.
Who is suitable for Foam Sclerotherapy?
The National Institute for Health and Care Excellence (NICE) has reviewed all the modern treatments for people with varicose veins and its experts have produced guidance on the subject : NICE Clinical Guideline CG168. Ultrasound-Guided Foam Sclerotherapy is recommended when endothermal treatments such as Endovenous Laser or Radiofrequency are not possible. Most people with small or moderate size varicose veins can be treated in this way and feeder veins associated with thread veins and spider veins can also be treated by foam sclerotherapy. Many people with recurrent varicose veins, that is veins that have come back after old-fashioned stripping operations are best treated by Ultrasound-Guided Foam Sclerotherapy. People with very extensive large varicose veins are usually best treated by a combination of foam sclerotherapy and phlebectomy to obtain rapid results with the best cosmetic appearance.
What are the risks of Foam Sclerotherapy?
Foam Sclerotherapy has proven to be safe and effective. The use of Foam Sclerotherapy is approved by the National Institute for Health and Care Excellence.
Sclerotherapy can cause side effects, including:
- blood clots in other leg veins
- changes to skin colour – for example, brown patches over the treated areas. These usually fade within 6 months but may be permanent
- temporary vision problems (a form of migraine)
- The appearance of new broken veins (usually temporary but may be permanent)
In very rare cases, sclerotherapy has been known to have serious potential complications, such as strokes or transient ischaemic attacks. These risks are mitigated by limiting the dose of sclerotherapy in any one session.
What happens after Foam Sclerotherapy?
You will be asked to take a brisk 15-minute walk immediately after your treatment. You should be able to walk and return to work immediately after having sclerotherapy. You will need to wear compression stockings or bandages for up to a week (we will advise on the exact requirement).
After you remove the bandages and stocking you can have a shower of bath. Avoid standing for long periods, keep mobile and drink plenty.
The treated areas may be a little lumpy and tender. You can take apply arnica cream to these area or an anti-inflammatory painkiller such as ibuprofen (check with a pharmacist if you are unsure whether you are suitable for these).
What are the Results of Sclerotherapy?
Sclerotherapy can treat virtually any abnormal vein in the body.
Larger veins in the leg are treated by Ultrasound-Guided Foam Sclerotherapy and smaller veins are treated by Microsclerotherapy.
A combination of Ultrasound-Guided Foam Sclerotherapy and Micosclerotherapy is very successful in treating moderate sized varicose veins and associated blue veins and spider veins.