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Foam Sclerotherapy

Ultrasound-guided foam sclerotherapy is the gold-standard treatment option for varicose veins when EVLA is not required, as recommended by the National Institute of Health and Care Excellence (NICE).

It is important to note, though, that the vast majority of patients do require EVLA.

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Foam Sclerotherapy
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What is foam sclerotherapy?

Foam sclerotherapy is used to treat both the symptoms and the causes of varicose veins and thread veins. Although it is sometimes the necessary primary treatment required to treat the underlying vein condition, it is most commonly used as a secondary treatment following EVLA, specifically to treat the residual and smaller varicose veins.

Foam sclerotherapy is carried out on an outpatient basis, and usually takes no more than 30-45 minutes, depending on how many veins need treating.

Our patients do not usually find the injections painful, and there is little to no recovery time following the procedure – meaning that you can usually resume normal activities straight away.

 

What does the foam sclerotherapy procedure involve?

A chemical sclerosant liquid is mixed into a foam with air and injected directly into the varicose veins. The foam displaces the blood in the veins and then the chemical destroys the cells in the lining of the veins. The veins shrivel up and your body naturally breaks down and absorbs the dead tissue.

 

A detailed description of sclerotherapy treatment

Pre-procedure

Prior to treatment an ultrasound scan will have been performed identifying what treatment the veins require. A full explanation of the treatment options including potential complications and success rates will have been given at your initial consultation. At the start of the appointment, you will be asked to sign to give your consent to the proposed treatment.

 

The theory

Sclerosants like STS have been used for many years to inject varicose veins. They work by killing the cells which form the skin that lines the vein wall. Without its skin, the vein dies off. Sclerosants work quite well for small veins, especially below the knee where good compression can be applied; however, if the underlying reflux is not dealt with, the varicose veins will just come back. More recently, it has been discovered that mixing the sclerosant with air or CO2 into a foam leads to a more effective closure of the veins.

 

The procedure

The veins to be treated are identified. A small needle (butterfly) is inserted and the foam injected. The foam displaces the blood in the vein maintaining good contact with the cells in the lining of the vein which are then killed, and the vein dies off. The veins then shrink, and the body gradually breaks down the dead vein and absorbs it. As with EVLA, whilst the veins have been destroyed, the blood is naturally rerouted to healthy veins improving your circulation.

The requirement for ultrasound guidance during foam sclerotherapy depends on the size of the veins being treated. Ultrasound guidance is used when treating large varicose veins, however, for smaller veins close to the surface it is not often necessary for the ultrasound to be used as visual guidance is sufficient.

Although some doctors treat large veins by foam sclerotherapy the results are not as effective or as durable as EVLA and we do not recommend this as a primary treatment for the majority of patients. We do use foam sclerotherapy for any residual varicosities remaining at follow up after EVLA. Some patients with recurrence of varicose veins after EVLA may just need some foam sclerotherapy.

Due to the chemical nature of the sclerosant, there is a safety limit restricting how much can be treated in one session. We would love to continue injecting until we have managed to inject all your veins, however, if your veins are extensive this is simply not possible as the safe dose would be exceeded. As such, we advise patients point out which veins are bothering them the most and our specialists will inject those first in case it is not possible to inject all of the veins in one sitting due to the safety limit. Further sessions of foam sclerotherapy may be needed to treat any veins remaining after the first session. Once all veins have been injected a stocking is applied which is worn for 7 days.

 

Follow-up

We want you to get the most out of each foam sclerotherapy session and so we advise you wait for a minimum of 4 weeks between each sessions so that you can see the results of the first session before beginning the next. If your veins are very extensive, you may need more than one follow up session.

 

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