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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 with varicose veins 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. It is most commonly used as a secondary treatment following EVLA, specifically to treat the residual and smaller varicose veins. It is sometimes the necessary primary treatment required to treat the underlying vein condition.

Foam sclerotherapy is the procedure of injecting a diluted drug, mixed into foam with air, directly into the varicose veins. The foam displaces the blood in the veins and then the drug destroys the cells in the lining of the veins. The veins shrivel up and your body naturally breaks down and absorbs the dead tissue.

It 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 treatment painful, and there is little to no recovery time following the procedure – meaning that you can usually resume normal activities straight away.

 

A detailed description of sclerotherapy treatment

Pre-procedure

Your consultant and assisting nurse will welcome you into the treatment room. At your initial consultation, an ultrasound scan will have identified which veins require which treatment. A full explanation of the treatment options – including potential complications and success rates – will have been given to you.

At the start of the foam sclerotherapy treatment appointment, we encourage you to ask any further questions before signing to give your consent to the proposed treatment.

Music will be played during the treatment (your choice). Your nurse will be at your side throughout the appointment.

The Procedure

The veins to be treated are identified. The procedure involves a small needle (butterfly) being inserted into the vein(s) and the foam solution injected. The foam displaces the blood in the vein and attacks the lining of the vein wall, causing the vein to shrivel up. The foam ensures good contact with the cells in the lining of the vein, producing the most effective results. The shrunken veins are then broken down and absorbed gradually by your body. As with EVLA, once the veins have been destroyed, the blood is naturally rerouted to healthy veins, improving your circulation.

The procedure may be undertaken using ultrasound guidance, but this is dependent on the size of the veins being treated. Ultrasound guidance is used when treating large varicose veins; but for smaller veins that are close to the surface, it is not often necessary for the ultrasound to be used, as visual guidance is sufficient.

Due to the series of tiny injections involved in the foam sclerotherapy procedure, some patients find them uncomfortable or mildly painful. The sclerosant used can often sting slightly.

The procedure usually takes around 30-45 minutes.

The sclerosant in foam sclerotherapy is made up of a drug called sodium tetradecyl sulphate (STS).

Sclerosants like STS have been used for many years to inject varicose veins. STS is a licensed drug which is prescription only and extremely safe. It can only be prescribed by a doctor and administered under the doctor’s supervision. There is a dosage safety limit restricting how much of the drug we can administer in any one session.

The drug works by killing the cells that 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. Mixing the sclerosant with air or CO2 into a foam leads to a more effective closure of the veins.

We would love to continue the session until we have managed to treat all your veins, but if your veins are extensive, this is simply not possible, as the safe dose would likely be exceeded. Further sessions of foam sclerotherapy (or microsclerotherapy) may be needed to treat any veins remaining after the first session.

All of our microsclerotherapy sessions conform to the strict guidelines of maximum doses allowable of the sclerosant.

We advise you to point out which veins are bothering you the most. If possible, our specialists will start treating those first, in case the safety limit is reached before managing to treat all of the veins.

The number of sessions that you will require is dependent on two main factors:

  • How many veins you have to start with
  • How well your veins respond to treatment (some veins may need treating again).

On initial assessment, we will try to advise how many sessions you are likely to require, based on our past patients’ experiences. Prior to booking an appointment, we are happy to send photos of your veins on to a consultant to review, to see if they can advise how many sessions you may need.

Post-Procedure

The nurse will help you put on a compression stocking (two if you have had both legs treated) to be worn for 7 days following treatment. The nurse will explain how to wear and bathe in these and will also provide you with aftercare advice, including any post-treatment symptoms to be aware of.

You are encouraged to go on at least a 10-minute walk prior to returning home.

Foam Sclerotherapy Aftercare

Following foam sclerotherapy treatment, you are to wear a class II compression stocking constantly for 7 days. This is unlikely to affect your movement, but we discourage you from going swimming in the stocking.

You can drive on the same day as foam sclerotherapy treatment.

We advise you to take a daily 20-minute daily walk, and we urge you to resume your normal activities.

We do, however, advise you listen to how your body feels and to not push it too far. Your body is doing a lot of the work for us in the weeks following treatment, absorbing the treated veins. If there is anything else that you should avoid for a period of time post-treatment, your consultant will advise you of this.

The sclerosant used can often cause some bruising of the skin, the extent of which depends on the size of the area treated and the number of veins in the area.

Foam Sclerotherapy Follow-Up

Following a primary sclerotherapy session, you may need to return to see us, but equally, you may not.

The need to return is usually self-assessed, based on how your leg looks and feels. If you are happy with the results, there is no need to pay for a follow-up appointment for us to agree and simply say, “Your legs look great, no further treatment needed.”

If, however, you would like reassurance, or indeed if you feel that you would benefit from further treatment, you can either book a reassessment follow-up or book directly in for further treatment. We advise you to wait at least 4 weeks between appointments, to ensure you get the most benefit from each treatment session.

There is no pressure to attend for a further treatment session straight away. You can wait up to 2 years before seeking another session without the need to attend for a new consultation and scan prior to treatment.

Foam Sclerotherapy vs. EVLA

If an underlying valve problem is found during your consultation, your treatment pathway is likely to involve the EVLA stages outlined within the Varicose Vein Treatment Pathway, rather than simply foam sclerotherapy.

Although some doctors treat large veins by foam sclerotherapy, the results are not as effective or as durable as EVLA. We want to ensure that your treatment has long-lasting results and sorts the root of the problem, and as such we do not recommend foam sclerotherapy 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.

Treatment Risks

With all medical treatments it’s important to weigh up the benefits versus the risks. With that in mind, we have provided you with a full outline of the known vein treatment risks.

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