Sclerotherapy is the procedure of injection of varicose veins. The veins are injected with a solution called a sclerosant which damages the internal lining of the vein and causes fibrosis within the vein. In time, your own body will then destroy the vein and it will disappear. A variety of solutions are used for this procedure such as sodium tetradecyl sulphate (STD) or Polidocanol and are available in different concentrations depending on the size of the vein being treated.
Normally sclerosant medication is injected as a solution directly into the vein to be treated. Foam sclerotherapy involves making small volumes of the solution into foam by mixing with a small volume of air. This can then be used to treat some of the larger underlying abnormal veins. This technique of foam production is called Tessari technique.
Ultrasound guided foam sclerotherapy has following advantages over traditional sclerotherapy-
Foamed nature of the sclerosant allows it to be seen on ultrasound while it spreads inside the targeted veins.
Foam sclerotherapy requires the use of smaller amount of chemical sclerosant than liquid Sclerotherapy.
Foam makes better contact with the inside of the vein walls and stays longer in contact with the vein walls, resulting in better results.?
Depending on the number of varicose veins you have, you may need a few sessions of treatment. One or more fine venous catheters or butterfly needles will be placed into the veins using ultrasound scanning. Your leg will then be elevated and foam solution will be injected in small volumes at a time into each of the needles. After this you will be asked to bend your ankle up and down in order to increase the blood flow in your deep veins.
Once enough foam has been injected, the needles will be removed and compression will be applied to your leg followed by a bandage in order to compress the treated veins.
We prefer to use thermal ablation or EVLT for most major Varicose Veins. Foam sclerotherapy is our second choice or used where thermal ablation is not possible due to very fine or twisted veins. Foam sclerotherapy can be associated with following complications-
Skin pigmentation and minor superficial thrombophlebitis can occur. Very rare complications are allergic reactions, skin ulceration, accidental arterial injections [ very rare but potentially catastrophic complication] DVT- deep vein thrombosis and PE-pulmonary embolism, transient visual disturbances or migraine type phenomenon and very rarely stroke. We recommend that you read NICE guidance on foam sclerotherapy if you are considering it.
At the Coltishall Clinic Dr Sanjay Gheyi MBBS MS FRCS BCAAM uses ultrasound guided foam Sclerotherapy to treat branch varicosities of the saphenous veins, as well as very superficial or very tortuous varicosities unsuitable for endovenous thermal (heat-based) ablation techniques such as EVLT, EVLA or VNUS. Note that it is sometimes impossible to advance the treatment catheter or the laser fiber of the EVLT systems along the length of tortuous veins. Foam sclerotherapy is a very good option in such cases. We use minimal volume and concentration of foam to minimise chance of complications.