Foam Sclerotherapy

What is foam sclerotherapy?

This article refers specifically to ultrasound-guided foam sclerotherapy treatment of medium-sized tributary veins.  Sclerotherapy and foam sclerotherapy can also be used to treat spider veins.

In this technique, a liquid sclerosant chemical is agitated with air to produce a foamed mixture. The ultrasound  is used to guide the physician to 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 foamed sclerosant push the blood out of the way maximizing the amount of sclerosant which contacts the blood vessel lining, leading to a better outcome. From one to three or more sessions of injections are usually required for complete closure of the failed veins.

Who is a candidate for foam sclerotherapy?

Patients who have 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. The technique requires a specialist who is skilled at ultrasound imaging as well as injecting foam sclerosant.

Where is the procedure done?

Foam sclerotherapy is carried out in the physician’s office while the patient rests comfortably on a bed with their legs slightly elevated. No local anesthesia is required but the patient will feel a few small needle pricks. Injecting the foam causes little or no discomfort, although the leg may ache a little afterwards. The varicose veins in the leg are checked with ultrasound to see if foam has entered them. The entire treatment takes about a half hour. After the procedure, medical prescription compression stockings are applied to the legs before the patient goes home. These should be worn for at least 2-3 weeks after the procedure.

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 with foam sclerotherapy?

The treated varicose veins can sometimes be felt as small thickened lumps under the skin. These can be tender initially but they 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 very 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.  For this reason, some doctors recommend an echocardiogram of the heart prior to performing foam sclerotherapy treatments.   The echocardiogram can detect abnormalities in the heart which would allow some of the foamed sclerosant to get into the arterial circulation and block small arteries in the brain.

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 wish to have cosmetic treatment of spider veins may need additional sclerotherapy sessions for smaller and recurrent or residual veins.