What is sclerotherapy?
Sclerotherapy, or injection of varicose veins (VVs), is one of the techniques used to treat varicose veins. The veins are injected with a solution called a sclerosant which damages the internal lining of the vein and causes the vein to seal. In time, the vein will shrink and gradually disappear.
The solution normally used for this procedure is called sodium tetradecyl sulphate (STD) and is available in different concentrations depending on the size of the vein being treated.
What is foam sclerotherapy?
Normally STD is injected as a solution directly into the vein to be treated. Foam sclerotherapy involves making small volumes of the solution into foam by rapid mixing and agitation with a small volume of air. This can then be used to treat the VVs. The foam solution causes intense spasm of the vein and a greater volume can be injected without using too much of the chemical STD solution.
This is performed under ultrasound control.
Are my veins suitable for foam injection sclerotherapy?
Most patients with small or moderate sized varicose veins can be treated in this way. Studies have shown that foam sclerotherapy is particularly effective in treating recurrent or residual varicose veins after previous surgery or RFA/EVLA.
If you have any underlying blood clotting tendency it may not be advisable to have foam sclerotherapy.
Those patients with very extensive large varicose veins are usually better treated with surgery to obtain a more rapid result in one sitting. Other varicose veins may be better treated with RFA/EVLA.
Following assessment with Doppler and/or Duplex ultrasound, Mr Abu-Own will discuss with you the options for treatment for your individual case to help you come to your decision on what is the best treatment for you.
What are the benefits of foam sclerotherapy over other treatments?
- Treatment is provided as an outpatient procedure
General anaesthesia and the inherent risks associated with it are avoided
Only minor discomfort is experienced during the treatment
Each session of treatment lasts only about half an hour
Little or no time is needed off work (but vigorous exercise should be delayed for a week)
There is less bruising and less pain than following surgery
What are the disadvantages of foam sclerotherapy?
- Multiple sessions are usually required to treat your VVs
Lumpiness and bruising may result and could take several weeks to resolve
On rare occasions brown staining may not clear completely and can be permanent
The final outcome may take a number months to evolve following treatment, and this is longer than would be taken following surgery
What does the procedure involve?
Depending on the number of varicose veins you have, you may need 2 or 3 sessions of treatment, and occasionally more than this. The VVs to be treated will be marked on your leg initially using ultrasound scanning.
For the larger VVs, a local anaesthetic will then be injected into a small area of skin, usually in the lower thigh or mid calf and a needle (cannula) will be placed into the vein, again using ultrasound scanning.This will be flushed with a salt solution containing heparin, a blood thinning agent, just to keep the needle open.
Two or three smaller needles (called butterfly needles) will then be inserted into the visible VVs in the leg and these will be similarly flushed. Your leg will then be elevated above the couch and the foam solution will be injected in small volumes at a time into each of the needles. Whilst this is being done you will be asked to bend your ankle up and down in order to increase the blood flow in your deep veins.
You may experience some slight stinging as the foam is injected but it is usually painless. The passage of the foam in the vein will be monitored by ultrasound scanning.
Once enough foam has been injected, the needles will be removed and pieces of sponge, gauze or bubblewrap (compression pads) will be applied to your leg followed by a bandage in order to compress the treated veins. An elastic compression stocking will then be applied to your leg.
What happens after treatment?
You should keep the compression pads, bandage, and stocking on continuously for 3-5 days. After this you may remove the pads and bandage and then replace the stocking which should be worn for a further 7 days.
You will be asked to walk for 10 minutes prior to leaving the clinic.
During this 7 day period, you may remove the stocking to shower and you may remove it at night if you wish. If you find the stocking comfortable and wish to wear it for longer, this may be helpful. Please bring your stocking back with you to your next visit as it may be possible to reuse it if you have further injections.
You should do plenty of walking and may generally do most normal activities without any problem. If in doubt ask your doctor.
You can be active as usual after the treatment and do not need to avoid anything in particular. However you should not drive on the day the procedure is performed, just in case you experience any visual disturbances (see below).
Will I need further treatment?
It is unlikely that all your varicose veins will improve after one set of injections and you may need a few treatments. You will be seen again in a few weeks time and further injections can be performed at that stage. Some of the untreated veins may have shrunk at that stage.
What are the complications?
Serious complications after ultrasound-guided foam sclerotherapy are rare.
Superficial Thrombophlebitis: Most people will experience some hard lumps which form in the treated veins. These are areas of blood clotting in the treated veins. This is nothing to worry about but may be associated with inflammation and discomfort. If this occurs, anti-inflammatory pain killers may help. These lumps will eventually subside and disappear but this may take several weeks or months. This process may be hastened by your doctor inserting a needle into the lumps and aspirating the clots which liquefy again after a few weeks.
Brown pigmentation of the skin: This can occur following superficial thrombophlebitis described above and can be permanent. However it will usually fade over a period of several months and may disappear completely.
Deep Venous Thrombosis (DVT): If the solution passes into the deep veins there is a risk of thrombosis. This may be very minor with no symptoms or a major blood clot with a risk of a pulmonary embolus (passage of a blood clot to the lungs). It is for this reason that only small volumes of the foam are injected at a time and the ankle is exercised in order to maintain good flow in the deep veins. Surgery also carries a risk of deep vein thrombosis.
Recurrent and Residual varicose veins: If you have any remaining varicose veins, it is usually possible to inject these at your next visit. However if you have a lot of very small varicose veins it may not be possible to eradicate all of these. It is possible that the treated vein could reopen. At present the risk of this is not known and only long term follow up data will provide this information. If this does happen it would be possible to treat the vein again, either by further injection or by surgery.
Skin Ulceration: If the solution does not go into the vein but goes into the surrounding tissues it can cause a small ulcer of the skin. This will heal up but this may take several weeks and could leave a scar.
Allergic Reaction: Allergy to the solution used is rare but can occur. If you have any allergies you should inform your doctor.
Visual Disturbance: There are reports of temporary visual disturbance with foam injections. It is not certain why this occurs but it is more common in people who suffer from migraines.
Stroke: There have been a very small number of reported instances of a stroke occurring after foam sclerotherapy. However this is out of many hundreds of thousands of treatments that have been performed worldwide. There may have been particular reasons why strokes occurred in these cases, including a high volume of foam injected.
Are there any follow-up consultations?
Mr Abu-Own routinely sees his foam sclerotherapy patients for a follow-up consultation at least once after the procedure. For self-funding patients, this is included in your pre-agreed all-inclusive procedure price.