Ultrasound guided foam sclerotherapy
Produced by:
Mr Paul Hayes MD FRCS
Mr Kevin Varty MD FRCS
Department of Vascular Surgery
Brief description:
- This information sheet is for patients who are to undergo injection treatment of their varicose veins.
- Here, we explain some of the aims, benefits, risks and alternatives to this procedure (operation/treatment). We want you to be informed about your choices to help you to be fully involved in making any decisions.
- Please ask about anything you do not fully understand or wish to have explained in more detail.
About foam sclerotherapy for varicose veins
Why are your veins being treated?
Sclerotherapy or injection of varicose veins is a procedure designed to prevent your varicose veins causing further damage to your skin, and hopefully avoiding ulceration. It may also improve the discomfort associated with varicose veins. If you have an ulcer this treatment may speed up the healing process and will reduce the risk of the ulcer returning by 50%. The veins are injected with a solution called a sclerosant which damages the internal lining of the vein and causes blood clotting within the vein. In time your own body will then destroy the vein and it will 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 some of the larger underlying abnormal veins which would not normally be treated with conventional sclerotherapy. This is performed under ultrasound control. The foam solution causes intense spasm of the vein so that a smaller amount of STD will treat a longer length of vein.
Is foam better than conventional surgery?
The initial results with foam sclerotherapy are very promising and this method of treatment offers an alternative to surgery. However it should be emphasised that this is a new treatment and at present the long term results are not yet known and it is not possible to say how this treatment compares in terms of results with conventional surgery.
Are my veins suitable for foam injection sclerotherapy?
Varicose veins involving isolated veins in the leg or involving the long saphenous vein or short saphenous vein are suitable for this form of treatment i.e. most varicose veins. If you have very extensive and very large varicose veins then you may do better with surgery rather than sclerotherapy. Your surgeon will advise you on this. If you have any underlying blood clotting tendency it may not be advisable to have sclerotherapy.
Where will my treatment take place?
On the day of your treatment you will attend the hospital. The date and time will be confirmed with you. You can eat and drink as normal before the procedure. The whole process will take around 2 hours but occasionally will be longer than this.
What does the procedure involve?
Depending on the number of varicose veins you have you may need 1 or 2 sessions of treatment, and very occasionally more than this. The main surface vein to be treated will be marked on your leg initially using ultrasound scanning. A needle 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 3 smaller needles (called butterfly needles) will then be inserted into the visible varicose veins 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.. 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 and the foam injections into each needle will be repeated 2 or 3 times.
Once enough foam has been injected the needles will be removed, pieces of sponge will be applied to your leg followed by a bandage in order to compress the treated veins. This will feel tight but should not be so tight as to make your foot discoloured or painful.
What happens after treatment?
If you normally drive, you may find it difficult to drive home with your bandages on and so should arrange for someone to accompany you.
You should keep the sponge andbandage on continuously for 5 days. After this you may remove the sponges and bandage and then replace the stocking which should be worn for a further 14 days. During this 14 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.
You should do plenty of walking and may generally do most normal activities without any problem. If in doubt ask your doctor. We will send him an information sheet about the treatment you have undergone.
Will I need further treatment?
It is unlikely that all your varicose veins will disappear. Any very small, or thread veins, will not be treated by this process and occasionally these may actually worsen. After six to eight weeks we will re-scan your leg and if there is still significant leakage down the vein in your leg then you may need a second round of treatment.
Will there be any follow up?
You will be seen in the out-patients approximately 6 to 8 weeks after your treatment.
What are the potential complications?
1. 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, such as ibuprofen, may help. These lumps will eventually subside and disappear but this may take several weeks or months.
2. Brown pigmentation of the skin
This can occur following superficial thrombophlebitis described above and can be quite extensive. Approximately one in three people will develop it to a greater or lesser extent. In about one case in five this can be permanent. However it will usually fade for a period of several months and may disappear completely.
3. Deep venous thrombosis
If the solution passes into the deep veins there is a risk of thrombosis of the deep veins. A thrombosis such as this happens once on every 250 procedures. 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.
3. Recurrent and residual varicose veins
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.
4. 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 usually heal up but this may take several weeks and will leave a scar.
5. Allergic reaction
Allergy to the solution used is rare but can occur. If you have any allergies you should inform your doctor.
6. Visual disturbance and chest pain
There are reports of temporary visual disturbance and chest pain with foam injections. This is thought to be due to the air bubbles rather than the solution injected and occurs once in every 250 patients treated.
6. Stroke
There have been 2 reported instances of a stroke occurring after foam sclerotherapy. However, this is out of over 12,000 patients that have been done and there may have been particular reasons why this occurred in these cases, including a high volume of foam injected.
