Foam sclerotherapy
Some varicose veins can be injected with a liquid to cause them to block up and so stop leaking. This is called sclerotherapy. It is used for treating small to medium size varicose veins. It involves the injection of a solution into diseased veins with the intent to create scar tissue inside the vein that will seal it closed. The veins then shrink and gradually disappear. The solution used is extremely safe and relatively painless. No anaesthetic or sedation is required as the needle that is used is smaller than those used for taking blood. For larger or deeper varicosities ultrasound is often used to "guide" the injections into the underlying diseased veins below the surface of the skin. This allows the medication to be administered to precise locations safely and accurately.
Here we can see the needle being guided into the vein using an ultrasound device. The image is magnified and the needle appears much bigger than it really is!
In this setting the liquid used is actually turned in to foam. This is made by mixing gas bubbles with the liquid, giving a consistency like shaving cream or mousse. One part of liquid solution will make 3-5 parts of “bubbly” foam. When injected inside a vein, the micro foam displaces the blood (rather than mixing with it) creating better contact with the vein wall. Improved contact between the medication and vein wall gives better and faster results. The expanded volume of the mixture also allows for less medication to be used at a weaker strength.
Here the liquid is being turned into a foam by passing it repeatly between 2 syringes prior to using it to treat the veins.
Sclerotherapy (vein injections) may be used alone as a treatment or it may be done during post operative visits to eliminate any diseased veins that were too small to remove during your operation. Thus, surgery and sclerotherapy are often complementary, enabling the specialist to treat as many of your veins as possible.
Pros and Cons of Sclerotherapy
Pros: One of the main advantages this technique has is that it requires no anaesthetic and can therefore be useful in older patients. It can be undertaken as an out-patient and patients walk out of hospital 10-15 minutes after the procedure is completed. The procedure causes minimal discomfort whilst it is undertaken and is well tolerated afterwards. These benefits mean that people can return to work or their normal activities within a day or two.
Cons: The main point to note about sclerotherapy is that it is not as durable as some other treatments. In the long term, over 10 years, the risks of the veins coming back are around 50%. This compares to a figure of around 10% with other treatments such as surgery. About 15% of patients treated with sclerotherapy require a second treatment to completely block the vein. Some people do not worry about having to have a further treatment at a later date as it is a fairly minor procedure.
If you are very concerned about the cosmetic outcome of your treatment please be aware that about 1 in 5 patients develop some brown skin marking along the line of the vein. With time this often fades but in some individuals it can be permanent.
Find out more about Ultrasound guided foam sclerotherapy.
