What is sclerotherapy?
Sclerotherapy or injection of varicose veins is a procedure designed to improve the appearance of your varicose veins. 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.
Then over time your own body will destroy the vein and it will go away. The solution normally used for this procedure is called sodium tetradecyl sulfate (STD) and it comes in different concentrations depending on the size of the vein being treated.
What is foam sclerotherapy?
Usually STD is injected directly into the vein, which is treated as a solution. In foam sclerotherapy, small volumes of the solution are made into foam by rapidly mixing and stirring with a small volume of air. This can then be used to treat some of the larger underlying abnormal veins that would not normally be treated with conventional sclerotherapy.
This is done under ultrasound control. The foam solution causes a severe spasm of the vein and a larger volume can be injected without using too much STD solution.
Is foam better than traditional sclerotherapy?
The first results with foam sclerotherapy are very promising and this method of treatment offers a possible alternative to surgery. However, it should be emphasized that this is a new treatment and the long-term results are not yet known and it is not possible to say how this treatment compares to conventional surgery or sclerotherapy.
Are my veins suitable for foam injection sclerotherapy?
Varicose veins with isolated leg veins or with the long saphenous vein or short saphenous vein (most varicose veins) are suitable for this form of treatment.
If you have very extensive and very large varicose veins, surgery may be better than sclerotherapy. If you have an underlying blood clotting tendency, sclerotherapy may not be advisable.
What does the procedure entail?
Depending on the number of varicose veins you have, you may need two or three treatment sessions, and occasionally more. The main vein surface to be treated is first marked on your leg with ultrasound. The local anesthetic is then injected into a small area of skin, usually the lower thigh or mid-calf, and a needle is reinserted into the vein using ultrasound.
This is flushed with a saline solution that contains heparin, a blood thinner, just to keep the needle open. Two or three smaller needles (called butterfly needles) are then inserted into the visible varicose veins in the leg and these are flushed in a similar manner. Your leg will then be raised above the couch and the foam solution injected into each of the needles in small amounts. In the meantime, you will be asked to bend your ankle up and down to increase blood flow to your deep veins.
You may experience minor stinging while injecting the foam, but this is usually painless. The passage of the foam into the vein is monitored by ultrasound and the foam injections into each needle are repeated two or three times.
Once enough foam has been injected, the needles are removed and a sponge, gauze, or bubble wrap (compression pad) is placed on your leg, followed by a bandage to compress the treated veins. An elastic compression stocking is then placed on your leg, including the thigh with a waist attachment. This will feel tight, but it shouldn’t be so tight that your foot becomes discolored or painful.
What happens after the treatment?
You should wear the compression pads, bandage and stocking continuously for 5 days. After that, you can remove the pads and bandage and then replace the stocking, which should be worn for another 7 days. During these 7 days you can remove the stocking for showering and at night if you wish. If you find the stocking comfortable and want to wear it longer, this can help. Please bring your stocking with you on your next visit as it may be re-used for further injections.
You should be able to run a lot and generally be able to easily perform most normal activities. If in doubt, ask your doctor.
You can be active as usual after the treatment and don’t have to avoid anything special. However, you should not drive on the day the procedure is performed just in case you notice any visual disturbances (see below).
Do I need further treatment?
All of your varicose veins are unlikely to improve after a series of injections, and you may need multiple treatments. You will be seen again in a few weeks, and additional injections may be given at this stage. Some of the untreated veins may have shrunk by this point.
What are the complications?
Most people will experience some hard lumps that form in the treated veins. These are areas of blood clotting in the treated veins. This is nothing to worry about, but it can cause inflammation and discomfort. In this case, anti-inflammatory pain relievers can help. These lumps will eventually subside and go away, but this could take several weeks or months. This process can be speeded up by having your doctor insert a needle into the lump and suction out the clots, which will liquefy again after a few weeks.
Brown pigmentation of the skin
This can occur after a superficial thrombophlebitis described above and can be permanent. However, it usually fades over a period of several months and can go away completely.
Deep vein thrombosis (DVT)
If the solution gets into the deep veins, there is a risk of thrombosis. This can be very minor with no symptoms or with a larger blood clot with a risk of pulmonary embolism (passage of a blood clot into the lungs). Because of this, small amounts of the foam are injected at a time and the ankles are trained to maintain good flow in the deep veins. Surgery also carries the risk of deep vein thrombosis.
Recurring and remaining varicose veins
If you still have varicose veins, you can usually inject them on your next visit. However, if you have a lot of very small varicose veins, you may not be able to remove all of them. It is possible that the treated vein will open again. The risk of this is currently unknown and only long-term follow-up data provide this information. In this case, the vein could be treated again with either another injection or surgery.
If the solution does not get into the vein but into the surrounding tissue, it can cause a small ulcer on the skin. This will heal, but this can take several weeks and leave a scar.
An allergy to the solution used is rare, but can occur. If you have any allergies, you should tell your doctor.
Transient visual disturbances have been reported with foam injections. It’s not sure why this occurs, but it’s more common in people with migraines.
Very low numbers of strokes have been reported after foam sclerotherapy. However, this goes back to many hundreds of thousands of treatments performed around the world. There may have been specific reasons why these cases developed strokes, including a high volume of foam injected.
If you have any further questions, please contact your advisor or one of their teams, or the nurses who look after you on the ward.