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How is ultrasound guided foam sclerotherapy different from regular sclerotherapy?

I am seeking non-surgical treatment for my varicose veins. How is the ultrasound used during ultrasound guided foam sclerotherapy? How is ultrasound guided foam sclerotherapy different from regular sclerotherapy? Are the recovery times the same?

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Doctors Answers (6)

Regular sclerotherapy uses a liquid sclerosant for medium and small sized veins. Foam sclerotherapy is more potent and can be used to treat larger branch varicose veins. The foam is a mixture of the same liquid sclerosant which is a medical grade detergent, but is then agitated with a gas (either air or carbon dioxide) to produce a temporary light soapy foam consistency. If the veins are easily visible then the injection may not require the assistance of ultrasound imaging. However, portions or all of the problem varicose vein(s) are often only seen by ultrasound. The foam is more potent because it stays in contact with the inner vein wall for a longer time. The ultrasound is used to find the vein and also to follow the needle to the vein. Once in the vein, a small amount of aspiration confirms venous blood and the injection is monitored by ultrasound which can easily show the flow of foam through the vein. Recovery times are similar or only slightly longer for foam of larger varicose veins compared to regular sclerotherapy of smaller veins. Normal activities can usually be resumed immediately following treatment.

The difference is in the solution. Foam has micro air bubbles in it, which produces a more robust inflammatory response, making it suitable for larger varicosities.

Ultrasound guidance allows one to visualize the veins under the surface of the skin in order to treat the underlying problem. Varicose veins often are like an iceberg with most of the problem beneath the surface. The ultrasound allows better decisions about where to place a needle for foam injection and to determine the rate and amount of foam injection. Additionally, the ultrasound probe can be swept across the skin to help squeeze blood out of varicose veins so foam can more readily fill them. Recovery time are about the same. If there are many very significant varicose veins, most patients need ultrasound guided foam sclerotherapy to treat the underlying abnormal veins before treating the veins on the surface.

Regular sclerotherapy is typically on the surface either by vision or using a transilluminating light. Ultrasound guided is for deeper veins such as perforator connecting veins and is not to inject the surface varicose veins. In my clinic I do not recommend injecting surface varicose veins if they are larger and bulging as it involves multiple visits (average three to five) plus additional visits to release the accumulated "trapped" blood. There is a higher incidence of pigmentation over these veins. As a surgeon I perform minimally invasive microphlebectomy where the veins are removed in sections through tiny punctures. No stitches needed. Walk in and walk out with a light dressing and back to normal activity in a day or so. With symptoms these may be covered by your insurance. Many insurers are now refusing to cover sclerotherapy of any kind, including Medicare.

Ultrasound guided foam sclerotherapy uses a shaving cream like foam instead of a liquid solution. The liquid solution is mixed with a gas, carbon dioxide or air, and agitated until it becomes the consistency of shaving cream. The foam is injected into the vein under ultrasound guidance. There is a proprietary foam called Varithena that is FDA-approved and will be available this fall. Foam has been around since the 1950's. It was never FDA-approved or standardized until recently. Foam, since it is thicker than liquid displaces the blood and irritates the vein lining more than liquid sclerosant at the same percentage solution. The foam can be maneuvered into branch veins and moved, whereas liquid solution washes away quickly. Foam can be used to treat large varices but often this causes the veins to become hard, lumpy and discolored. Laser and radio-frequency devices close large straight veins more effectively. Recovery depends on the size of the vein treated. The other issue is that foam sclerotherapy can have side effects of neurological sequelae. These have included migraines, mini strokes and strokes. Varithena did not have any significant neurological sequelae in their trials, but it was formerly under FDA review as Varisolve, where they used a stronger percentage of polidocanol and this was not FDA-approved due to neurological events.

Ultrasound foam is a superior treatment choice in my opinion. It is much more potent than spider vein sclerotherapy. Most people return to work the same day.

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