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Why are foam injections used if they do not treat varicose veins as effectively?

I saw that a new study found that laser ablation is the most effective treatment for varicose veins, and that foam injections do not have as good of results. Why are foam injections used at all if they do not treat varicose veins effectively?

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Doctors Answers (6)

That is an excellent question. The primary cause of varicose veins in the legs is due to refluxing saphenous vein(s) and perforating veins, which allow high pressure and reverse flow of venous blood to both enlarge and damage the veins. The most effective treatment to close these higher pressure venous trunks is by using laser or radio frequency ablation. Once the main trunk (or source) of the problem is closed, then the smaller side branches can be more effectively closed with foam sclerotherapy. Foam is NOT a good choice for trying to close the proximal saphenous vein(s) compared with laser ablation. However, foam is excellent for use on smaller branch varicose veins with lower venous flow and pressure, or where a laser fiber can not be placed due to a twisted, tortuous, or scarred vein (which is uncommon). So the best choice of technique is dependent on several factors including the size, shape, severity or reflux, and location of the vein. Sclerotherapy and foam definitely have a place in vein treatment, but are typically for the smaller-sized veins.

In the United States, foam ablation of the saphenous veins is considered "experimental" and not FDA-approved. There are companies working on delivery systems to provide a safer and effective treatment. Foam is used in other countries where lasers and money are not available for saphenous ablations. In the United States, Medicare doe not cover medically necessary sclerotherapy of any kind. Treatments of this kind should only be performed by experienced surgeons under ultrasound guidance.

I know the study you are referring to - it is called: A Randomized Trial Comparing Treatments for Varicose Veins, by Dr Julie Brittenden, in this September NEJM. The study was comparing treatment of saphenous and varicose veins. It included results for foam sclerotherapy of the saphenous vein which we do not do in the United States, to laser ablation of the saphenous vein which we do perform in the United States, and it followed patients just six months. These make the findings of the study a bit difficult to apply to the way we treat veins and perform foam sclerotherapy treatments in the United States. What we can say is that in general all of the treatments - surgery, laser ablation and foam sclerotherapy, worked pretty well.

They are perceived as cheaper, and do not require local anesthetic. However, the failure rate is too high. Note: Catheter-based ablation is the most effective, and that includes both laser and radio frequency ablation. RFA has a slightly higher long-term success rate.

There are lots of studies out there! Some are good some not so good. Some are self-serving. I personally agree with Dr. John Bergen that "Foam is the future." There is a place for all modalities of endovenous ablation. Foam is better for some and laser maybe for others, and also radiofrequency is a valuable tool. I would encourage you to read on and decide what is best for you. I personally am a huge fan of foam.

I like to use foam as an add-on. I probably would not foam an entire GSV or LSV, but if someone had had laser and still had venous insufficiency below the incision, or there was a tortuous segment in the middle of the vein, I would use foam for this section. Below the knee the nerves and veins run very close together and sometimes injecting with foam is a good option to decrease the risk of nerve injuries.

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