Ultrasound-guided foam sclerotherapy is considered the benchmark treatment for varicose veins when EVLA is not necessary, according to National Institute of Health and Care Excellence (NICE) recommendations.
Image Credit: Veincentre
It should be noted, however, that most patients with varicose veins do require EVLA.
What is foam sclerotherapy?
Used to treat both the symptoms and the causes of varicose veins and thread veins, foam sclerotherapy is most frequently used as a secondary treatment following EVLA, in particular, to treat the residual and smaller varicose veins. From time to time, it is the necessary primary treatment needed for the treatment of the underlying vein condition.
Foam sclerotherapy is the process of injecting a drug that has been diluted with air into a foam mixture directly into the varicose veins. The foam displaces the blood in the veins, and the drug destroys the cells in the lining of the veins. The veins wither up, and the body naturally begins to break down and absorb the dead tissue.
Typically performed on an outpatient basis, the procedure generally takes around 30-45 minutes, depending on the number of veins that need treating.
Patients tend not to feel pain with the procedure. There is little to no recovery time immediately after the procedure – meaning that you can usually resume normal activities straight away.
A detailed description of sclerotherapy treatment
Pre-procedure
When a patient begins the process, a consultant and assisting nurse will provide a warm welcome into the treatment room, and an ultrasound scan will be used to identify which veins need treating.
After the initial consultation, a comprehensive explanation of the treatment options – including potential complications and success rates – will then be explained to the patient.
Patients are encouraged to ask any further questions at the start of the foam sclerotherapy treatment appointment before signing any documents to give consent to the proposed treatment.
To ensure a calming environment, music of the patient’s choice can be played during the treatment with a nurse on hand throughout the appointment.
The procedure
Once the veins that need treating have been identified, a small needle (butterfly) is inserted into the vein(s), injecting the foam solution. As previously mentioned, the blood in the vein is displaced, and the drug attacks the lining of the vein wall, causing the vein to shrivel up.
Good contact is ensured as the foam coalesces with the cells in the lining of the vein, generating extremely effective results. The veins are then broken down, shrunken and gradually absorbed by the body. As with EVLA, once the procedure is complete, the blood is rerouted naturally to healthy veins, enhancing circulation.
The procedure may be performed with the assistance of ultrasound guidance, but this depends on the size of the veins being treated. Ultrasound guidance is employed when treating larger varicose veins, but it is not often necessary when treating smaller veins near to the surface, as visual guidance will suffice.
While relatively pain-free, the tiny injections involved in the foam sclerotherapy procedure could cause some discomfort or mild pain symptoms for some patients: the sclerosant may sting slightly.
The procedure usually takes around 30-45 minutes.
Post-procedure
Once complete, a nurse is on hand to assist with the fitting of a compression stocking (two if both have been legs treated). This will be worn for seven days following treatment. The nurse will explain how to wear and bathe with the socks and provide aftercare advice, including any post-treatment symptoms to be aware of.
Patients are advised to take at least a 10-minute walk prior to returning home.
Foam sclerotherapy aftercare
After foam sclerotherapy treatment is complete, patients must wear the class II compression stocking at all times for seven days. While this should not impact general movement, patients are discouraged from going swimming in the stocking.
It is possible to drive on the same day as foam sclerotherapy treatment.
Patients are advised to take a 20-minute daily walk and urged to resume their normal activities.
However, as with any procedure, patients should pay attention to how their body feels and not push it too far. In the weeks following treatment, the body is healing and doing a lot of work absorbing the treated veins. The consultant will advise of anything a patient should specifically avoid during post-treatment.
The sclerosant may also cause some bruising of the skin, the degree of which depends on the number of veins in the area and the size of the area treated.
Foam sclerotherapy follow-up
After the primary sclerotherapy session, patients may be called for a post-treatment consultation. Generally, the need to return is self-assessed, based on how a patient’s leg looks and feels while recovering.
If a patient is satisfied and happy with the results, there is no need to pay for any follow-up appointment for a consultant to agree with a patient and simply say, “Your legs look great, no further treatment needed.”
However, if a patient wishes to receive further guidance or reassurance, or indeed if the patient feels as though they would benefit from further treatment, then a reassessment follow-up can be scheduled for additional treatment. A recovery time of 4 weeks between appointments is advised to ensure the greatest benefit from each treatment session.
Patients should feel no pressure to attend a further treatment session immediately. Furthermore, patients can also allow up to two years before booking another session without needing to attend a new primary consultation and scan before treatment.
Foam sclerotherapy or EVLA?
Suppose any underlying valve problems are found during the consultation. In that case, the patient's treatment pathway will usually follow the EVLA stages outlined within the Varicose Vein Treatment Pathway, rather than simple foam sclerotherapy.
Although some doctors will treat large veins using foam sclerotherapy, the results tend not to be as effective or durable as EVLA. Treatment should have long-lasting results and get to the root of the problem, as such foam sclerotherapy is not recommended as a primary treatment for the majority of patients.
Foam sclerotherapy is used for any residual varicosities at follow-up after EVLA. Some patients that see the recurrence of varicose veins post-EVLA may benefit from simple foam sclerotherapy treatment.
Treatment risks
As with all medical treatments, it is of utmost importance to consider all the benefits and risks involved. With that in mind, Veincentre offers a comprehensive outline of the known vein treatment risks.
About Veincentre
Veincentre are the UK’s leading varicose veins specialists using Gold Standard, minimally invasive techniques, with 15 clinics nationwide.
At Veincentre, we provide the most effective, proven treatment and the highest quality of care that is accessible to everyone. We treat the cause, not just the symptoms! All our treatments are minimally invasive – walk-in, walk-out, require no general anaesthetic, no surgery and no time off work.
The most important aspect of care for any condition is the ability and attitude of the team of doctors and nurses looking after you. We have headhunted some of the most experienced and respected vein specialists in the UK. By choosing Veincentre, you can be assured that discomfort will be minimized, outcomes will be optimized, and you will be looked after by a team who really care for you
From your initial point of contact you will be communicating with our patient advisers, who only deal with patients who suffer from varicose veins so are all highly experienced and can confidently answer all of your queries or provide any advice.
Start your journey to healthy veins and happy legs…
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