Foam Sclerotherapy for Varicose Veins

Foam sclerotherapy is an injectable solution consisting of polidocanol foam. Foam sclerotherapy can be used to treat varicose veins, spider veins, and reticular veins, but the focus of this page is on varicose veins. Treatment with foam sclerotherapy is typically done by a vein specialist using ultrasound guidance, which is why foam sclerotherapy is often referred to as ultrasound guided foam sclerotherapy, or UGFS for short.

Foam sclerosant was approved for use by the FDA in 2013, and since its approval, sclerotherapy with foam has been commonly used to treat vein disease. UGFS can be used to treat both the cosmetic appearance of varicose veins as well as the persistent symptoms of vein disease, including swelling, pain, aching, throbbing, heaviness, and itching.

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Other varicose vein treatments work by applying intense heat to the inside of the vein (ablation) or by gluing the vein shut. Foam sclerotherapy, however, is a nonthermal, non-adhesive therapy. Foam sclerotherapy works by exposing the inside of the vein to a foam-based chemical agent called a sclerosant. Because the foam has tiny air bubbles in it, ultrasound imaging can be used to accurately guide its placement. The foam pushes blood out of the vein while the sclerosant irritates the vein walls, resulting in dehydration, inflammation, and closure of the treated vein. The unwanted vein fades in appearance, and blood is rerouted through nearby healthy veins.

Because of its foam-based delivery mechanism, foam sclerotherapy can be used to treat nearly every case of varicose veins, and it has the unique advantage of being able to treat varicose veins that are exceptionally large, lie deep below the surface of the skin, and are highly branched or twisted [1, 2]. Other varicose vein treatments, including thermal ablation and vein glue are not as effective in these scenarios.

The sclerotherapy procedure only requires a single puncture in the leg, and does not require any cutting or any anesthesia. To start, Polidocanol Endovenous Microfoam (PEM) is injected into the desired vein with a 27 or 30 gauge needle. Sometimes, air is also injected into the foam mixture. The extremity where the vein is located might be elevated to aid the distribution of the foam mixture. Ultrasound is used to visualize the location of the foam. In large veins like the great saphenous vein, foam is repeatedly injected until a syringe aspirates no more blood to ensure complete coverage. In total, the foam sclerotherapy procedure takes around 30 to 60 minutes to complete.

After your foam sclerotherapy procedure, you may be asked to wear compression stockings and to limit intense physical activity to help ensure complete closure of the treated veins. Otherwise, you can return to normal daily activities including work immediately after the procedure. Most patients see visible improvement of vein clearance after 1 treatment session, although multiple sessions may be required for complete vein clearance.

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The efficacy of vein treatment is often discussed in two different ways: (1) does the treatment relieve vein symptoms, and (2) does the treatment last? In regards to symptom relief, foam sclerotherapy is just as effective as other vein treatment methods, including thermal ablation, VenaSeal vein glue, and vein stripping surgery.

There have been at least a handful of studies on the durability of foam sclerotherapy. In one study comparing vein closure rates with laser ablation, conventional surgery, and foam sclerotherapy, vein closure rates at one year post treatment were 88.5% for endovenous laser ablation, 88.2% for conventional surgery, and 72.2% for foam sclerotherapy [3]. This study suggested that foam sclerotherapy wouldn’t be as durable as other treatments. However, in another study, 90% of great saphenous veins remained close after two sessions of foam sclerotherapy over an average 3.25 years of follow-up [5], suggesting that foam sclerotherapy is just as good if not better than alternatives. It’s also interesting to note that varicose vein recurrence does not always cause symptoms. One study found that 70% of patients did not experience clinical vein symptoms again even after a treated vein reopened [4].

Looking at all of the evidence, we think it’s fair to say that treatment efficacy is approximately equal between the different types of vein treatment, both in terms of symptom relief and durability.

Most foam sclerotherapy side effects are temporary and resolve within a few months after the procedure. Following foam sclerotherapy, patients may experience these side effects:

Mild pain and inflammation at the injection site

Skin hyperpigmentation

Rash

Ulceration (rare)

Deep vein thrombosis (rare)

An adverse reaction to the sclerosant (rare)

Foam sclerotherapy has distinct advantages over other common varicose vein treatments, including:

Immediate symptom relief

Quick procedure

Effective in complex veins

Single needle puncture

No cutting, no tumescence, no local anesthesia

No risk of burning or tissue damage

Minimal pain during the procedure

Get in touch with us at ProVascularMD to learn more about varicose veins, foam sclerotherapy, and your options.

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