Varithena Procedure
in Los Angeles

Minimally Invasive
Varicose Vein Treatment

Ultrasound-guided Varithena procedure performed by vein specialist in Los Angeles, California

Varithena procedure is a foam sclerotherapy solution that is used for varicose vein treatment. It’s unique in that it is a non-thermal, non-tumescent alternative to thermal vein ablation, and therefore has distinct advantages over other common vein procedures:

  • 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

Our vein specialists answer common questions about the Varithena procedure and explain the role of this unique therapy in our vein treatment armamentarium. Get in touch with us at ProVascularMD to learn more about your veins and your options.

Vein Specialist Dr. Michael Lalezarian in Los Angeles, California

Vein Specialist

Dr. Michael Lalezarian

Vein problems? We can help you get your legs back.

Dr. Michael Lalezarian is a double-board certified Vascular Interventional Radiologist specializing in minimally invasive vein treatments. He is a committed partner in the battle against the devastating consequences of venous insufficiency.

5-Star Varithena treatment in Los Angeles

“I was referred to Dr. Lalezarian from my orthopedic surgeon for varicose vein treatment options. From the second I walked into the office, I was at ease and felt very welcomed from Kimberly and the staff. Upon meeting the doctor, he was so kind and fully explained my options after the initial ultrasound on both legs. I decided to go with the sclerotherapy and am so happy that I did. The procedures were quick and virtually painless but the results are life changing for me. The pain suffered for so many years and countless sleepless nights are a thing of the past.”

Vickie W, March 2022

What is Varithena?

Varithena is the trademarked name for an injectable polidocanol foam solution that is used to treat varicose veins. This is typically done by a vein specialist using ultrasound guidance, which is why the Varithena procedure is more generally referred to as ultrasound guided foam sclerotherapy (UGFS). The sclerotherapy, in this case, refers to the polidocanol.

Foam sclerosant was approved for use by the FDA in 2013, and since its approval, sclerotherapy with foam has been commonly used to treat venous reflux in the great saphenous vein (GSV) and accessory vessels. Foam sclerotherapy with ultrasound guidance 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.

Vein Treatment in Los Angeles
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Explanatory Varithena procedure drawing

How Does Varithena Work?

Unlike thermal ablation treatments for varicose veins, the Varithena procedure is a nonthermal, non-tumescent therapy. The therapy 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 displaces blood while the sclerosant irritates the vein walls, resulting in dehydration, inflammation, and eventual 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, Varithena 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.

What Happens During the Varithena Procedure?

The Varithena procedure is a Varithena injection and 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, gas 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 Varithena procedure takes around 30 to 60 minutes to complete.

After the 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.

Is Varithena Effective?

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, Varithena 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 Varithena treatment. 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 Varithena 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 Varithena 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.

Vein Treatment in Los Angeles
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Varithena foam treating multiple branching veins simultaneously

Varithena foam treating multiple branching veins simultaneously.

What are the Advantages of Varithena vs Other Vein Treatments?

Because Varithena is non-thermal and non-tumescent, it eliminates the risk of nerve or skin injury posed by thermal ablation techniques. Even without local anesthesia, patients tend to report minimal pain throughout the Varithena procedure. In addition, sclerotherapy is the only method of vein closure that does not require a catheter to be placed along the length of the vein. Therefore, its greatest advantage is in treating large, deep veins that are highly branched and twisted. This versatility has led many vein specialists, ourselves included, to exclusively offer Varithena for varicose veins.

What Are Varithena Side Effects?

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

  • Mild pain and inflammation at the injection site
  • Skin hyperpigmentation
  • Rash
  • Ulceration (rare)
  • Deep vein thrombosis (rare)
  • An adverse reaction to the sclerosant (rare)
  • Is Varithena Right For Me?

    Varithena treatment is just as effective as other leading vein treatments, and has clear advantages over other alternatives. A vein specialist at ProVascularMD can help you evaluate your options and decide if Varithena is right for you. Contact us to schedule your visit today!

    Vein Treatment in Los Angeles
    See a Vein Specialist
    More Resources
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    Stages of Venous Insufficiency

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    Los Angeles Vascular Specialist Dr. Michael Lalezarian

    Vascular Specialist in Los Angeles

    Learn more about Los Angeles Vascular Specialist Dr. Michael Lalezarian.

    References

    [1] Scovell, S. Liquid, foam, and glue sclerotherapy techniques for the treatment of lower extremity veins. UpToDate. Accessed April 2020.
    [2] Morrison, N., Gibson, K., Vasquez, M., Weiss, R., Cher, D., Madsen, M., & Jones, A. (2017). VeClose trial 12-month outcomes of cyanoacrylate closure versus radiofrequency ablation for incompetent great saphenous veins. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 5(3), 321–330.
    [3] Biemans AA, Kockaert M, Akkersdijk GP, van den Bos RR, de Maeseneer MG, Cuypers P, Stijnen T, Neumann MH, Nijsten T. Comparing endovenous laser ablation, foam sclerotherapy, and conventional surgery for great saphenous varicose veins. J Vasc Surg. 2013 Sep;58(3):727-734.e1. Epub 2013 Jun 13.
    [4] Coleridge Smith, P. (2009). Sclerotherapy and foam sclerotherapy for varicose veins. Phlebology, 24(6), 260–269.
    [5] Chen CH, Chiu CS, Yang CH. Ultrasound-guided foam sclerotherapy for treating incompetent great saphenous veins–results of 5 years of analysis and morphologic evolvement study. Dermatologic Surg., June;38(6):851. Epub 2012 Apr 27.
    [6] Chapman-Smith, P., & Browne, A. (2009). Prospective five-year study of ultrasound-guided foam sclerotherapy in the treatment of great saphenous vein reflux. Phlebology, 24(4), 183–188.

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