Patient Advice on Foam Sclerotherapy

Ultrasound Guided Foam Sclerotherapy

Varicose veins are swollen, twisted unsightly veins with faulty non-return valves. Impaired blood flow in these veins causes aching, itching, heaviness and also skin damage such as eczema and even ulceration. Varicose veins do not heal spontaneously and invariably deteriorate over time.

Ultrasound guided foam sclerotherapy offers a new alternative to surgery in treating varicose veins. The procedure is carried out in less than one hour under local anaesthetic in the out-patient department.

This information has been compiled by a team of venous specialists for BUPA hospitals. Please contact your local BUPA hospital to enquire if this service is available locally.

Advisory panel:

JJ De Gorter BUPA Medical Director
Donald Adam Birmingham
Gareth Bate Birmingham
Andrew Bradbury Birmingham
Philip Coleridge-Smith London
Nick Hickey Worcester
Tim Lees Newcastle
Simon Payne Portsmouth
Sue Topp London
Steve Tristram Basingstoke

Advantages of foam sclerotherapy

  • Avoids the need for hospital admission, surgery and general anaesthesia.
  • Results in minor discomfort during treatment and only minimal bruising compared with surgery.
  • All treatment is performed as an outpatient and little or no time is required off work.
  • Much less expensive than varicose vein surgery.

Disadvantages of foam sclerotherapy

  • Usually only one leg is treated per appointment (with surgery both legs may be treated simultaneously).
  • More clinic attendance’s required than for surgical treatment (usually 3-4 appointments if both legs are treated).
  • A few months is required for final outcome to be obtained with resolution of all bruising and uncomfortable lumpiness.)
  • Brown skin staining can take a long time to fade, occasionally still being present after a year (surgery can also cause this, although less often than sclerotherapy)
  • Thread veins may develop in the region of treatment in susceptible people. These may be treated by microsclerotherapy, if necessary. (these may also appear following surgical treatment for varicose veins)
  • Your colour duplex ultrasound scan will also help guide your Surgeon in the choice of treatment – some veins are more suited to this treatment then others.

Preparing for treatment

Please bathe as normal prior to treatment but avoid any lotions / perfumes. Wear loose clothing and soft shoes (your leg will be bandaged). You may want a friend to drive you home. You will have the opportunity to ask further questions at the hospital before giving your written consent to treatment.

How is this treatment given?

Foam sclerotherapy is performed lying on a couch in the outpatient consulting room with the help of an injection of local anaesthetic. The aim is to inject and destroy the main surface vein, which is causing the varicose veins. The long saphenous vein is injected just above the knee in the thigh and the short saphenous on the back of the calf. A needle is placed within the vein with the help of ultrasound imaging. The leg being treated is elevated to empty all the surface veins. The foam is prepared and injected into the vein. The foam rapidly spreads along the vein and is guided by ultrasound. Injection of foam continues as the foam spreads into the varicose veins. Several injections of foam may be needed. Additional injections can be given during follow-up visits to treat any veins that the foam has not reached initially.

What does the injection feel like?

Often very little sensation or sometimes minor discomfort.

Recovery

Following foam injections we apply a firm bandage and compression stocking to the leg. The bandage can be removed after 7 – 10 days. A strong elastic stocking should be worn continuously until your next appointment (usually about a fortnight).

After treatment carry on with your usual activities. Avoid vigorous exercise, gentle walking is best. When resting, raise your leg above hip height (avoid standing still or sitting with legs down if possible). A modest ache in the leg should respond to simple pain-killers. You may drive, provided you are confident of performing an emergency stop.

Side effects and complications

A very few people experience chest tightness, a cough or visual disturbance (like a migraine) during treatment. These effects are transient, lasting less than 30 minutes or so.

Very rare allergy to the foam has been reported.

Bruising and lumpiness is usual after treatment, Arnica and anti-inflammatory drugs (like diclofenac, ibuprofen etc) can help (either tablets or topical gel). Occasionally trapped blood is tender and may need removal by needle suction. The lumpiness sometimes takes months to gradually settle down.

Brown skin staining is often seen where the veins have been treated – this usually fades in a few months but can sometimes still be seen after a year.

Deep vein thrombosis occurs very rarely but can be serious. Compression stockings help prevent DVT but if your leg becomes painful or swollen please contact the doctor who treated you immediately.

Thread veins (spider veins) sometimes develop after treatment (especially if you already have some). They may also occur after surgery and are treatable.

An ulcer may occur at the site of injection – this is rare. It will heal but may leave some brown staining.

You may develop further varicose veins in the future – this also applies to surgery. If you develop more varicose veins – please return for further assessment.

Side effects and complications of foam sclerotherapy

A very few people experience chest tightness, a cough or visual disturbance (like a migraine) during treatment. These effects are transient, lasting less than 30 minutes or so.

Very rare allergy to the foam has been reported.

Bruising and lumpiness is usual following treatment, Arnica and anti-inflammatory drugs (like diclofenac, ibuprofen etc) can help (either tablets or topical gel). Occasionally trapped blood is very tender and may need removal by needle suction. The lumpiness can sometimes take months to gradually settle down.

Brown skin staining is often seen where the veins have been treated which can sometimes still be seen after a year.

Deep vein thrombosis occurs very rarely but can be serious. Compression stockings help prevent DVT but if your leg becomes painful or swollen please contact the doctor who treated you immediately.

Thread veins (spider veins) sometimes develop after treatment (especially if you already have some). They may also occur after surgery and are treatable.

An ulcer may occur at the site of injection – this is rare. It will heal but may leave some brown staining.

You may develop further varicose veins in the future – this also applies to surgery. If you develop more varicose veins – please return for further assessment.


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