History.
The use of injections to eliminate abnormal veins dates back more than 100 years. In 1942 Orbach described
a method of creating a foam or froth with the solution he injected. He claimed that this increased the efficacy of injection treatment.
This technique was used by a small number of surgeons but never caught on.
In 1992 Juan Cabrera, a surgeon from Granada, Spain, found
that he could greatly enhance the effect of injection treatment by making a foam of very small bubbles, which he called 'microfoam'.
He used ultrasound imaging to guide his injections into the main surface veins and found that surgery was unnecessary.
Over the last
6 or 7 years the use of foam injections has spread widely in Europe, South America, and the U.S. Phlebologists have used a number
of different methods to create the foam that they inject but the result is the same: using a foam greatly increases the effect of
the treatment without producing any additional side-effects.
A pharmaceutical company, Provensis, has commenced development of
a commercial foam called 'Varisolve', a form of polidocanol, which is now in Phase III clinical trials. This is specifically
intended to treat varicose veins.
What is injected?
The solutions that are injected are exactly the same as those which are already
used to treat varicose veins. These are mixed with air to create a mousse or microfoam. It has been shown that this is perfectly safe
to inject into the veins. The air is rapidly absorbed from the veins leaving the solution to treat the veins. Until 2010, sodium tetradecyl
sulfate (STS) was the only highly effective FDA approved sclerosant available in the United States. Polidocanol has been widely used
in Europe for many years but was approved by the FDA earlier this yuear for treatment of spider and reticular veins.
We primarily use STS in our clinics but have polidocanol available. Unfortunately the type of veins polidocanol is approved
for are considered cosmetic by most insurance companies, but it is available for patients paying cash for treatment.
Why does foam
work?
When a solution is injected into a vein it is immediately diluted by the blood, reducing its efficacy. Foam pushes the blood
out of the way and completely fills the vein: the foam is not diluted by the blood. In fact, far less solution has to be injected
to obtain the same effect.
The treatment.
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Only after any large vein reflux has been treated, reticular veins are injected. Using small
bore needles low concentrations of sclerosant foam are injected into the reticular veins that feed the visible spider veins. After
the reticular veins have been treated any remaining spider veins are injected using very tiny needles and very low concentrations
of sclerosant.
Finally a compression stocking and a firm bandage are applied to the leg. The aim of this is to keep the veins compressed
so that they do no fill with blood when the patient stands up. The bandage is usually worn for 36 hours followed by an elastic compression
stocking for a further 4 to 7 days.
Who is suitable for foam sclerotherapy?
Most patients with reticular and/or spider veins can be
treated in this way. If there has been previous surgery to the veins of the leg this does not cause any difficulty in using foam sclerotherapy.
In fact, it is usually far easier to treat recurrent veins by foam injections than by more surgery. If spider or reticular veins recur
some years after initial treatment then it is straightforward to use the same method foam sclerotherapy again.
Who performs this treatment?
At
present only a limited number of physicians in the US are experienced in this treatment. It needs a specialist who is skilled in correct
dosing of sclerosant and mixing of foam as well as injecting veins. While it is much more effective than saline injections, it requires
specialized training for it to be safe and effective.
Summary
· Foam sclerotherapy is an improved method of treating spider and reticular
veins.
· There is NO need for an operation under general anesthetic.
· The treatment only involves injections with very tiny needles
·A treatment session is complete in 30 - 40 minutes.
· A firm compression bandage must be worn for 36 hours afterwards.
· Mild discomfort
and a little bruising often follow treatment. This is much less than following surgical treatment.
· No time off work is needed, except
to attend the clinic appointments.
· The costs of treatment are much lower than for surgical methods.
· Some small lumps may be felt
in place of the veins after treatment. These resolve completely over several months. Temporary staining of the skin may occur in a
small percentage of patients. | 
