Visual Foam Sclerotherapy of Spider & Reticular Veins

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.

Recently a pharmaceutical company, Provensis, has commenced development of a commercial foam called 'Varisolve' which is still undergoing 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. Sodium tetradecyl sulfate (STS) is the only highly effective FDA approved sclerosant available in the United States. Polidocanol is widely used in Europe but is in only limited use in the U.S. because it is not FDA approved. We primarily use STS in our clinics.

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.

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 phlebologists 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.