Ultrasound Guided Foam Sclerotherapy (USFS)

 

This technique is an alternative to surgical treatment for varicose veins. It can be used to treat most varicose veins, although very large and extensive veins may be best treated by alternative methods.


How does it work?

US image of cannulated vein

Conventional injection treatment (sclerotherapy) could only effectively treat bulging varicose veins, but not the main long or short saphenous veins and hence only treated the symptom and not the source of the trouble. Ultrasound guided foam sclerotherapy aims to treat the source of the problem by obliterating the long or short saphenous vein, or both if need be, as well as treating the obvious varicose veins.


How is the treatment given?

 
"Spasm" of vein with foam

A needle is placed in the vein with guidance from ultrasound imaging after a small amount of local anaesthetic has been used to minimise discomfort. The leg is elevated to empty blood from surface veins and the foam is prepared to inject into the vein. The foam spreads rapidly along the vein and is monitored using ultrasound. Only one site of injection of foam may be needed but often the foam does not reach all the varicose veins and some additional injections are required, one or two weeks later.


Is it painful?

Foam injection is not usually painful and normally causes no discomfort, although sometimes a little aching is felt for a few minutes.


Compression regime

Following foam injections firm bandages and then a compression stocking are applied to the leg. The bandages can be removed after 7 - 10 days but the elastic stocking should be worn continuously for a further 7 days, except for bathing or showering.


What can I do after the injection?

Following the injection treatment, which is carried out in the Outpatient department, you are able to walk normally and continue work. It is best to avoid very vigorous exercise for the first week but walking normally is good for you. Some aching in the leg may be experienced but this usually settles down within 2 to 4 weeks. Most people do not find this troublesome, although a few need to take simple painkillers from time to time.


How many sessions of treatment?

Normally one leg is treated at a time. If the varicose veins affect both legs treatment to the other leg is given 2 weeks later. We aim to check the treatment has worked and treat any residual varicose veins, 2 weeks following the main treatment. This usually means that for a single leg 2 visits are planned and for both legs 3 visits are recommended.


What happens next?

In most cases varicose veins are eliminated by this treatment. Some bruising is often seen but resolves after a few weeks. Some of the more prominent veins become firm and lumpy and can still be felt beneath the skin. They are not usually visible from the surface unless they have been very prominent beforehand. These lumps slowly resolve over 3 to 6 months. Sometimes pale, brown discolouration of the skin appears where large veins have been treated but this gradually fades over a number of months.


Are there any risks?

There is a very small risk of allergic reaction to the foam which is injected. As with surgery or any other varicose vein treatment, deep vein thrombosis can rarely occur. Transient visual disturbance has been reported immediately after treatment but with full recovery over 20-30 minutes. This occurs in less than 1% of patients but seems more likely in migraine sufferers. Occasionally thread veins can develop overlying treated veins but this can also occur after surgical removal.

Phlebitis (inflammation of the treated vein) can occur in about 5% of people, usually a week or two after bandages are removed. This is treated with anti-inflammatory agents such as ibuprofen either as a topical gel (if mild) or by tablets.

There have been three patients reported in the world literature who have suffered strokes after foam sclerotherapy (amongst many thousands of treatments world wide). All three had underlying heart defects which led to the complication. While this is clearly a potentially serious risk it is extremely rare.