SCLEROTHERAPY WITH FOAM

Sclerotherapy with foamed sclerosants is not new, but there is new interest in it. This is especially true when it comes to larger veins.

Detergent sclerosing agents such as sodium tetradecyl sulfate and polidocanol are vigorously mixed with air to create a foamy solution. This "foam" when injected into a vein causes an inflammatory reaction in the wall of the vessel leading to its closure and eventual fibrosis and obliteration. This has been shown to be quite effective since the foam bubbles appear to "hang up" on the vein wall better than non-foamy liquid agents.

Foam sclerosant therapy has been used for all types of abnormal veins of the lower extremities, but it appears to work best for small reticular veins that can be seen just under the skin and for residual or recurrent varicose veins that do not bulge on the skin surface. Foam works as well as liquid sclerosants for the obliteration of telangiectasias or spider veins.

In the last few years more experience has been gained with foam ultrasound guided sclerotherapy (USGS). USGS refers to the injection of sclerosing agents into superficial veins that are deep to the skin and cannot easily be seen from the skin surface. With the use of ultrasound to visualize these deeper lying veins, the physician is able to "hit" the target vein with injection. One or more veins may be injected at a single session of USGS. The procedure is done in the office with only minimal discomfort.

Patients who receive foam injections into veins of the lower extremities may experience symptoms transiently. Patients with a history of migraine headaches may suffer an attack. A cough may occur in some patients, and eye symptoms have been reported. None of these symptoms are long lasting and usually resolve quickly. An injected vein may develop clot, which may be tender and painful. This always resolves with time. Deep vein thrombosis, the development of clots in the deep veins of the legs, is rare.

The surgeons at Southwest Vein Institute have accumulated a large experience with foam sclerotherapy. European vein specialists have extensive experience with this treatment and have enjoyed excellent patient outcomes. In summer 2006, Dr. Reeder attended an international conference on foam sclerotherapy in Bologna, Italy, where surgeons presented their experience and results.

We believe that foam slerosant injection therapy greatly enlarges our options for the treatment of manifestations of vein disease. It has proved particularly valuable as an easy and effective method of treating problems such as recurrent varicosities, incompetent perforating veins that allow high venous pressure to be transmitted to superficial veins, segments of incompetent long superficial veins that are located in areas of the leg that will not allow endovenous laser application, and spider veins that are resistant to the usual liquid sclerotherapy. Additionally the combination of foam sclerotherapy with other proven treatment methods reduces the chance of recurrent varicose veins.

Foam sclerotherapy has become the treatment of choice for congenital venous malformations. These frequently debilitating and unsightly appearing masses of dilated and convoluted veins that may occur in extremities, in the head and neck, and on the trunk, have proven resistant to surgical removal. With foam sclerotherapy vein specialists are finding that cures are now likely.