Varicose veins - Foam sclerotherapy

Introduction

What is it?

Foam sclerotherapy is a minimally-invasive procedure that uses a chemical or ‘sclerosant’ such as sodium tetradecyl sulphate mixed with air to irreversibly close the section of the varicose vein. Once the sclerosant comes in contact with the vein it causes a reaction that will reduce the visibility of the vein at the skin surface

Will I need to do any preparation?

Foam sclerotherapy is often undertaken without the need for anaesthetic, however you should confirm this with your surgeon. If this is the case, you will not have to fast before the procedure. You should check with your surgeon if there are any medications (such as anticoagulation) you should stop beforehand.

Technique

What does it involve?

For this procedure the surgeon will ask you to lie in the best position for them to access the vein. If the target vein is located in the back of the calf, you will likely be asked to lie on your front. During the procedure, the surgeon will ask for the bed to be tilted with your head-up or down. This will either be to fill the vein, so it is easier to target, or empty improving treatment. 

Modern varicose vein treatments are often undertaken as day case procedures. This often leads to a quicker recovery time following the treatment and means you do not have to fast beforehand. In some circumstances it may be appropriate to undertake the procedure under general anaesthetic, and it is worth clarifying this with the surgeon in your consultation.

Before starting foam sclerotherapy, the surgeon will use an ultrasound machine to rescan the veins. They will then prepare the leg and may drape it with sterile drapes. 

As the needles used for foam sclerotherapy are often the same used in taking blood, local anaesthetic may not be used. Once the target vein has been identified they will use the small needle to access the vein. The ultrasound confirms that the needle is in the correct position.

Once the needle position is confirmed, the foam will be prepared and then slowly injected. If you feel discomfort as the chemical is injected, you should mention it to the surgeon. 

Depending on the configuration of the veins, the surgeon may need to repeat the procedure in different positions.

Foam sclerotherapy can be used for small varicosities or spider-veins. If discussed prior to the operation the surgeon may choose to do an adjunctive procedure if you also have large varicosities.  

Post procedure course (follow-up)

In the days after the procedure you should aim to regularly mobilise. You may also be asked to wear a compression stocking to reduce the risk of DVT. In some circumstances, for example if you have a high risk of DVT, you may be asked to take an anticoagulant tablet or injection following the procedure. Always check the discharge paperwork for detailed post procedure instructions.

If you find that the skin has been irritated or is painful after the procedure, you may find the use of chestnut oil or topical non-steroidal gel useful. Consult your surgeon if there is any concern following the procedure, and for the post-operative instructions.

How long will I say in hospital?

Often the foam sclerotherapy procedure are done as day cases and you will be able to go home the same day.