Foam Sclerotherapy Dallas, TX
Sclerotherapy with foamed sclerosants is not new, but there has been renewed interest in this treatment in the past decade. This is especially true as it applies to larger veins that are not amenable to laser or radiofrequency ablation procedures.
To create foam detergent sclerosing agents such as sodium tetradecyl sulfate and polidocanol are vigorously mixed with air. When the foam is injected into a vein it causes an inflammatory reaction inside the wall of the vessel leading to its closure and eventual scarring, obliterating the vein. Foam has been shown to be more effective than liquid for treatment of diseased veins because the small microbubbles cling to the vein wall better than liquid agents, thereby improving the contact of the sclerosant with the vein wall.
Foam sclerosant therapy has been used for all types of abnormal veins of the lower extremities. It appears to work best for small (1-2 mm) reticular veins that are visible just beneath the skin. Foam also works well for residual or recurrent varicose veins that do not bulge on the skin surface, but can be seen with ultrasound. Foam works as well as liquid sclerosants for the obliteration of telangiectasias or spider veins.
Foam sclerotherapy has also become the treatment of choice for congenital venous malformations. These frequently debilitating and unsightly tumor masses of dilated and convoluted veins may occur in the extremities, trunk, and head and neck. They are often difficult to remove with surgery, and have in the past had a high rate of recurrence. With foam sclerotherapy vein specialists are finding that cures are now likely.
Ultrasound Guided Sclerotherapy
In the last few years more experience has been gained with foam ultrasound guided injection sclerotherapy (USGS). This refers to the injection of foamed sclerosing agents into larger diseased superficial veins that are deep to the skin under ultrasound guidance. Ultrasound is required because the veins cannot be seen on examination. With the use of ultrasound to visualize these veins, the physician is able to target the vein for injection. One or more veins may be injected at a single session of USGS. The procedure is done in the office with a small needle producing only minimal discomfort.
Patients who receive foam injections into veins of the lower extremities may experience mild side effects briefly. Patients with a history of migraine headaches may suffer an attack. A cough may occur in some patients, and "floater" visual symptoms have been reported. None of these symptoms are long lasting and they usually resolve quickly. An injected superficial vein may also develop a blood clot, which may become tender and mildly painful. These symptoms always resolve over a few weeks time. Deep vein thrombosis, the development of clots in the deep veins of the legs, is very rare.
At the Reeder Vein Institute, Dr. Reeder and Dr. Darnell have a great deal of experience with modern foam sclerotherapy. In Europe foam sclerotherapy has been used by vein specialists for many years with excellent results. In the Summer 2006, Dr. Reeder attended an international conference on foam sclerotherapy in Bologna, Italy, where surgeons presented their experience and results with emerging foam sclerotherapy techniques.
We believe that foam sclerosant injection therapy is a major advance in the treatment of vein disease. It has proven 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 ablation applications, and spider veins that are resistant to the usual liquid sclerotherapy. Additionally, foam sclerotherapy often enhances other vein treatment modalities, reducing the chance of recurrent varicose veins, venous ulcers, and spider veins.