What is sclerotherapy (sclero) with foam for venous insufficiency?

Foam Sclerotherapy for Venous Insufficiency

Foam sclerotherapy is an effective, minimally invasive treatment option for venous insufficiency that involves injecting a sclerosant agent mixed with air to create foam, which displaces blood and causes endothelial damage, leading to vein closure and symptom relief. 1

What is Foam Sclerotherapy?

Foam sclerotherapy is a technique that transforms liquid sclerosants into foam by mixing them with air, typically using the Tessari technique with a three-way tap. This creates a microfoam that:

• Displaces blood in the vein rather than mixing with it
• Increases contact time with the vein wall
• Provides greater efficacy compared to liquid sclerosants
• Can be visualized under ultrasound guidance for precise treatment 2, 3

Common Sclerosing Agents

The most commonly used sclerosants for foam preparation include:

• Sodium tetradecyl sulfate (STS)
• Polidocanol
• Hypertonic saline (less commonly) 1, 3

Applications and Indications

Foam sclerotherapy can be used to treat:

• Varicose veins of various sizes
• Saphenous trunk incompetence
• Incompetent perforating veins
• Venous stasis ulcerations
• Pelvic venous disorders 1, 2

Procedure Details

1. Pre-procedure assessment: Confirm absence of significant arterial disease
2. Ultrasound guidance: Used to target specific veins accurately
3. Venous access: Obtained percutaneously through varices or targeted veins
4. Foam preparation: Created using the Tessari technique
5. Injection: Foam is injected under ultrasound guidance
6. Post-procedure: Compression therapy (20-30 mmHg) is applied 1, 4, 3

Efficacy and Outcomes

• Studies show efficacy rivaling traditional surgical ligation and stripping
• Rapid ulcer healing (2-6 weeks) in cases of chronic venous insufficiency
• Relief of painful lipodermatosclerosis and dermatitis
• Some decrease in skin hyperpigmentation
• Total occlusion rates of 75-98.6% for treated veins 2, 3, 5

Advantages of Foam Sclerotherapy

• Low cost compared to other interventions
• Quick patient recovery with minimal downtime
• No need for analgesics or sedation
• Outpatient procedure
• Can be used in combination with other treatments like radiofrequency ablation 2, 3, 6

Potential Complications

Serious complications are rare, but may include:

• Transient pain (common but self-limiting)
• Trapped thrombus requiring evacuation
• Cutaneous staining
• Deep vein thrombosis (rare, 0.3-1.8%)
• Transient neurological symptoms (rare)
• Cutaneous necrosis (very rare) 2, 3

Combined Treatment Approaches

Foam sclerotherapy is often used in combination with other treatments:

• Can be performed alongside radiofrequency ablation (RFA) in a single session
• Combined approach may reduce risk of thrombophlebitis in tributaries
• One-step approach (RFA + foam sclerotherapy) has shown 100% closure of treated truncal veins and 91.7% closure of tributary veins 6

Special Considerations for Pelvic Venous Insufficiency

For pelvic venous disorders:

• Stop-flow foam sclerotherapy techniques may be used
• Balloon occlusion of high-outflow collaterals can optimize sclerosant efficacy
• Studies show significant symptom improvement (approximately 75%) 1

Follow-up Care

• Compression therapy should be continued for optimal results
• Follow-up ultrasound within 1-2 weeks to confirm vein closure
• Some patients may require more than one treatment session 2, 5

Foam sclerotherapy represents an important tool in the modern treatment of venous insufficiency, offering a balance of efficacy, safety, and patient convenience when performed by experienced practitioners.