How does foam sclerotherapy treat saphenous vein (SV) varix?

From the Guidelines

Foam sclerotherapy is a highly effective treatment for saphena varix, with studies showing its efficacy comparable to surgical stripping of the great saphenous vein. The procedure involves injecting a detergent-based sclerosant mixed with air or gas into the affected vein under ultrasound guidance, causing endothelial damage, inflammation, fibrosis, and eventual closure of the vein 1. The most commonly used sclerosants include sodium tetradecyl sulfate (STS) or polidocanol, typically in concentrations of 1-3%.

Key Points of Foam Sclerotherapy

• The foam format increases contact time with the vein wall and allows for treatment using lower volumes of sclerosant compared to liquid forms.
• Compression therapy is applied for 1-2 weeks after injection to promote vein closure and prevent recurrence.
• The procedure is minimally invasive, can be performed in an outpatient setting, and typically takes 15-30 minutes.
• Patients can usually resume normal activities within 24 hours, though strenuous exercise should be avoided for 1-2 weeks.
• Multiple sessions may be required for complete resolution of larger varicosities.

According to a recent study published in the Journal of the American College of Radiology, foam sclerotherapy is a recommended treatment option for lower extremity chronic venous disease 1. Another study published in the British Journal of Surgery found that foam sclerotherapy had comparable outcomes to surgical stripping of the great saphenous vein at 8-year follow-up 1.

Comparison with Other Treatments

• A 2014 Cochrane review concluded that endovenous laser ablation, radiofrequency ablation, and foam sclerotherapy are as effective as surgery for great saphenous vein varices 1.
• The 2013 National Institute for Health and Care Excellence clinical guidelines recommend surgery as third-line therapy after endovenous thermal ablation and sclerotherapy 1.

Overall, foam sclerotherapy is a safe and effective treatment option for saphena varix, with a low risk of complications and a high success rate.

From the FDA Drug Label

The active ingredient of Asclera is polidocanol. Polidocanol is a sclerosing agent that locally damages the endothelium of blood vessels. When injected intravenously, polidocanol induces endothelial damage. Platelets then aggregate at the site of damage and attach to the venous wall. Eventually, a dense network of platelets, cellular debris, and fibrin occludes the vessel. Finally, the occluded vein is replaced with connective fibrous tissue.

The treatment of saphena varix using foam sclerotherapy with polidocanol involves:

• Endothelial damage: Polidocanol induces damage to the endothelium of the blood vessel.
• Platelet aggregation: Platelets aggregate at the site of damage and attach to the venous wall.
• Vessel occlusion: A dense network of platelets, cellular debris, and fibrin occludes the vessel.
• Replacement with fibrous tissue: The occluded vein is eventually replaced with connective fibrous tissue. 2

From the Research

Foam Sclerotherapy for Saphena Varix

• Foam sclerotherapy is a minimally invasive treatment for varicose veins, including saphena varix, which involves injecting a foam solution into the affected vein to close it off 3, 4, 5, 6, 7.
• The procedure is typically performed under ultrasound guidance to ensure accurate placement of the foam solution 3, 4, 5, 6, 7.
• Studies have shown that foam sclerotherapy can be an effective treatment for saphena varix, with significant improvement in symptoms and quality of life 3, 4, 5, 6, 7.

Comparison with Other Treatments

• Foam sclerotherapy has been compared to other treatments for saphena varix, including endovenous laser ablation, radiofrequency ablation, and surgical stripping 3, 4, 5, 6, 7.
• While foam sclerotherapy may have a higher recanalization rate compared to other treatments, it is generally considered a safe and effective option for patients with saphena varix 3, 4, 5, 6, 7.
• A study published in the Journal of Vascular Surgery found that foam sclerotherapy had a lower technical failure rate compared to surgical stripping, but a higher recanalization rate compared to endovenous laser ablation 5.

Outcomes and Complications

• Studies have reported varying outcomes and complications associated with foam sclerotherapy for saphena varix, including recanalization, recurrence, and nerve injury 3, 4, 5, 6, 7.
• A systematic review published in the Cochrane Database of Systematic Reviews found that foam sclerotherapy had a lower risk of complications compared to surgical stripping, but a higher risk of recanalization 6.
• Another study published in the Journal of Vascular Surgery found that foam sclerotherapy had a significant improvement in quality of life and symptoms, but a higher recanalization rate compared to endovenous laser ablation 7.