Foam Sclerotherapy for Varicose Veins

Foam sclerotherapy, also known as ultrasound guided sclerotherapy, is a technique for eliminating varicose veins, particularly larger ones. It's performed by injecting the veins with a foam that causes the veins to scar inside, so that they eventually harden, close up, and disappear.

Traditionally, liquids were used for sclerotherapy. Foam sclerotherapy mixes a chemical and a gas (sometimes air), yielding a thicker, foamy consistency. In the United States, the chemical used might be polidocanol (Varithena™), sodium tetradecyl sulfate, sodium morrhuate, or glycerin. The resulting agent is kind of like shaving cream or foamy hand soap.

Advantages of foam sclerotherapy

Foam sclerotherapy offers two advantages over traditional sclerotherapy:

  • Because the foamy sclerosing agent (the chemical that hardens the veins in order to eliminate them) is thicker than a liquid, it doesn't mix with blood in the vein but rather displaces it. That allows the foam to work longer and more effectively than liquids and makes it better for use in larger veins.
  • Also, the thickness of the foam makes it visible on ultrasound. That allows the physician to use ultrasound to guide and observe its placement, spread, and effects more effectively. For that reason, the procedure is sometimes called "ultrasound-guided foam sclerotherapy for varicose veins."

The foam sclerotherapy procedure

Foam sclerotherapy is performed in your doctor's office. First, the doctor administers a local anesthetic to numb the treatment area. Once the area is anesthetized, the sclerosing foam is injected, using duplex ultrasound to ensure it goes exactly where it's supposed to.

Depending upon how extensive an area is being treated, you may need more than one injection. The whole thing usually takes less than an hour, and in many cases as little as 15 minutes.

After foam sclerotherapy treatment

Most people can return to their normal routine immediately after foam sclerotherapy. To aid the healing process, your doctor may have you wear a compression stocking or bandage for anywhere from a few days to a month.
More than half of patients achieve satisfactory results with one treatment of foam sclerotherapy, noticing a visible improvement shortly after the procedure. In some cases, it can take longer to see results, though, and in some cases you'll need follow-up treatments.

Is foam sclerotherapy right for you?

Foam sclerotherapy is particularly well suited for treating larger varicose veins, especially if more conservative approaches like using compression stockings haven't helped. It's also the recommended first approach to clearing large veins after they've been surgically treated. However, for a particular long vein on the leg (the saphenous vein), the Society for Vascular Surgery and the American Venous Forum recommend a different type of procedure (called endovenous thermal ablation) instead of foam sclerotherapy.

You should not undergo foam sclerotherapy if you:

  • Are pregnant.
  • Have acute thromboembolic disease (including deep vein thrombosis and pulmonary embolism).
  • Known to be allergic to the chemicals used.
  • Have a patent foramen ovale (an incomplete closure of in the wall between the two upper chambers of the heart), or you should at least talk with your doctor about your condition, because the procedure carries additional risk for people with that condition.

Risks associated with foam sclerotherapy

Common problems include hyperpigmentation, a darkening of the skin color that happens as much as 30 percent of the time. In most of those cases, though — 70–90 percent of the time — it goes away within a year. The actual procedure can be painful, and it's not uncommon to experience itching, redness, pain and bruising around the treatment site, though that should go away within a few days.

Less common problems: On rare occasions people may experience a visual disturbance, headache, or confusion. Foam sclerotherapy has been associated with a higher risk of microembolisms, tiny clots or obstructions which may form around the treated area (or, in the case of people with a patent foramen ovale, these may form in the heart).

There have been a few extremely rare cases (less than 1 in 10,000) where people have experienced heart attack, pulmonary embolism, stroke, and even fatalities after treatment with foam sclerotherapy. Those very small risks can be greatly reduced by following your doctor's instructions regarding elevating your leg and mobilizing it enough. The use of pre-mixed foams, rather than those mixed in your doctor's office, might also lower the risk of these severe reactions.

Costs and insurance coverage of foam sclerotherapy

If foam sclerotherapy is necessary to treat a medical problem (more common with larger varicose veins), the procedure may be covered by insurance, though insurance companies tend to have very specific criteria as to what's in and what's out. If the foam sclerotherapy is for a cosmetic procedure or the specifics of the medical situation don't meet your insurer's requirements, it won't be covered. Check with your insurer to find out more about your coverage.

Most procedures range in cost from $300 per treatment session up to $1,000 or more, and can vary based on the extent of the treatment area. Foam sclerotherapy typically costs less than surgery.

Updated: October 1, 2014

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