Sclerotherapy has been around as a treatment option since 1935, but it is only recently, with the advent of Foam Sclerotherapy that it has become a widely recognised treatment for varicose veins.

Sclerotherapy is performed under ultrasound guidance with the injection being made directly into the target vein. The liquid injected is called a ‘sclerosant’ and chemically burns the vein causing inflammation. The inflamed vein hardens preventing blood from flowing back into the veins and then, over time, the body eats away the vein leaving only a small area of scar tissue.

The Sclerosant may be a liquid or, in ‘Foam Sclerotherapy’ is made into a foam; the latter working better than the liquid variety.

By injecting the foam into the veins it pushes out the blood from the vein and burns the vein wall. If some of the blood refluxes back into the vein, it mixes with the foam and causes a clotting affect i.e. Thrombophlebitis or Sclerothrombus. This is not only painful but can lead to brown staining.

Foam Sclerotherapy is best suited to veins of 3mm or less, with the bigger veins not being so effectively treated as there is too much blood within the veins for the foam to displace it.

Foam was created by mixing the liquid sclerosant with air.  The Nitrogen within the air is not readily absorbed in the blood and can travel up through the venous system into the heart and on to the brain. This does not cause a problem in most cases but can lead to visual disturbance for up to 20 minutes in about 1 in 20 people (5%). Most centres have now adapted the technique to use an oxygen and carbon-dioxide gas mix, allowing the bubbles to dissolve quicker and so reducing the adverse symptoms.

It takes about 14 days for the vein walls to scar completely thus preventing the blood from refluxing back down the veins. During this period, Compression Hosiery should be worn, to stop blood from re-entering the vein and thus aiding the healing process.

Laser treatment has advantages compared with sclerotherapy for treating spider and reticular veins. Sclerotherapy induced hyperpigmentation is the result of hemosiderin deposition and an inflammatory response. Hemosiderin deposition occurs through extravasated red blood cells . Laser coagulative destruction of spider veins does not have this response. It has been shown that Sclerotherapy is not as successful as laser and radio-frequency ablation techniques in  the treatment of main truncal veins, but is very good at treating the smaller side branches, feeding branches and thread veins.

The technique can be used in an office base setting with very little setup, except for a good quality ultrasound machine and experienced vascular scientist to direct the injections.

There are, however, several potential drawbacks to the procedure including:

• Discomfort
• Bruising and skin discolouration
• Skin ulceration
• Phlebitis
• DVT
• Allergic reaction
• Usually multiple treatments are required