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Sclerotherapy and foam sclerotherapy - what is it?
With liquid sclerotherapy, spider veins and smaller varicose veins are removed, with foam sclerotherapy larger varicose veins and with ultrasound-controlled foam sclerotherapy larger, somewhat deeper varicose veins such as B. also treated saphenous veins.
The principle of the procedure is to seal the treated vessel.
Liquid sclerotherapy and foam sclerotherapy have established themselves as safe and effective therapies for varicose veins.
Liquid sclerotherapy and ultrasound-controlled foam sclerotherapy are methods of treating varicose veins (varices). Their active principle is that they chemically irritate the vein walls and thus close the pathologically enlarged blood vessel. Both in liquid sclerotherapy (sclerotherapy) and in sclerotherapy by means of ultrasound-controlled foam sclerotherapy, the body itself takes over this process - triggered by liquid or foam-like medicine that is administered into the vein.
Sclerotherapy with liquid sclerosants, which began around 150 years ago, has significantly expanded the treatment options for varicose veins. It is now mainly used to remove spider veins and very small varices. This is because foam sclerotherapy has increasingly overtaken it since the beginning of the 21st century. In the meantime, this gentle and effective method has become an indispensable part of modern varicose disease therapy.
No anesthesia necessary, can be carried out on an outpatient basis, painless - compared to operative vein stripping or vein-preserving operations, sclerotherapy and foam sclerotherapy have some advantages. But they also have disadvantages, are not equally suitable for everyone affected and in some cases also compete with thermal treatment methods such as endovascular thermal methods or vein glue (which has yet to prove its safety and long-term success rate). Which method is used to treat varicose veins is therefore an individual decision that the doctor and patient should make together. The form and severity of the varicose vein problem should be taken into account as well as the wishes of the person affected.
How do liquid sclerotherapy and foam sclerotherapy work?
- Sclerotherapy is based on the planned intravenous introduction of a sclerosing agent (in Germany the active ingredient polidocanol). This causes a targeted dissolution of the vein wall and consequently the entire varicose vein, which is then converted into a connective tissue cord.
- In order to also be able to close large varicose veins, the liquid sclerosing agent is foamed with air in a defined mixing ratio during foam sclerotherapy.
Polidocanol has been approved as a sclerosing agent in Germany since 1966. The active ingredient irritates the vein wall and leads to an inflammatory reaction there. As a result, the vessel walls stick together so that the varicose vein closes. The body then converts the vein into connective tissue.
So that its effect on the vein to be treated remains limited, the sclerosing agent must only act for a very short time. This is very important, because otherwise it could get into other vessels with the bloodstream and block them. This is prevented because the active ingredient is inactivated when it comes into contact with the blood. The downside of the coin is that sclerotherapy with liquid polidocanol therefore only works well up to a certain varicose vein size.
There is no such limit in foam sclerotherapy - or at least not to the same extent. In this method, the sclerosing drug is mixed with air to create a fine-bubble foam that displaces the blood in the vein. On the one hand, this increases the contact area with the vein wall. On the other hand, it takes longer for the agent to mix with the blood and be deactivated. Therefore, with ultrasound-controlled foam sclerotherapy, larger veins up to the trunk veins can also be obliterated. However, more than one session may be required to treat very large veins.
Triggering inflammation in the walls of the varicose vein and gluing them together - this is the idea behind the desolation of table salt. As the name suggests, concentrated, sterile saline solution is injected into the vein with a syringe. The method is touted as particularly gentle, not least by healing therapists, who are not allowed to inject medication and are not allowed to use ultrasound for control. In fact, sclerosing with table salt is not without its risks, has hardly been scientifically investigated and is therefore not recommended in the treatment guidelines. Patients who are considering this treatment should seek detailed advice beforehand - preferably from a phlebologist in their area.
When are sclerotherapy and foam sclerotherapy used?
Sclerotherapy and foam sclerotherapy are suitable for all types of varicose veins.
Liquid sclerotherapy is mainly used for spider veins and small varicose veins. For varices on the large veins, ultrasound-controlled foam sclerotherapy is more effective.
Important advantages of the procedure compared to the surgical therapies are the low side effects and the shorter recovery time.
Sclerotherapy with liquid Polidocanol can in principle be used for all types of varicose veins. Phlebologists use them primarily for spider veins and small varices. This is because larger veins can be obliterated much more effectively with foam sclerotherapy. With this method, all forms of varicose veins can now be treated - including the saphenous veins. It is sometimes combined with other treatment methods such as laser and radio frequency therapy or surgical vein stripping. Compared to stripping and vein-conserving operations, obliteration and foam sclerotherapy have some advantages. The most important are:
- No anesthesia is required for the therapy. Stressful general or partial anesthesia, which are associated with certain risks, are no longer necessary.
- Because of the very low blood loss, patients who are taking anticoagulant medication can also be treated. You can usually continue to take other medicines.
- Since there is no cutting, the treatment does not leave any scars. In addition, the risk of bleeding or wound infections is lower than with surgical therapies.
- After sclerotherapy with liquid or foamed sclerosing agents, the patients experience little or no pain. Other side effects such as bruising, nerve damage or damage to lymph vessels are also less common than after varicose vein surgery or endovascular procedures.
- The patients can usually go straight back to their normal everyday life
- Foam sclerotherapy can be repeated at any time and can also be applied to varicose veins that have already been treated. This is not possible or at least difficult with other treatment methods.
- Foam sclerotherapy is the only method that can treat all types of varicose veins. With other methods this is not possible or at least difficult.
On the other hand, there are also certain disadvantages. For example, that deserted saphenous veins can open up again and then have to be treated again. This cannot happen with the stripping operation, as the surgeon removes the varicose veins here, but as with all procedures, new varicose veins can develop due to the weak veins that are usually present.
Ultrasound-controlled foam sclerotherapy is usually not part of the catalog of services provided by statutory health insurance and must therefore be paid for yourself. However, some health insurance companies bear the costs under so-called integrated treatment contracts. Patients can find out whether they have this option at their health insurance fund or from the attending physician.
How does the treatment work?
All procedures can be performed on an outpatient basis and without anesthesia.
In foam sclerotherapy, the sclerosing agent is given into the varicose vein either by syringe or with a special instrument - the catheter.
The foam sclerotherapy takes place under ultrasound control. This enables the doctor to precisely control the treatment.
Liquid sclerotherapy and foam sclerotherapy are usually carried out on an outpatient basis by a resident phlebologist. Since none of the procedures require anesthesia, the patient can eat and drink normally on the day of treatment. In foam sclerotherapy, the corresponding skin area is first disinfected and the sclerosing agent is foamed with a syringe system. With the patient lying down, the phlebologist shows the varicose vein to be treated with an ultrasound examination. Then he pierces the skin and vein wall with the cannula and injects the foam into the vein - all under ultrasound control. The vein, cannula and foam are clearly visible on the ultrasound images so that the doctor can observe and control how the sclerosing agent is distributed.
This process is repeated along the varicose vein until the entire desired route is obliterated. Alternatively, a catheter can be used for foam sclerotherapy. This is a thin, flexible instrument that the phlebologist inserts from the lower part of the affected varicose vein into the vein towards the upper leg. When withdrawing, he then applies the foam in small portions into the varicose vein.
At the end of the varicose vein treatment, the puncture sites are treated with liquid sclerosing agent or foam. Before the patient can go home, he or she is given a compression bandage or compression stocking.
What happens after the treatment and what side effects can occur?
After treatment, patients can and should move immediately.
Side effects such as bruising and hardening in the deserted area do occur, but usually go away on their own.
Since only a limited amount of sclerosing agent may be given at a time, two or more treatment sessions may be necessary in patients with pronounced varicose veins.
After foam sclerotherapy, patients should go for a walk. This activates the blood flow in the venous system and prevents thrombosis. Compression therapy improves the success of the sclerotherapy and should therefore be carried out for as long as the doctor specifies. He also knows when his patient can return to intense sporting activities. Sports that are not too strenuous, such as walking, moderate swimming, and cycling, are usually immediately possible.
Sclerotherapy therapy is considered a safe procedure with few side effects. Nevertheless, undesirable side effects can occur. This includes:
- Small bruises, rarely infections and wound healing disorders at the injection sites
- Hardening, rarely inflammation of the veins
- Very rare allergic reactions to sclerosing agents, bandages or plasters
- Temporary visual disturbances with foam sclerotherapy, which usually subside without consequences after 20 to 30 minutes, are extremely rare.
- Migraine attacks can sometimes occur during foam sclerotherapy in people who already have migraines.
After foam sclerotherapy of large veins, as with all other varicose vein therapies, deep vein thrombosis could occur. To prevent this rare complication, the doctor may prescribe medication in risky situations that reduce the blood's ability to clot.
What sometimes happens is that the skin over the deserted vein turns brown. The reason for this are deposits of a mixture of sclerosing agent and blood, which sometimes have to be punctured and expressed by the doctor. Often this skin discoloration disappears on its own after a few weeks. Until then, patients should avoid extensive sunbathing.
Only a limited amount of the sclerosing agent should be used in each treatment session. Therefore, in the case of very large spider veins and pronounced varicose veins, it may be necessary to spread the liquid sclerotherapy or foam sclerotherapy over two or more appointments.
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