Foam Sclerotherapy--An Alternative Treatment for Varicose Veins

BY KAREN M. DENTE

MIAMI --The new endovenous techniques such as foam sclerotherapy have made small dysfunctional veins easy to obliterate, according Dr. John J. Bergan, of the UCSD School of Medicine and the Scripps Memorial Hospital, La Jolla, Calif., at the annual meeting of the American Venous Forum.

"Foam can be used for nearly anything. Unlike laser or radiofrequency treatment, foam will go into any peripheral vein and flow into the accessory saphenous vein," Dr. Bergan said.

"Ultrasound-guided foam sclerotherapy is very good. The smaller varicose veins are very easy to close," agreed Dr. Neil S. Sadick of Cornell University, New York.

Foam can be made from detergent agents such as Sotradecol and polidocanol at any concentration from 0.25% to 3% with a mixing ratio of 1:4 using room air.

FOAM HEALS VENOUS ULCERS IN WEEKS RATHER THAN MONTHS, WHICH MAKES THIS PROCEDURE A "DRAMATIC CHANGE IN TREATMENT."

Foam can be used from the skin down to any vein segment. "One of the easiest procedures available is the treatment of the tangle of superficial veins underneath venous ulcers. These can best be treated using foam sclerotherapy," said Dr. Bergan. Foam heals ulcers in weeks rather than months, he said, referring to this procedure as a "dramatic change in treatment."

Increasing numbers of patients are appearing who have persistent symptoms after previous laser therapy. "About one-third of patients with laser therapy will need to have treatment for the remaining varices," said Dr. Bergan. "And these will have continuaton of symptoms that can be successfully treated with foam."

Another great advantage of foam sclerotherapy is the avoidance of surgery on the small saphenous vein and prevention of sural nerve injury. Severe complications of foam sclerotherapy are rare but can include migraine. The usual side effects of sclerotherapy including matting, superficial thrombi, and residual pigmentation can also be seen with foam treatment.

Dr. Bergan stressed the need to carefully evaluate for abnormal vein segments in each patient before starting treatment, especially in those with May-Thurner or Klippel-Trenaunay syndrome, who have a higher chance of presenting with venous malformations.

"You must also be very careful with other patients who may have other conditions," he cautioned.

"Sclerosant foam treatment is cheap, painless, simple, and not disabling," said Dr. Bergan. He stressed the need for standardization of treatment methods with the adoption of such new therapies as they are proved efficacious.