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Foam sclerotherapy of the saphenous veins

Foam sclerosis SSV and GSV

KAVS3L ultrasound-guided foam sclerotherapy

Sclerotherapy has come a long way since first attempted in 1682, when a Swiss doctor tried inducing thrombus formation by injecting acid into a vein. Over the years, medical scientists have experimented with an immense variety of sclerosants (from the Greek skleros, “hard”), though many were ultimately abandoned as having inferior safety profiles to surgical stripping. The most versatile and effective sclerosants by far are detergent solutions, whose foaming properties yield superior efficacy at lower concentrations. Compared to liquid sclerosants, foam sclerotherapy offers significantly higher rates of reflux elimination and patient satisfaction while requiring fewer treatments on average. Both of the foam sclerosants most commonly employed in the US (sodium teradecyl sulfate and the more recently approved polidocanol) offer low rates of allergenicity, cause no pain when injected, and carry a low risk of hyperpigmentation.

Though long considered a preferred method of treating telangiectsias and reticular veins, foam sclerotherapy’s usage on larger varicose veins remained limited in the United States until relatively recently, when new medical innovations facilitated rapid production of better-quality foam at a far lower cost. Today, ultrasound-guided foam sclerotherapy is used on vessels of all sizes, from the tiniest spider vein to the largest great saphenous vein.

The thin, flexible KAVS3L catheter has a trio of Luer-lock adapters: one lumen for the guide wire, one for the occlusion balloon, and one for the three-way tap used to produce and deliver the sclerosant foam. The rounded catheter tip provides good ultrasound visibility, and the catheter itself has graduated (10 cm) markings for additional visual guidance.

Advantages for patients

  • Quick, comparatively inexpensive outpatient procedure
  • Allows immediate return to daily activities

Advantages for practitioners

  • Quick, comparatively inexpensive outpatient procedure
  • Allows immediate return to daily activities
  • Minimal risk of bruising, scarring or hyperpigmentation
  • Non-thermal, non-tumescent method

Treatment protocol

Indication: saphenous veins up to Ø8mm

1. In preparation for the procedure, perform ultrasound mapping of the vessel to be treated and identify a suitable access point. 

2. Check the occlusion balloon by filling it with saline and then aspirating it out again. Flush the catheter with the sclerosant solution.

3. Create the access point: Administer local anaesthetic, puncture the vein with the introducer needle and thread in the guide wire. Use the guide wire to outline the course of the vein on the skin. Remove the needle and insert the access sheath, making a slightly wider incision if necessary to facilitate insertion. Once the access sheath is in place, remove the guide wire and flush the vein with heparine water.

4. Under ultrasound guidance, insert the catheter, leaving about 1-2 cm between the catheter tip and the connecting vessel (e.g., the saphenofemoral junction). Occlude the vein with the balloon and then retract the sheath.

5. Turn the stopcock to prevent the balloon from deflating. Foam the sclerosant (4:1 mixture of air to solution) and then begin the infusion. Use the ultrasound probe itself to “milk” the foam along the full length of the vein to ensure even distribution, aspirating foam out again along the way. Make sure not to leave the foam in for longer than three minutes.

6. Once the foam has been fully aspirated, turn the stopcock and deflate the occlusion balloon before removing the catheter. Suture the percutaneous site and apply compression.

Review foam sclerotherapy

Clinical studies

Foam sclerotherapy

Glen Alder, Tim Lees; Phlebology. 2015 Nov;30(2 Suppl):18-23.

Foam sclerotherapy: techniques and uses

Nisha Bunke, Katherine Brown, John Bergan; Perspect Vasc Surg Endovasc Ther. 2009 Jun;21(2):91-3.

Foam sclerotherapy, surgery, sclerotherapy, and combined treatment for varicose veins: a 10-year, prospective, randomized, controlled, trial (VEDICO trial)

G Belcaro, M R Cesarone, A Di Renzo, R Brandolini, L Coen, G Acerbi, C Marelli, B M Errichi, M Malouf, K Myers, D Christopoulos, A Nicolaides, G Geroulakos, S Vasdekis, E Simeone, A Ricci, I Ruffini, S Stuard, E Ippolito, P Bavera, M Georgiev, M Corsi, M Scoccianti, U Cornelli, N Caizzi, M Dugall, D Christopoulos, M Veller, R Venniker, M Cazaubon, M Griffin; Angiology. 2003 May-Jun;54(3):307-15. doi: 10.1177/000331970305400306

Treatment of Varicose Long Saphenous Veins with Sclerosant in Microfoam Form: Long-Term Outcomes

Cabrear, J; Cabrera Jr, J; Garcia-Olmedo, MA; Phlebology 2000;15(1):19-23

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Alternative treatment

The Veineo® procedure

A minimally invasive method of treating saphenous veins using radiofrequency (RF) energy.