Treatments

Sclerotherapy (Foam Treatment)

Posted on by Prof. Dr. Özgür KILIÇKESMEZ

Sclerotherapy is an effective method for treating varicose and spider veins. During this procedure, healthcare professionals inject a specialized chemical solution into problematic veins using a very fine needle. This treatment is typically performed in clinical settings and yields highly successful results for small vessels. It offers a rapid recovery process, although it may take weeks or even months to see full effects. As a minimally invasive solution for varicose vein issues, patients can return to daily life quickly. Unlike other procedures such as laser therapy, sclerotherapy can rapidly treat large areas.

What Is Sclerotherapy?

Sclerotherapy is a method used to treat venous varicosities. It is especially preferred for aesthetic concerns or bothersome symptoms in the lower extremities and can also be effective for certain hemorrhoid cases. The technique is designed to create inflammation in the vein wall followed by fibrosis. This process ends the vein’s function and reduces its appearance.

Sclerotherapy has a long history:

  • Treatment of venous insufficiency and varicose veins dates back to Galen, Celsus, and Hippocrates.
  • Modern sclerotherapy techniques were first described in the 1850s.

Common sclerosant agents:

  • Osmotic agents: glycerin, hypertonic saline
  • Detergents: polidocanol, sodium tetradecyl sulfate (STS)
  • Iodinated agents

In the 1940s, sodium tetradecyl sulfate was introduced into modern practice, greatly expanding the method’s acceptance and applications. Today, sclerotherapy remains the gold standard for superficial varicose veins, reticular veins, and telangiectasias in the lower extremities. Its minimally invasive nature enables patients to resume normal activities quickly.

When Is Sclerotherapy Indicated?

Sclerotherapy is chosen for various venous conditions, especially cosmetic concerns. The technique varies by vein size and type:

  • Varicose veins
  • Spider veins
  • Reticular veins
  • Telangiectasias

These superficial structures can be treated with foam or liquid sclerotherapy. Sclerotherapy also addresses deeper or larger vein issues:

  • Saphenous vein reflux
  • Enlarged collateral veins
  • Perforator veins
  • Vascular malformations

Ultrasound‑guided sclerotherapy successfully treats these conditions, offering an important alternative for patients with serious venous disorders like deep venous insufficiency.

Additionally, sclerotherapy can be effective for advanced cases such as venous ulcers and chronic venous insufficiency. Foam sclerotherapy has been shown to outperform compression therapy in these situations, with high patient satisfaction and noticeable quality‑of‑life improvements.

Sclerotherapy is also indicated in special cases:

  • Active bleeding hemorrhoids
  • Hemorrhoids at high risk of major bleeding
  • Patients with HIV or AIDS

When Is Sclerotherapy Contraindicated?

Sclerotherapy should not be performed in certain conditions. Absolute contraindications include:

  • Allergy to a specific sclerosant
  • Active systemic infection or infection at the treatment site
  • Deep vein thrombosis
  • Severe peripheral arterial disease
  • Advanced collagen vascular diseases
  • Cardiovascular or neurological complications after prior sclerotherapy

Relative contraindications include:

  • Severely limited mobility
  • Predisposition to severe allergic reactions
  • Asthma
  • Severe deep venous insufficiency
  • Thrombophilia
  • Pregnancy or breastfeeding
  • Patent foramen ovale (risk of paradoxical embolism after foam sclerotherapy)

Extensive varicosities require careful consideration due to higher recanalization risk. In hemorrhoid treatment, sclerotherapy is contraindicated for thrombosed hemorrhoids, specific allergies, thrombophilia, inflammatory bowel disease, and severe organ failure.

How Should Patients Prepare for Sclerotherapy?

Patients and physicians engage in shared decision‑making before sclerotherapy. Possible side effects and risks are discussed in detail, especially in patients using disulfiram, minocycline, or oral contraceptives. The procedure is performed under sterile conditions, with the treatment area carefully prepped and draped. Patients are usually treated in a supine or seated position for optimal vein visualization. If ultrasound guidance is used, the device is set to vascular mode. Foam sclerosant preparation involves air mixing by the Tessari or double‑syringe technique. All preparations are completed meticulously before treatment.

How Is Sclerotherapy Performed?

Sclerotherapy needle
Sclerotherapy needle

Sclerotherapy treats varicose and spider veins, proceeding from larger to smaller vessels. A sclerosing agent is injected to occlude veins. The agent flows through the treated area into adjacent veins. Correct intraluminal placement is confirmed by aspiration before injecting the required volume. Key points:

  • In mild cases, a single session can treat all superficial veins in one leg; extensive involvement may require multiple sessions.
  • Careful technique minimizes hyperpigmentation and recanalization risk.
  • Needle size should be 30 gauge or smaller.
  • Sclerosant volume should suffice to blanch the vein.
  • Post‑treatment, patients rest in supine or seated position for a few minutes.

Post‑treatment care:

  • Apply bandages or compression stockings to the treated area.
  • Continue compression for seven days.
  • Encourage walking with compression garments.

What Are the Complications of Sclerotherapy?

Local side effects include pain, redness, and swelling after injection. Less common effects are itching, ulceration, telangiectatic matting, visible red capillaries, and increased hair growth. Approximately one‑third of patients develop skin hyperpigmentation, appearing six to eight weeks post‑treatment.

Local side effects:

  • Pain
  • Redness
  • Swelling
  • Itching
  • Ulceration
  • Telangiectatic matting
  • Increased hair growth
  • Hyperpigmentation

Systemic side effects include chest tightness and transient visual disturbances. Transient ischemic attacks, dizziness, and migraine‑type headaches (especially in migraine sufferers) have been reported. Inadvertent deep venous injection can cause these systemic effects.

Failure to fully obliterate the target vein may require additional procedures, minimized by prolonged compression. Complication rates do not differ significantly between foam and liquid formulations.

Systemic side effects:

  • Chest tightness
  • Visual disturbances
  • Transient ischemic attacks
  • Dizziness
  • Migraine‑type headaches

What Is the Post‑Procedure Course?

After sclerotherapy, bandages and gauze are applied to maintain vein closure and should remain for 24–48 hours. During this critical recovery period:

  • Avoid strenuous activities.
  • Avoid prolonged standing or sitting.
  • After bandage removal, wear compression stockings for 3–7 days, depending on vein condition.

What Are the Advantages of Sclerotherapy?

Sclerotherapy treats varicose and spider veins without anesthesia. Compression bandages minimize pain, bruising, and swelling. The method has high success rates for small varicosities:

  • No anesthesia required
  • Minimal pain with compression bandage reducing bruising and swelling
  • High success in small varicose veins
  • 50–80 % vein obliteration in one session
  • Capillaries resolve in 3–6 weeks
  • Larger veins may take 3–4 months to resolve

Frequently Asked Questions

Yes, Pilates is allowed after sclerotherapy. However, wait 24–48 hours and consult your doctor before starting any exercise. Low‑impact exercises are recommended in the first days to promote circulation and healing. Avoid strenuous or heat‑exposing activities, and wait at least one week before high‑intensity workouts. Avoid sun exposure.

Session number varies by vein extent and size. Typically, patients need 2–6 sessions. Mild cases may require 1–2 sessions; extensive cases may need 4–6. Allow 3–4 weeks between sessions to enhance efficacy.

Swimming is not recommended for at least 48 hours to reduce infection and complication risk. Avoid hot baths, saunas, and direct sun exposure for two weeks. Always follow your doctor’s timeline before water activities.

Yes, facial sclerotherapy treats spider veins and broken capillaries. Sclerosant injection shrinks veins, which are then absorbed. Results depend on vessel density and flow; treatment plan is individualized.

Foam sclerotherapy can cause allergic reactions, necrosis, infection, pain, and edema. Patients should consider these risks and seek detailed information before deciding.

Sclerotherapy is not covered by SGK. Patients with private insurance may claim costs depending on their policy. Verify coverage with your insurer.

Sclerotherapy is usually performed by vascular surgeons or dermatologists. Radiologists may perform ultrasound‑guided sclerotherapy. Internists or general surgeons can also offer this treatment, providing various options for varicose vein management.

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