Patient information on Ultrasound guided foam sclerotherapy for the treatment of varicose veins (in the leg)

Who this leaflet is for and what is its aim?

This leaflet is for patients who have been diagnosed with varicose veins and have been recommended to have ultrasound guided foam sclerotherapy.

This leaflet aims to explain the procedure and its risks.

Background Information

Varicose veins are very common, affecting at least 20-40% of the adult population in the UK. This condition can be painful and in certain cases if untreated, can lead to leg swelling, pigmentation of the skin of the lower leg, and ulcers. There are a number of ways that varicose veins can be treated – endothermal treatment, sclerotherapy, open surgery and conservative treatment.

You have been recommended to have open surgery to remove these varicose veins. It is assumed that you have had a conversation about the suitability of these different techniques of treating your veins in the clinic with the vascular surgery team in charge of your care (see below).

The great saphenous vein starts at the ankle, runs underneath the skin of the calf and thigh, and ends in the groin. In the groin, the great saphenous vein connects with the femoral vein (in the deep system of veins).

The small saphenous vein starts at the back of the foot, runs underneath the skin of the calf, ending behind the knee (at a variable level). Behind the knee, the vein connects with the popliteal vein (in the deep system of veins).

Veins in the legs drain blood from the foot back to the heart. This is driven by your muscles pumping the blood up against gravity, and the veins have delicate one-way valves that prevent blood flowing back to the foot.

In varicose veins these valves become incompetent, and blood flows back to the foot leading to higher vein pressure and the signs and symptoms of varicose veins.

The Procedure

Sclerotherapy or injection of varicose veins is a procedure designed to close your varicose veins in order to prevent further damage to your skin and hopefully avoid ulceration. It may also improve the swelling or discomfort associated with varicose veins.

If you have an ulcer, this treatment may speed up the healing process and will reduce the risk of the ulcer returning by around 50%.

The veins are injected with a solution called a sclerosant which damages the internal lining of the vein and “sclerosis” and inflammation of the vein. In time your own body will then destroy the vein and it will disappear. The solution normally used for this procedure is called sodium tetradecyl sulphate (STS), which is a detergent and is available in different concentrations depending on the size of the vein being treated. The sclerosant is mixed with air to create a foam which helps it be more effective.

Are my veins suitable for foam injection sclerotherapy?

Most patients with varicose veins are potentially suitable for this form of treatment. If you have very extensive and very large varicose veins then other treatments may be preferable to sclerotherapy. Your surgeon will advise you on this. If you have any underlying blood clotting tendency it may not be advisable to have sclerotherapy.

Before your procedure

On the day of your treatment you will attend clinic. The date and time will be confirmed with you. Please eat and drink as normal before the procedure – this helps the veins fill as much as possible. The whole process will take around 30 minutes but occasionally longer. In addition, because treatments can be unpredictable, there may be a wait of an hour or so before your treatment

Should I continue my normal medication before treatment?

This depends on your own situation. We would normally advise you to stop taking the combined oral contraceptive pill or hormone replacement therapy tablets one month before the foam sclerotherapy treatment. This is to reduce the risk of deep vein thrombosis (DVT), which can be increased if you are taking medicines containing the hormone oestrogen.

Please inform your doctor at the hospital if you are taking warfarin, apixaban, edoxaban or rivaroxaban or similar blood thinning medication, as sometimes this may need to be stopped before your procedure though this is rare.

During your procedure

Depending on the number of varicose veins you have, you may need one or two sessions of treatment and, very occasionally, more than this. The main surface vein to be treated will be checked initially, using ultrasound scanning.

A needle will be placed into the vein, again using ultrasound scanning. This will be flushed with a salt solution to keep the needle open. Typically, a further two or three small needles (alled butterfly needles) will then be inserted into the varicose veins in the leg and these will be similarly flushed.

Your leg will then be elevated by tipping up the couch you are lying on and the foam solution will be injected in small volumes via each of the needles. You may experience some slight stinging as the foam is injected but it is usually painless.

The passage of the foam in the vein will be monitored by ultrasound scanning and the foam injections into each needle may need to be repeated two or three times.

Once enough foam has been injected the needles will be removed, pieces of gauze will be applied to your leg initially. The surgeon may then choose to apply a compression stocking or a bandage, in order to compress the treated veins. This will feel tight but will not be so tight as to make your foot discoloured, painful or lose sensation. If this does occur, please remove the bandage and the stocking. The stocking or bandage act to reduce pain after treatment rather than affect how well the treatment works.

Getting about after the procedure

Once your procedure is completed you will be able to walk back to the waiting area. You should stay in the waiting area for around 15 minutes, after which you can go home.

Leaving hospital

The operation is usually performed as a day case. You should be able to walk in and out of the treatment room without significant issues.

Resuming normal activities including work

If you normally drive, you may find it difficult to drive home with your stocking and bandages on and so should arrange for someone to accompany you.

You should do plenty of walking and generally may do most normal activities without any problem.

We would advise that you do not plan any long-haul flights (three hours) within six weeks of your treatment (to minimise the risk of DVT). If in doubt, ask your treating team at the hospital. We will send your GP a letter about the treatment you have undergone.

Special measures after the procedure

Self-adherent compression bandages, or non-adherent crepe bandages, can be removed usually after 24 hours (this will be guided by the surgeon performing the procedure).

Once the bandages are removed, you may be given a pair of compression stockings to wear for a week, or until the legs feel comfortable. The purpose of the stockings is to support the leg, to help blood flow through the deep veins of the leg and to reduce the amount of bruising and tenderness.

At night, the stockings can be removed if this is more comfortable.

If you are still concerned, please call the daytime number for the hospital given to you on the information sheet, the Cambridge Vascular Unit Vascular Specialist Nurses, or you can call your GP.

Intended Benefits

To prevent further damage to your skin and hopefully avoid ulceration. It may also improve the swelling or discomfort associated with varicose veins.

Alternatives

Foam sclerotherapy has been in widespread use in the NHS for at least 20 years. The National Institute for Clinical Excellence (NICE), now recommend the use of foam sclerotherapy before surgery is considered. Some techniques are better suited for some types of veins than others, and your surgeon will have weighed up the benefits of other treatments in your case.

The alternative treatments include heating and sealing the vein under local anaesthetic (also called endothermal ablation, laser ablation, radiofrequency or VNUS ablation, or sealing the vein using medical glue) or surgery (saphenous vein stripping and avulsions). Occasionally, patients are suitable for one or more of these, but there is often one treatment that will suit your particular vein type more than the others.

If you think you want to consider one of the other therapies, please contact the Vascular Surgery team before your day of treatment as it is often not possible to switch treatments on the day planned for your operation

Medication

Bring all of your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP

Please tell the ward staff about all of the medicines you use. During your stay If you wish to take your medication yourself (self-medicate) please speak with your nurse. Pharmacists visit the wards regularly and can help with any medicine queries.

My Chart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

More information is available on our website: MyChart

Contacts

Do feel free to contact the Cambridge Vascular Unit Specialist Nurses on 01223 348526 or Email Cambridge Vascular Unit if you have any questions or anxieties.

Sources of evidence

• The Vascular Society Website: The Vascular Society (opens in a new tab)
• The circulation foundation website: Circulation Foundation UK (opens in a new tab)