ULTRASOUND GUIDED SCLEROTHERAPY

FOAM SCLEROTHERAPY:

It is an adjunctive treatment modality. It is preferred for persistent varicose veins that do not respond to or persist after primary treatment. Foam sclerotherapy or liquid sclerotherapy is preferred depending on diameter of the varicose vein. In foam sclerotherapy that is used for middle-sized and large varicose veins, sclerosing agent is mixed with air and the resultant foam is administered into the lumen. Since foam has poor interaction with blood, it is more efficient than liquid sclerotherapy. Moreover, the foam can be directed to the target vessel by positioning the leg and the outcome can be verified with an ultrasound test. Foam sclerotherapy can successfully eliminate even giant varicose veins due to its superior efficiency. Sclerotherapy is a practical and pain-free procedure, but disappearance of varicose veins takes longer time. Here, the issue is to use ultrasound guidance in order to administer those agents, which occludes the lumen by shrinking the vessel, in a controlled manner. Otherwise, those agents can migrate to deeply located systemic veins. They may cause formation of clots in those vessels and result in pulmonary embolism, albeit rare. The second issue is to avoid overdose in a session, since the agent may trigger various side effects beyond recommended doses. While this method has no serious side effect, if it is applied by experienced physicians, it also makes significant contribution to cosmetic outcomes.

Foam Sclerotherapy Technique:

1. After treatment of damaged vessels that are the underlying cause of the condition is completed, a tiny needle is inserted to rest varicose veins under ultrasound guidance.
2. A foamy sclerosing agent (that shrinks vessels) is administered into the lumen of the vein.
3. The leg is positioned according to ultrasound images and it is ensured that the foam occludes all varicose formations.
4. After treatment is applied, size of varicose veins is gradually reduced by the body and it usually takes several months to see final outcomes.

LIQUID SCLEROTHERAPY:

Color Doppler Ultrasound can visualize deeply located veins that leak blood in most people with capillary varicose veins. If we consider capillary varicose veins as branches of a tree, it is the root of the tree that is the main underlying cause of the leak and should be treated.

For treatment of capillary varicose veins, Doppler ultrasound test plays a significant role to identify those feeder vessels. When sclerotherapy is applied to a branch, both feeder vessel is occluded and one injection enables management of all capillary varicose veins that are located in a large area.

Liquid Sclerotherapy is similar to Foam Sclerotherapy.

After sclerotherapy is properly applied, “superficial capillary varicose vein treatments” should be employed for the rest capillary varicose veins or ones that have no feeder vessel to be occluded by sclerotherapy. Recently, two methods are available for this purpose.

1. Superficial Transdermal Laser
2. Radiofrequency thermocoagulation

Since Superficial Transdermal Laser requires penetration of laser beams into skin, color changes are likely. It is necessary to avoid exposure to sun. It should not be preferred especially in summer due to those side effects.

For radiofrequency thermocoagulation, a thin needle is inserted into capillary varicose veins through the skin and radiofrequency energy is delivered. It is an efficient novel method and becomes popular gradually. Side effects of laser therapy are usually not the case. Moreover, it can be applied in hottest days of summer and one may swim in the sea the day after, since it is not necessary to avoid exposure to sun.