Ultrasound-Guided Sclerotherapy

WHAT IS ULTRASOUND-GUIDED FOAM SCLEROTHERAPY?
This treatment method is commonly known as foam therapy or needle therapy. It is a complementary treatment procedure, usually performed in addition to laser or radiofrequency ablation treatments. It is used to treat varicose veins that persist on their own after treatment of large, damaged veins. The treatment choice depends on the size of the varicose veins, and either foam sclerotherapy or liquid sclerotherapy is applied.

In foam sclerotherapy, a sclerosing medication is mixed with air to form a foam and administered intravenously. Because the foam mixes less with blood, it is more effective than liquid sclerotherapy. Furthermore, by positioning the leg, the foam can be directed to the desired vein and visualized with ultrasound. Because it is more effective, foam sclerotherapy can successfully treat even very large varicose veins. Sclerotherapy is practical and painless, but it takes some time for the varicose veins to disappear.

WHAT ARE THE RISKS OF FOAM SCLEROTHERAPY?
Although foam sclerotherapy has been used for many years, it carries some significant risks. Ultimately, you are injecting a powerful drug intravenously, which destroys the vein by chemically damaging it. The most important thing to remember here is to ensure that the administered chemical doesn't reach the deep veins we don't want it to reach. To achieve this, the veins that will play a role in the passage to the deep veins must first be sealed with heat-based methods such as laser ablation or radiofrequency ablation.

In some cases, heat-sealing the saphenous veins alone isn't sufficient, as there are many connections between the varicose veins that rise from the skin and the deep veins. In these cases, the risk of the administered chemical passing into the deep veins has been a major concern for doctors treating varicose veins worldwide. We developed a technique to address this issue and published it under the title "Fill and Aspirate Foam Sclerotherapy."

In our article titled "Fill and aspirate foam sclerotherapy (FAFS): A new approach for sclerotherapy of large superficial varicosities concomitant with endovenous laser ablation of truncal veins," published in Clinical Radiology, one of the world's most prestigious journals, we published our technique, which significantly reduces this risk in foam sclerotherapy treatment of large-diameter veins. Those interested can access the details of our article by clicking the following link (https://www.ncbi.nlm.nih.gov/pubmed/25446324).

If the chemical we administer passes into unwanted veins in large amounts, it can cause clots in these veins and, in rare cases, can cause clots to travel to the lungs. A second point to be careful about is not to exceed the recommended dose in a single session, as these medications can have various side effects after a certain dose. Don't let this intimidate you; in experienced hands, this method has no serious side effects and significantly contributes to the desired cosmetic results.

How is Foam Sclerotherapy Performed?
After laser ablation or RF ablation of the primary damaged veins of large veins has been completed, a very fine needle is inserted into the remaining varicose veins using ultrasound guidance. A sclerosing chemical is then injected into the vein, creating a foam-like substance that shrinks the veins, allowing the foam to fill all the varicose veins.

After treatment, the body gradually reduces and eliminates the varicose veins. While the varicose veins disappear quickly, the scars on the skin, especially in dark-skinned patients, may take several months to fade.

WHAT IS LIQUID SCLEROTHERAPY?
Some people with capillary varicose veins have no problems other than the subcutaneous vessels. In others, color Doppler ultrasound can reveal deeper leaking vessels that cause capillary varicose veins. If we think of capillary varicose veins as branches of a tree, treating the root of this tree and the vessel that is the primary source of the leakage will significantly increase success and provide a satisfactory cosmetic result.

If the problem is solely subcutaneous narrowing, a simple cosmetic treatment can achieve a satisfactory result. However, if there is a leak in a deeper vessel and the capillary varicose veins are associated with this vessel, it is important to identify these feeding branches with a Doppler ultrasound before treating the varicose veins. If ultrasound-guided sclerotherapy is performed in such a patient, both the feeding vessel is sealed and all capillary varicose veins in a large area can be treated with a single injection.

How is Liquid Sclerotherapy performed? How does it differ from Foam Sclerotherapy?

In fact, it's not a different method from foam sclerotherapy. The chemicals used are the same. However, this chemical isn't mixed with air to create foam; it's administered directly into the vein as a liquid. For capillary varicose veins remaining after laser ablation and foam sclerotherapy treatments, or for superficial capillary varicose veins that lack a feeding branch to be closed with sclerotherapy, liquid sclerotherapy = needle varicose vein treatment = superficial capillary varicose vein treatments should be applied.

This is the most commonly used superficial capillary varicose vein treatment today. However, in some cases, there are two other treatment methods that don't use chemicals.

1. Superficial Transdermal Laser
2. Radiofrequency Thermocoagulation

These treatments have some disadvantages. For example, superficial transdermal laser therapy can cause color changes because the laser must pass through the skin. Sun exposure should be avoided. Due to these side effects, it should be avoided, especially during the summer months.

Radiofrequency thermocoagulation involves passing a thin needle through the skin to reach the capillary varicose veins and delivering RF energy. It is a new and effective method that has become increasingly popular in recent years. The side effects of laser therapy are generally not observed with this method. Furthermore, since sun exposure is not required after treatment, it can be applied even on the hottest days of summer, and patients can swim the next day.