Injection sclerotherapy is a treatment that intentionally damages the lining (endothelium) of veins by injecting a chemical into the vein and inducing a chemical phlebitis or inflammation. For this purpose, sclerosis liquid or foam sclerotherapy is used.

The advantage of foam over liquid sclerotherapy is that with a small amount of sclerosis (but high volume!), veins are better fulfilled, ie.foam “pushes” blood from the veins which results in enhanced and prolonged contact of sclerosis and vein wall. An especially important feature of foam derives from the presence of air bubbles in the foam, which represent a contrast agent for ultrasound. Therefore, ultrasound imaging can detect the passage of foam through the vein and track its spread.

This makes the procedure harmless because the dispersion of foam into deep veins and damage to the deep venous system and pulmonary circulation can be avoided. After the sclerosant agent damages the venous wall, further processes in the vein can go in two directions. Ideally, immediately, the damage ofvenous walls causesthe vein walls to stick together, and the inflammatory process leads to the fibrotic remodeling and definitive closure of the vein. However, in some cases, sclerotherapycan causemore or less pronounced thrombophlebitis, which can be manifested as induration, redness, warmth, and inflammation in the area of treated veins. After this second scenario, the possible outcome can be complete or partial vein thrombosis, but if essential, the vein can be completely reopened. If necessary, the procedure can be repeated.

After the treatment, it is necessary to wear an elastic bandage or elastic stocking.

What kind ofsclerotherapy treatment and what kind of compression?

There is no strongscientific evidenceto unambiguously indicate the type of compression (elastic bandage or elastic stockings) and duration it should be applied after sclerotherapy treatment.There is a distinction between the application of compression therapy after sclerotherapy of reticular veins and telangiectasia on one hand, and sclerotherapy of large veins on the other side.

Reticular leg veins and telangiectasias (“Capillaries”)

While some doctors do not use compression therapy after sclerotherapy of reticular veins and telangiectasiaa, some argue that the same principles as for sclerotherapy of large veins should be used. In practice, elastic stockings of compression ratio 1 or 2, or an elastic bandage are used. It has been shown that only three days of the application of compression therapy after the sclerotherapy of reticular veins and telangiectasia give better results than when compression therapy is not used. Some slightly better results can be expected if the compression therapy is applied for three weeks.

Venous varicosities

It has been shown that the optimal application of compression therapy after vein sclerotherapy foam improves the results of treatment. After vein sclerotherapy (foam sclerotherapy in most of the cases today), compression therapy can be applied, in the form of elastic stocking of compression ratio 2, which is patient custom-made. A therapeutic compression stocking has to be put on immediately after the procedure and worn for up to 5 to 7 days. Seven days after the surgery the patient is required to attend a check-up. It is highly recommended to wear the medical stocking, although the doctor will individually advise patients of the degree of compression of the stocking required.

What is the best method for me?

A varicose veins treatment plan should be made for each patient individually.

The method of treatment depends on the venous pathology in question. If it is only a case of localised extensions without Doppler signs of insufficiency of arterial or perforating veins, then a foam sclerotherapy or varicose vein removal (phlebectomy) is the best option. However, the situation can be more complicated if there is an insufficiency of these veins. In this case it is necessary to solve the insufficiency, which usually includes radiofrequency ablation therapy of the femoral part of the magnasaphenous vein (main superficial vein that runs from the ankle to the groin), or an additional sklerosisphlebectomy of the remaining branch varicose veins.

Sometimes, in order to achieve an optimal outcome, different operating (classical and endoluminal) techniques have to be combined. Therefore, the operator must be competent to treat varicose veins using not only endovenous treatmentbut also conventional surgical methods. Because every medical procedure, including vein surgery,has some potential complications, it is highly important that the person who is engaged in vein operations is able to recognise and treat any complications. Therefore, it is important for this person to be a vascular surgeon. They are trained to review the problem of varicose veins in all aspects and provide optimal treatment for varicose veins using all methods available to modern medicine and modern vascular surgery.
Each of these methods has its specifics and the patient should be familiar with each and every one of them. Taking into consideration not only the medical indications but also the wishes of the patient, an optimal method of treatment of varicose veins can be established for each patient.