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Ultrasound Guided Foam Sclerotherapy (UGFS)
Ultrasound guided foam sclerotherapy (UGFS) has recently been approved by BUPA for the treatment of varicose veins. The treatment must be provided by a recognised practitioner who has undergone a formal course of training.
Ultrasound guided foam sclerotherapy uses ultrasound to identify veins in the legs. The superficial veins which become varicose veins can then be filled with foam. The foam is made from a mixture of air, carbon dioxide, sodium tetradecyl sulphate or polidocanol.
The foam once injected into the veins reacts with the vein wall causing a controlled form of thrombophlebitis. This will damage the vein wall. The air is absorbed from the foam and the vein walls collapse giving rise to a fibrous thread replacing the original vein. The vein and the fibrous tissue are then destroyed by the bodies own immune system getting rid of the vein.
The technique is suitable for people with medium sized veins and particularly suitable for patients who are unsuitable to undergo any form of anaesthesia.
The technique is particularly useful for the management of recurrent short saphenous vein problems and in patients who have had multiple surgical procedures.
The procedure is associated with some problems. These problems include pain, recurrence and some skin pigmentation. Using a careful technique and good compression these complications can be minimised.
Venous Fast
This is a radiofrequency catheter which can be inserted into the veins using either local or general anaesthetic.
When a general anaesthetic is used it is still necessary to infiltrate fluid around the vein to create a puddle in which the vein is situated. Radiofrequency current is then applied to the vein and under ultrasound control the vein is seen to collapse.
The technique damages the inside of the vein and again the bodies own immune system will destroy the veins.
The technique in many ways is similar to endovenous laser treatment (EVLT). The heat applied using Venous Fast is generated by a radiofrequency generator until EVLT where the heat is applied using a laser fibre.
A number of studies have been carried out suggesting that the laser technique is more painful than the venous fast technique.
Both techniques can be associated with residual veins which may require removal either by an ultrasound guided foam technique or multiple ministab avulsions.