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History of Foam Sclerotherapy Treatment of Varicose Veins

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Foamed sclerosant inside a vein: Once foam is introduced into the vein, it is hyperechogenic on ultrasound. In this picture, a La Jolla Vein Care doctor points to the foamed medication inside the vein. Notice it appears ‘white.’

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Foamed sclerosant used for sclerotherapy has a ‘foam’ or frothy-like appearance.

In 1994 and 1950, E.J. Orbach introduced the concept of a macro bubble air-block technique to enhance the properties of sclerosant in performing macrosclerotherapy.  Apparently, few vascular surgeons were interested in the subject and the technique languished.  The work of Juan Cabrera and colleagues in Spain attracted attention of some vein specialists and interest in the use of foam technology in treating venous insufficiency was reawakened. Administration of foamed sclerosant was reintroduced in the early 1990s by Cabrerra, who summarized a broad experience in 1997. By the 1990’s, broad use of diagnostic ultrasound imaging made it possible to monitor foam distribution with ultrasound scanning. Some 40 years earlier, and before the development of ultrasound scanning, foam had been used in Germany to treat varicose veins.  At that time, foam was made by special syringes and its distribution was assessed by touch, instead of ultrasound scanning. Tessari , prior to the year 2000 developed an easy way of making liquid sclerosant into foam using two syringes and a three-way stop cock.   By 2000, Sica was able to report a three-year experience using foamed sclerosant in treating saphenous varices.  Since that time, foam has appeared increasingly in general use. Around 2000, Dr. John Bergan began describing the utility and success of foam treatment to physicians in the United States and can be attributed to bringing its awareness to North America. Over the past decade foam has gained world-wide popularity for the treatment of varicose vein tributaries in place of surgery. Varithena foam was recently FDA approved to treat the great saphenous vein with foam sclerotherapy.  Dr. Bergan predicted that microfoam sclerotherapy will eventually replace all other methods.  Presently, it is most commonly used as an adjunct to endovenous ablation of the great and small saphenous veins or as a sole treatment for surface varicose veins.

Am I Too Old? Varicose Vein Treatment at Any Age

We’re often asked, ‘Am I too old to treat my varicose veins?’  The answer is no. Since modern varicose vein treatments are largely non-surgical, there are appropriate treatment options for those of any age. While varicose veins are more common with each decade of life, they can appear on young teenagers or at any time in older adults.    For active older adults, addressing varicose vein conditions is even more important to maintain healthy legs.    Otherwise, symptoms of leg heaviness, fatigue, swelling and pain can slow you down.  There are other complications of untreated varicose veins such as superficial thrombophlebitis, varicose vein rupture and leg ulceration, in severe cases.  There are a variety of minimally invasive treatment options for varicose veins, and depending on the individual preference, severity of the condition and the veins affected will help you and your doctor determine the best treatment course.

This is a 90 year-old female who wanted her varicose veins treated because they were bothersome to her when she played tennis and she didn’t like the way they look. These varicose veins were treated with painless injections, given at two treatment sessions. This is called foam sclerotherapy treatment of varicose veins.
The after picture is at one month following the varicose vein injections (foam sclerotherapy). She tolerated the treatment well and she was able to return to normal activities right away, with the main restriction being wearing compression stockings for several weeks.

 

New Foam Treatment of Varicose Veins

In November of 2013, the US Food and Drug Administration (FDA)  approved Varithena,™   a new type of foam treatment for the treatment of patients with incompetent veins and visible varicosities of the great saphenous vein (GSV) system. Varithena is a pharmaceutical-grade, low-nitrogen, polidocanol foam dispensed from a canister device. In two pivotal, placebo-controlled Phase III trials, VANISH-1 and VANISH-2, Varithena achieved a clinically meaningful improvement in the symptoms of superficial venous incompetence and the appearance of visible varicosities and addressed the underlying venous incompetence in the majority of patients treated. Varithena (polidocanol injectable foam) is a sclerosing agent indicated for the treatment of incompetent great saphenous veins, accessory saphenous veins and visible varicosities of the great saphenous vein system above and below the knee.  Varithena improves the symptoms of superficial venous incompetence and the appearance of visible varicosities.  Treatment is a minimally invasive, non-surgical procedure that requires neither tumescent anesthesia nor sedation.  Foam sclerotherapy has been used for years by medical doctors. What is new with Varithena , is that the foam is pre-made with low-nitrogen as opposed to room air, and is dispensed in a proprietary canister.   It is not yet available in doctors offices. Making Foam

Dr. Oz Show Highlights Foam Sclerotherapy Treatment for Varicose Veins

The June 1st episode of The Dr. Oz Show brought attention to foam sclerotherapy. He describes it as latest, most advanced technique to eradicate painful, varicose veins. Dr. Oz’s guest demonstrated how the procedure is performed: He used a vein light to visualize the veins, followed by a painless injection of a foamed solution. He also mentions that the old Varicose Vein Treatments hurt because of the saline solution that used to be used, but newer solutions such as polidocanol, are nearly painless.

We’re pleased that Dr. Oz brought much need attention to foam sclerotherapy, as we have been using it as an alternative to surgery for years. What most people don’t realize is that foam sclerotherapy is not new, but rather newly recognized. Foam sclerotherapy offers patients a non-surgical alternative for the treatment of varicose veins. There is essentially no down-time and return to normal activities is immediate.