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Foam
Sclerotherapy
State-Of-The-Art in Scleroptherapy:
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Foam sclerotherapy is a wonderful safe treatment for medium and large varicose veins. This rapidly evolving new treatment is the result of more than 20 years of work by few European physicians; notably Dr. Frullini of Italy (my instructor in foam sclerotherapy).
Foam sclerotherapy consists of an injection of small amounts of a sclerosing agent that has been transformed from liquid into foam by a rapid exchange of air and liquid sclerosing agent between two syringes connected by a small three-way valve.
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Why does foam-sclerotherapy
work better than liquid-sclerotherapy for medium & large varicose
veins?
With traditional liquid sclerotherapy, once the sclerosing
liquid is injected in a vein, it quickly dilutes with blood, resulting in decreased
concentration of sclerosing agent within the lumen of the target vein. Therefore,
an effective concentration of sclerosant is not staying in touch with the inner
surface of the vein for a sufficient amount of time in many cases. While foam
displaces the blood away and remains in contact with the inner layer of injected
veins for a longer and more effective period. This makes foam sclerotherapy
a much more effective treatment than liquid sclerotherapy. Furthermore, with
foam there is much less post treatment local pain, discomfort, and pigmentation
of the overlying skin. In summary, foam is much more effective and associated
with fewer side effects in the treatment of varicose veins. Nowadays, many European
pioneers of foam-sclerotherapy prefer foam over surgery, as presented at the
latest World Congress on Vein Disease in San Diego in the summer of 2003. Obviously,
physicians who lack experience in liquid-sclerotherapy and are not trained in
foam-sclerotherapy should not perform sclerotherapy.
Aside from Faom Sclerotherapy as described above, the latest major breakthrough in this field, and a successful safe treatment for varicose vein disease is endovenous laser occlusion of varicose vein, known as EVLT (EndoVenous Laser Treatment) and ELVeS (Endo Laser Vein System). This scar free treatment is performed in the office and without the need for general anesthesia. The patient can return to work the next day in most cases. This procedure consists of insertion of a thin laser fiber optic catheter in the varicose vein and positioning the catheter tip near the region of the incompetent valve. Then, while pulling out the fiber optic catheter, laser is delivered to the lumen of the varicose vein. Results of this form of treatment have been very promising. This treatment modality is considered to be a major breakthrough in phlebology that we have been awaiting
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This scar-free treatment is performed in the office and without the need for general anesthesia. Patients can return to work on the same or next day in most cases. This procedure consists of insertion of a thin laser fiber optic catheter, under local anesthesia, in the varicose vein and positioning the catheter tip near the region of the incompetent valve under ultrasound imaging. Then, while pulling out the fiberoptic catheter, laser is delivered to the lumen of the varicose vein. Results of this form of treatment have been outstanding.
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In my opinion, ELVeS / EVLT is the greatest breakthrough in phlebology that we have been awaiting for decades. During 2002-2006, I have performed more than 500 cases of ELVeS with 100% success rate, no important complications, and great patient satisfaction.
One other treatment that you may have heard of is VNUS Closure (using radiofrequency energy to close varicose veins). This treatment was approved by the FDA in 1999. Many doctors and patients are confused about choosing between EVLT/ELVeS and VNUS Closure. As one of the few physicians in the Bay Area who have experienced with both VNUS Closure and ELVeS, and based on my own experience with both treatment methods, I can mention the following:
Both of these treatments modalities can work well and are designed to be done at office setting and without the need to place the patient under general anesthesia. Thus, eliminating risks associated with general anesthesia and hefty costs associated with the use of operating rooms. Patients should be able to return to routine activities immediately after the procedure in most cases. As such, a great majority of my patients drive themselves back to work or home after their treatment and do not loose any work days.
The
end result is that in majority of cases both ELVeS/EVLT and VNUS Closure work
well for the treatment of great saphenous varicosities associated with SFJ incompetence.
But, in my opinion, there are some differences between the two that deserve
attention. I should add that while in my office I use ELVeS method (using 980nm
laser generator), I believe that all current endovenous laser systems produce
very similar clinical outcomes. When I personally compare ELVeS to VNUS Closure,
there are differences between the two treatment methods that have
convinced me to choose ELVeS over VNUS Closure:
1-
ELVeS (using a laser fiberoptic) is easier and faster than VNUS Closure.
2- ELVeS has a better success rate, especially
when treating larger veins.
3- Varicose vein size is practically not an issue
with ELVeS, while especially large varicose veins seem not to be a good candidate
for treatment by VNUS Closure.
4- Intravenous Heparin (a strong blood thinning
medication) is not necessary with ELVeS. However, Heparin use is an integral
part of VNUS Closure.
5- Cost of ELVeS catheter and ancillary products
is at least three times less than VNUS Closure. A cost saving that can be passed
on to patients.