Foam sclerotherapy for varicose veins - London.

Foam sclerotherapy is an ultrasound-guided injection technique that closes varicose veins from the inside. A sclerosant, most commonly polidocanol or sodium tetradecyl sulphate (marketed in the UK as Fibro-Vein), is agitated with air or CO2 into a fine foam. The foam is injected directly into the refluxing vein under real-time ultrasound, displacing blood and causing a controlled inflammatory injury to the vein wall. Over the following weeks the vein fibroses, shrinks, and is reabsorbed by the body.

It is a recognised, evidence-based treatment for varicose veins, recommended by NICE alongside endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) as a first-line option for symptomatic varicose veins where duplex has confirmed truncal reflux. It is also the treatment of choice for many cosmetic thread veins and reticular veins on the legs.

A venous duplex ultrasound is done first, either at the same visit or beforehand, to map exactly which veins are refluxing and how the pattern connects. Without a duplex map, foam sclerotherapy is a guess.

On the day, wear a loose skirt or loose trousers you can slip on and off easily. Eat and drink normally. Take your usual medication. Blood-thinning tablets are almost never stopped for foam sclerotherapy. There is no need to fast. A lift home is a nice-to-have rather than a requirement: most patients drive themselves home or take public transport straight after.

Bring the compression stocking with you if a clinic has posted one out in advance, otherwise it will be fitted at the end of the session.

Foam sclerotherapy is a day-case, walk-in walk-out procedure. Total time in the treatment room is typically 30 to 45 minutes per leg. Local anaesthetic is not required for most patients, because the needles used are very fine and the injections themselves cause only a brief prickle.

You lie on the couch, the leg is scanned with duplex, and the target vein is identified. The consultant draws up the sclerosant, agitates it into a fine, dense foam using the Tessari technique, and injects it through a butterfly needle or short cannula directly into the vein under live ultrasound guidance. Several veins can be treated in one session.

Immediately after the injections, a class-2 graduated compression stocking is fitted from foot to thigh. You walk for 10 to 15 minutes around the clinic, get changed, and go home.

For truncal varicose veins, occlusion rates are typically 75 to 85 percent at 12 months. At 5 years, durability falls off compared with endovenous laser or radiofrequency ablation, and top-up sessions are often needed. This is the honest trade-off: foam is cheaper, gentler and more flexible, but less permanent.

For thread veins and reticular veins, the results are excellent, with most patients seeing significant fading over 2 to 3 sessions spaced 4 to 6 weeks apart. Complete disappearance is uncommon and a small proportion of new fine veins (matting) can appear.

A duplex review at 6 weeks confirms closure of the treated segments and identifies anything that needs a second session.

You walk out of the clinic straight after the session. Walking is actively encouraged for the rest of that day and every day of recovery, as movement of the calf muscle protects the deep venous system from clot formation.

The compression stocking is worn for 2 to 3 weeks. Some clinics recommend day-only wear from the outset, others day and night for the first week and day-only thereafter. Follow the individual clinic’s protocol. Avoid the gym, heavy lifting, running and hot baths for one week. Showers are fine.

Long-haul flights are best avoided for 4 to 6 weeks because of a small increased risk of deep vein thrombosis. Short-haul travel is generally fine after 2 weeks, with the stocking worn in flight and regular walking during the trip. Bruising and firm cords along the treated veins are normal and settle over 4 to 8 weeks.