At present, foam sclerotherapy is approved in Austria, Belarus, Belgium, Cuba, France, Germany, Hungary, Italy, Iraq, Japan, Jordan, Lebanon, Luxembourg, Netherlands, Portugal, Russia, Spain, Sweden, Ukraine and United Kingdom. The development of Duplex-Guided Sclerotherapy in connection with foam sclerotherapy has resulted in a renaissance of this method as a minimally invasive treatment for larger varicose veins such as tributaries and the saphenous veins. The technique involves injecting foamed sclerosants into the affected veins. In several studies, higher efficacy was shown with foam compared to liquid.
To a large extent, effect of sclerotherapy depends on how long the agent remains in direct contact with the targeted vein wall. Equally important for the success of the treatment is the ratio between the diameter of the varicose vein and the concentration of the sclerosing agent.
Foam is more effective because the foamed sclerosant is able to displace blood, thereby maximizing the contact time and the surface area between the sclerosing agent and the vein endothelium without dilution effects for an extended period of time. Compared to liquid sclerotherapy, this effect allows lower concentrations and volumes to be used to achieve a successful treatment of larger varicose veins. In addition the foam is visible via ultrasound imaging and can be easily tracked and guided to the source of the venous problem.
This method is effective, safe and easy to use for experienced medical professionals.8 In general, sclerotherapy requires a minimum of equipment. However, some training is recommended to acquire the essential skills before commencing the treatment.
Preparation of foam sclerosants
Only detergent sclerosants such as Aethoxysklerol® can be converted into Aethoxysklerol®microfoam. To produce the Aethoxysklerol® microfoam, the liquid sclerosant is mixed with a small quantity of a gas such as air. Standardized Aethoxysklerol® microfoam is prepared using the EasyFoam® kit which contains two syringes and a special bidirectional check valve. One syringe is prefilled with sterile air to produce an optimal gas to liquid ratio of the mixture. After aspiration of liquid Aethoxysklerol® into the second syringe, the two syringes are connected and the entire content is pumped 20 times without interruption from one syringe into the other. This standardized method produces a stable, homogenous and viscous microfoam with fine bubbles.
Lauromacrogol 400 (polidocanol) foam is indicated for the treatment of medium sized and large varicose veins
A multi-center, randomized study (ESAF)9 was conducted to prove the efficacy and safety of foam sclerotherapy for treatment of the great saphenous vein. In the study, patients with incompetent great saphenous veins were treated either with Aethoxysklerol® microfoam 3% using the EasyFoam® kit, or with liquid Aethoxysklerol® 3%. After injection of standardized Aethoxysklerol® microfoam a significantly larger number of patients (69%) was successfully treated than in the group (27%) treated with liquid. Reflux time, refill time and patient satisfaction improved to a significantly better extent with Aethoxysklerol® microfoam. No difference in safety was observed between the two treatment groups. For more studies please contact us.
Sclerotherapy is known to have few side effects if it is performed properly. These complications include hematoma, allergic reactions, necrosis, skin hyperpigmentation, matting and superficial thrombophlebitis.
For a complete overview of side effects and contraindications, please download the Summary of Product Characteristics.
Please note: Not all concentrations and indications are available in every country. Trade names may vary from country to country. Information on this website is based on German Summary of Product Characteristics.
Please refer to your national marketing authorization.
8 Breu FX., Guggenbichler S., Wollmann JC. 2nd European Consensus Meeting on Foam Sclerotherapy 2006, Tegernsee, Germany. Vasa 2008 37 Suppl 71: 1-29.
9 Rabe E. et al. Efficacy and Safety of Great Saphenous Vein Sclerotherapy Using Standardised Polidocanol Foam (ESAF): A Randomised Controlled Multicentre Clinical Trial. Eur J Vas Endovasc Surg 35 2008; 238-245.