Injection Variables

Fewer numbers of injections per treatment session are required with compression foam sclerotherapy compared to liquid sclerotherapy [20]. The distance between injection sites can also be increased.One or two injections per session are usually sufficient for large varicose veins [15].When choosing the optimal location for injecting telangiectatic and reticular veins, most phlebologists found no difference between the injection points for conventional liquid sclerotherapy and foam sclerotherapy. However, the injection points for long saphenous and short saphenous veins with the “open needle” (needle placement without the syringe being connected) and/or “direct puncture” techniques should be at the safest and most accessible location according to the pretreatment duplex examination. The distance to the saphenofemoral junction should be no less than 10 cm [15]. Most sclerotherapists treat varicose veins proximally to distally, starting with the largest veins (with reflux) before treating the smaller veins. After injection of the viscous foam into the vein, the foam column may be directed manually from the point of injection to other areas by repositioning the leg(s) or with manipulation of the duplex probe.

One of the greatest adjuncts for performing successful foam sclerotherapy is the use of DUS during the procedure. The recommended ultrasound frequencies should be between 7.5 and 13 MHz [15].


For the most part, the side effects of compression foam sclerotherapy are similar to those of liquid sclerotherapy, but some occur slightly more frequently with foam sclerotherapy, particularly migraine headaches in those patients with a history of migraine headaches, and transient visual disturbances in patients with patent foramen ovale [21].

Postsclerotherapy compression is highly recommended to avoid thrombus formation. However, it is suggested that a period of approximately 5 min postinjection should elapse before applying manual compression, to avoid propelling foam into the deep venous system. Follow-up treatment regimens for foam sclerotherapy do not appreciably differ from the general recommendations for liquid sclerotherapy.

As previously stated, foam sclerotherapy is a powerful combatant of varicose veins. In the hands of a specialist, foam sclerotherapy is effective and offers relatively few and mild side effects.Although opinions vary in regard to the details of treatment, general consensus has established certain protocols for foam preparation and treatment regimens.