Ultrasound guided sclerotherapy is used to close down deeper veins of the vessels that drain the skin veins. By injecting these vessels with an ultrasound imaging machine to guide the process major varicose veins can be treated.
Until the 1990s the deeper saphenous and perforator sourced varicose veins were treated by surgery. Some perforators were successfully managed by surface directed sclerotherapy.
About 1990 the French successfully developed the concomitant use of the ultrasound imaging machine to guide the injection of stronger sclerosant solutions.
The strongest strengths of solutions can be placed at the highest flow points to control problem areas. The result has been spectacular with even major varicose vein problems being able to be closed.
Microfoam Sclerosant Use
With the detergent-based molecule sclerosing agents it is possible to create a foam, as in dishwashing or bath foams. Some soft foams had been produced in over the years.
Some years ago a Spanish development of one of the common sclerosants was revealed as being useful to treat practically every type of varicose vein as well as some previously untreatable severe vascular malformations.
While many throughout the world have waited for the general release of this microfoam (delayed due to pharmaceutical considerations in its manufacture), an Italian team has developed an alternative microfoam with no alteration to the chemical structure of the solution.
With the presentation of this in 2000, many practitioners have embraced this new development with enthusiasm as it allows for the treatment of an even wider range of problem varicose veins with smaller doses of the medication. By displacing blood as it is instilled more effective coating of the treated vessels is achieved.
At Springdale we developed an enhancement of this by using some in-line 5u microfilters which creates the microfoam more rapidly and predictably. This has been reported in the literature by Dr Mitch Goldman and others.
These days our treatment of choice for the damaged larger draining veins is laser treatment inside these veins. The procedure is similar, using the ultrasound to access the veins. The laser energy is introduced by means of a fine fibre. Some anaesthetic is placed around the vein to mask the feeling of the heat generated.
Comparing outcomes, there is a lesser chance of the treated vein opening up again. The procedure using the laser takes longer and there is a higher cost associated with it. At your assessment I let you know the best approach for your problem.
Ultrasound guided sclerotherapy has been even more effective with the use of microfoams. It is still a mainstay of therapy with directed laser therapy proving even more superior for larger vessels.