NEW YORK (Reuters Health), Aug 30 - Ultrasound-guided foam sclerotherapy safely achieves complete occlusion in 91% of legs with varicose veins, according to a report in the British Journal of Surgery for August. Still, longer follow-up is needed to determine if the benefits are lasting.
A study reported in 1944 provided the first evidence that adding air to liquid sclerosants enhanced their efficacy in treating varicose veins. However, this concept received little attention until about a decade ago when researchers showed that sclerotherapy with foam was more effective than with liquid sclerosants, particularly under ultrasound guidance.
Previous reports looking at foam sclerotherapy for varicose veins have focused largely on the saphenous system, study authors Dr. S. G. Darke and S. J. A. Baker, from the Royal Bournemouth Hospital in the U.K., note. In the present study, the researchers assessed the outcomes of a consecutive series of patients, many of whom had extra-saphenous disease.
A total of 192 patients were referred for varicose vein treatment over a 15-month period. Eleven of these patients selected surgery, while the remainder chose ultrasound-guided foam sclerotherapy.
Ultrasound-guided foam sclerotherapy involved the use of polidocanol in a 1:3 mixture with air. Under ultrasound guidance, 1% foam was injected into superficial veins, while 3% was used for saphenous trunks. The maximum permitted foam volume was 14 mL.
Of the 220 legs treated with ultrasound-guided foam sclerotherapy, 163 showed complete occlusion of varicosities after one intervention. With a second treatment, 32 additional legs achieved complete occlusion and with a third, one more responded. Thus, overall rate of complete occlusion was 91%.
With the exception of two legs with great saphenous vein incompetence that failed ultrasound-guided foam sclerotherapy, the remaining legs without complete occlusion did achieve partial blockage.
The presence of small saphenous vein varicosities rather than great saphenous vein incompetence predicted treatment success after one session. Likewise, direct cannulation of the vein with Seldinger technique was more often successful than indirect butterfly cannulation.
Ultrasound-guided foam sclerotherapy was generally well tolerated and was not associated with any serious complications. Several patients experienced phlebitis and pigmentation, which could have cosmetic implications, but further follow-up is needed, the authors note.
While encouraging, "the results reported here are very early," the researchers point out. "It remains uncertain whether these early results will translate into similarly satisfactory longer-term outcomes, even if further injections are necessary."
Last Updated: 2006-08-29 12:57:41 -0400 (Reuters Health)
Br J Surg 2006;93:969-974.
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![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
