Guide to Successful Foam Sclerotherapy for Varicose Veins. Live Demonstration.

Essential steps to successful ultrasound guided foam sclerotherapy. In this live demonstration, I show you step by step how I cannulate a vein and inject foam sclerotherapy. Here are my tips.
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I am going to do the foam sclerotherapy now. I like to do perform foam sclerotherapy using a “Blue Butterfly” (cannula). It is called a “Blue Butterfly Cannula” because it has a passing resemblance to a butterfly and it is blue (in colour), which means that it is a 23 gauge (size) cannula. It has a piece of transparent tubing which allows me to see that I have cannulated (the vein). The butterfly wings allow me to use very delicate movements as if writing with a pen. So it is very easy in my opinion to cannulate small veins with a blue butterfly (cannula). Ok, so I am going to do it in the standard way and I am looking at the “offending vein” -the target vein- in transverse section (my preferred method) I am going to use the butterfly needle to cannulate the vein. It is a very fine needle so it shouldn’t cause too much in the way of discomfort. The vein is 2 millimetres in diameter that we are cannulating. Here we have got confirmation that we are in the vein by the very slow movement of dark blood in the vein. So, 3 criteria for successful cannulation have been passed. I have seen the tip of the cannula inside the vein on ultrasound - that is criterion number one. Number 2, I have seen dark blood come back suggesting we are in fact in a vein - it is not bright red. And criterion 3 is that (the blood in the tubing) is non-pulsatile - suggesting we are not in an artery. I don’t wish to cause Carole (the patient) any alarm, but in the event that an artery was cannulated and injected, the consequences could be disastrous. So I am very careful - when using the cannula- we have those strict criteria to confirm before we do any injections of foam sclerotherapy. The final criterion - and we are very cautious about this - is that we see the foam in the vein (on ultrasound) and also that the injection is painless. This should cause Carole no pain whatsoever and we can see the foam going into the vein - confirmed on ultrasound. So now have in total 4 criteria for successful cannulation and injection of foam sclerosant. I very frequently combine foam sclerotherapy with laser and phlebectomy all in one session. I think it is very safe and it deals with any veins that are slightly deeper in the leg that may not be accessible to laser or phlebectomy . I have no evidence yet to suggest that it reduces the recurrence rate but a priori (reasoning) would suggest that it does.

[@vicentetorres1880]

Great explanation.
Greetings from Mexico

[@arminmarashizadeh5540]

Thanks dear professor for your educative video, what is your choice for FS in veins that sit deeper and you can not cannulate with blue cannula?

[@VeinCareAcademy]

Thank you for your kind feedback. If the veins are deeper, I use a longer cannula eg Venflon

[@Desikitchen031]

I had same treatment n i m much better than before

[@small-timegarden]

Hello thank you for the video. I would like to ask a question please. How it's. How do you avoid sclerosant going into the deep system of veins? Thank you very much

[@rolansanchez7046]

Is the liquid used the same with the dextrose liquid used in dehydrated patients injected in the veins during hospitalization?

[@mohamedahmed1023]

Is bruising, swelling, and tenderness a month or so after the injection specifically at the site of the injected vein (not generalized) okay?

[@ngz2842]

Yes there will be a black mark around the injected area

[@cherry-annfrancis-lau3392]

Does this cause nerve damage