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Varicose veins are swollen or mis-shapen veins that do not perform their function properly because they have abnormal valves. Normally, these valves help return blood to the heart. The most common area for varicose veins is the legs, although they can also occur in other areas such as the oesophagus, pelvis and ovaries, or the lower rectum and anus (haemorrhoids).
This condition is very common and affects both men and women. Up to 25% of the population may develop varicose veins on their trunk, and in women older than 50 years, some form of venous insufficiency may occur in more than 50%.
Their physical appearance can vary widely, from varicose veins on the legs (swollen cords of veins that bulge under the skin) to the cosmetically displeasing capillary dilatation or spider veins that usually occur on the thighs, legs and ankles. In very extreme cases, ulcers or wounds may develop on the legs, which can take a long time to heal and be very incapacitating.
Currently there are several forms of treatment for varicose veins, from surgery or phlebectomy (removal), to endovascular (inside the vein) treatment systems using laser, radiofrequency, mechanical-chemical occlusion and even gluing. Sclerotherapy is minimally-invasive and is probably the least aggressive and most versatile treatment currently available.
This medication is injected in the form of a foam, which is made by mixing a sclerosing agent with a gas. Normally this agent is polidocanol (POL) or sodium tetradecyl sulfate (STS) mixed with air.
There are several methods for preparing the foam, but until now the most commonly-used method has been that described by Lorenzo Tessari in 2001. View references
Sclerotherapy is a technique that can be used in practically all types of varicose vein, of any size and in any location, although larger veins have a higher risk of recurrence. From spider veins or subcutaneous capillaries to large varicose veins, all of them can be treated with sclerotherapy. This treatment can also be used in venous malformations.
Foam sclerotherapy treatment of large varicose veins is performed under ultrasound guidance: that is, using an ultrasound machine to view the procedure as it is done. The results have an effectiveness and safety comparable to some conventional surgical procedures, although the recurrence rate is higher and therefore requires a closer follow-up to monitor for new varicose veins (recurrences).
The great advantage of this treatment in comparison with other procedures is its flexibility and scope for personalisation, and that it is performed as an outpatient procedure without interfering in daily activities.
Probably no other treatment or technique offers so many possibilities.