Ultrasound Guided Foam Sclerotherapy (UGFS)

Non-surgical vein closure procedure
for varicose veins & venous insufficiency.

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Ultrasound guided foam sclerotherapy (UGFS) is a minimally invasive method of closing off unwanted veins. It is a type of nonthermal vein ablation that does not require heat from a laser. Instead, a chemical foam, called a sclerosant agent, is injected into the vein. Because the foam has tiny air bubbles in it, ultrasound imaging can be used to accurately guide its placement. The foam displaces blood and irritates the vein walls, resulting in dehydration, inflammation, and eventual closure of the vein. The unwanted vein fades in appearance, and blood is rerouted through other healthy veins.

Foam sclerosant was approved for use by the FDA in 2013, and since its approval, sclerotherapy with foam has been commonly used to treat venous reflux in the great saphenous vein. Foam sclerotherapy with ultrasound guidance can be used to treat both the cosmetic appearance of large varicose veins (≥6 mm) as well as the persistent symptoms of vein disease such as swelling and pain.

VIP Vein Specialist performing the ultrasound guided foam sclerotherapy (UGFS) procedure in Visalia, CA
The ultrasound guided foam sclerotherapy (UGFS) procedure.

VIP: Your UGFS Providers in Visalia, CA

We are VIP Specialists, and we’re to help you get your legs back to health. Our Vascular and Interventional Specialists provide a full suite of screening, diagnostic, and treatment services for spider veins, varicose veins, and more advanced stages of venous insufficiency.

Our vein treatment center is conveniently located in downtown Visalia, California at the corner of Locust Street and East Acequia Avenue. Schedule your visit today!

Dr. Ashkan Shahkarami

Vascular & Interventional Specialist

UGFS procedure provider Dr. Ashkan Shahkarami in Visalia, CA

Dr. Bennett K. Abe

Vascular & Interventional Specialist

UGFS procedure provider Dr. Bennett K. Abe in Visalia, CA

Dr. Francisco E. Valles

Vascular & Interventional Specialist

UGFS procedure provider Dr. Francisco E. Valles in Visalia, CA

Dr. Glade Roper

Vascular & Interventional Specialist

UGFS procedure provider Dr. Glade Roper in Visalia, CA

Dr. Daniel Hightower

Vascular & Interventional Specialist

UGFS procedure provider Dr. Daniel Hightower in Visalia, CA

UGFS Procedure in Visalia, CA

Vascular & interventional Procedure (VIP) Specialists Logo, Visalia California
Legs with visible varicose veins and skin color changes in the feet
Woman with varicose veins on one leg
Leg with visible swelling and bulging varicose veins caused by venous insufficiency
Legs with varicose veins and skin color changes caused by vein disease

What Happens During the UGFS Procedure?

To start, Polidocanol Endovenous Microfoam (PEM), is injected into the desired vein with a 27 or 30 gauge needle. Sometimes, gas is also injected into the foam mixture. The extremity where the vein is located might be elevated to aid the distribution of the foam mixture. Ultrasound is used to visualize the location of the foam. In large veins like the great saphenous vein, foam is repeatedly injected until a syringe aspirates no more blood. In total, UGFS takes 30-60 minutes to complete.

When is UGFS the Right Treatment?

Foam treatment is most effective in treating varicose veins that are large, lie deep below the surface of the skin, and are highly branched or twisted [1, 2]. Tortuous varicose veins, superficial veins, recurrent veins, and partially occluded varicose veins are all types of veins that can be treated through ultrasound-guided sclerotherapy with foam. It is important to keep in mind that multiple treatment sessions may be necessary for complete vein clearance. In addition, adverse reactions to treatment are possible.

Still, most patients are able to tolerate UGFS. Common contraindications for vein treatment include pregnant women, individuals at increased risk of clotting, and patients with known patent foramen ovale. A Vein Specialist at VIP can help you determine if ultrasound guided foam sclerotherapy is the best treatment option for you.

UGFS Procedure in Visalia, CA

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How Well Does UGFS Work?

Minimally invasive vein ablation therapies that can be performed in the outpatient, office setting are just as effective as surgical removal of varicose veins. In one study comparing vein closure rates with laser ablation, conventional surgery, and foam sclerotherapy, patients reported comparable quality of life scores. Meanwhile, varicose vein closure rates at one year post treatment was 88.5% for endovenous laser ablation, 88.2% for conventional surgery, and 72.2% for foam sclerotherapy [3].

While one session of ultrasound-guided foam sclerotherapy is moderately successful for treating saphenous veins, additional treatment sessions may increase the long-term success rate. Treatment success can be limited by vein recurrence, which can occur if there is recanalization, or the return of blood flow to a previously cleared vein. In one study trial, saphenous vein recanalization occurred in 27% of patients at 1 year post treatment and in 64% of patients at 5 years post treatment [4]. In another review, 90% of great saphenous veins treated did not undergo recanalization after two sessions of foam sclerotherapy over a mean 3.25 years of follow-up [5].

Importantly, UGFS treatment success has a variety of meanings for different people. Vein recurrence or recanalization may occur, yet symptoms might still be well controlled and clinical improvement may be maintained in the long-term [4,6]. In one study, where saphenous vein recanalization occurred, 70% of patients did not have worsened clinical symptoms [4].

What are the Advantages of UGFS Over Other Options?

Ultrasound guided foam sclerotherapy, being a type of nonthermal ablation, eliminates the risk of nerve or skin injury from burns. Because UGFS is minimally invasive, it has a shorter procedure time, and one session can be completed within 30-60 minutes in the outpatient setting. Patients can return to work immediately, and the recovery time is shorter compared to other invasive options such as open surgical ligation and stripping of veins.

Sclerotherapy is the only method of endovenous closure that does not require a catheter to be placed along the length of the vein. Therefore, its greatest advantage is in treating large, deep veins that are highly branched and twisted. A foam sclerosant is able to displace blood rather than mix with it to dilute the blood volume. This results in greater efficacy of treatment, as a lower concentration of foam is needed to achieve the same therapeutic effect as a liquid agent.

UGFS Procedure in Visalia, CA

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Ultrasound Guided Sclerotherapy Side Effects

Following ultrasound guided sclerotherapy with foam, patients may experience mild side effects including pain and inflammation at the injection site. Ulceration, skin hyperpigmentation, and rash are also potential side effects. Although rare, deep vein thrombosis can occur.

Specific side effects depend on the type of sclerosing agent used. Most side effects are temporary and resolve within a few months after the procedure.

Is Foam Sclerotherapy Safe?

Foam sclerotherapy with ultrasound is a relatively safe procedure. Most patients will experience some pain and inflammation at the injection site. Allergic reaction and other serious adverse side effects like deep vein thrombosis are very rare.

What Happens After UGFS and When I Go Home?

At the end of the procedure, you may have to sit for several minutes to wait for bleeding at the injection site to stop. You should limit intense physical activity immediately after the procedure. Your physician may or may not advise you to wear compression stockings after foam treatment. Otherwise, there are no restrictions and most patients can return to work right away.

What Can I Expect After Foam Sclerotherapy?

Pain at the injection site may make driving difficult. You might be asked to wear compression stockings and to limit intense physical activity. Otherwise, you can return to normal daily activities. Most patients see visible improvement of vein clearance after 1 treatment session, although multiple sessions may be required.

Is UGFS Right For Me?

Minimally invasive vein closure is the ‘gold standard’ treatment for symptomatic varicose veins, and has clear advantages over more conservative and more surgical approaches. A Vein Specialist at VIP Specialists can help you evaluate your options and decide if UGFS or a different minimally invasive vein treatment is right for you!

Patient undergoing vein ultrasound screening before her VNUS Closure procedure

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[1] Scovell, S. Liquid, foam, and glue sclerotherapy techniques for the treatment of lower extremity veins. UpToDate. Accessed April 2020.
[2] Morrison, N., Gibson, K., Vasquez, M., Weiss, R., Cher, D., Madsen, M., & Jones, A. (2017). VeClose trial 12-month outcomes of cyanoacrylate closure versus radiofrequency ablation for incompetent great saphenous veins. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 5(3), 321–330.
[3] Biemans AA, Kockaert M, Akkersdijk GP, van den Bos RR, de Maeseneer MG, Cuypers P, Stijnen T, Neumann MH, Nijsten T. Comparing endovenous laser ablation, foam sclerotherapy, and conventional surgery for great saphenous varicose veins. J Vasc Surg. 2013 Sep;58(3):727-734.e1. Epub 2013 Jun 13.
[4] Coleridge Smith, P. (2009). Sclerotherapy and foam sclerotherapy for varicose veins. Phlebology, 24(6), 260–269.
[5] Chen CH, Chiu CS, Yang CH. Ultrasound-guided foam sclerotherapy for treating incompetent great saphenous veins–results of 5 years of analysis and morphologic evolvement study. Dermatologic Surg., June;38(6):851. Epub 2012 Apr 27.
[6] Chapman-Smith, P., & Browne, A. (2009). Prospective five-year study of ultrasound-guided foam sclerotherapy in the treatment of great saphenous vein reflux. Phlebology, 24(4), 183–188.

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The Materials available on visaliavips.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients.