A significant study published in the Journal of Vascular Surgery: Venous and Lymphatic Disorders adds to the growing body of evidence supporting ultrasound-guided foam sclerotherapy (UGFS) as an effective, safe, and durable treatment for varicose veins. I find this research particularly valuable because it follows patients for a full five years, giving us genuinely long-term data rather than the shorter-term results that many studies report.
What was the study?
Researchers at three specialist vein centres in Italy reviewed the outcomes of 346 patients who had undergone UGFS for incompetent saphenous veins between 2018 and 2023. The saphenous veins are the main superficial veins of the leg and are the most common source of varicose vein problems.
All patients were treated with a foam sclerosant and followed up for up to five years. The study looked at three main questions:
- How durable was the treatment? Did the varicose veins stay away?
- How safe was it? What complications occurred?
- Did patients’ quality of life improve as a result of treatment?
How effective was the treatment?
The results were encouraging. At the end of the follow-up period, 85.5% of patients had no evidence of reflux (the backwards flow of blood that causes varicose veins) in their saphenous trunk. Looking at five-year disease-free rates, 77.7% of patients remained free of recurrent venous disease.
Of the patients who did develop recurrence, most did so around four years after their initial treatment. Importantly, for those who needed a further round of foam sclerotherapy, the re-treatment had an 80% success rate. This aligns with what we see in clinical practice: foam sclerotherapy is not always a permanent, single-session cure, but it is a highly effective option even when retreatment is required.
Does vein size affect the results?
One of the most striking findings in this study concerns the diameter of the vein being treated. Patients with a saphenous vein of 8 mm or less in diameter had a five-year recurrence-free rate of 91.3%. For patients with a vein wider than 8 mm, that figure dropped considerably to 46%.
This is something I think it is really important for patients to understand. It does not mean that larger veins cannot or should not be treated with foam sclerotherapy, but it does mean that the realistic outcome needs to be discussed carefully at the outset. For patients with very dilated veins, there may be a higher likelihood of needing repeat treatment over time, and other treatment options may also need to be considered.
Did quality of life improve?
Yes, significantly. The researchers measured patients’ quality of life before and after treatment using two validated scoring tools: the Venous Clinical Severity Score and the Chronic Venous Disease Quality of Life Questionnaire. Both scores improved substantially after treatment, with the difference being statistically significant. These findings correlate with what we hear from our own patients at Southwest Veins, who consistently report improvements in symptoms such as aching, heaviness, and swelling, as well as greater confidence in the appearance of their legs.
What about safety and side effects?
The study reported a reassuringly low rate of serious complications.
- Immediate complications such as headache or brief visual disturbances occurred in 3.7% of patients (thirteen patients in total). These are short-lived effects that resolve without treatment and are related to small amounts of foam gas temporarily entering the circulation.
- Endovenous foam-induced thrombosis (a small clot within the treated vein) was detected in six patients (2.8%) at one week after treatment. This is a recognised phenomenon in the treated vein itself and is distinct from deep vein thrombosis.
- Skin discolouration (hyperpigmentation) appeared in 10.7% of patients. As I explain to patients at consultation, this brown shadowing along the treated vein usually fades over several months, although it can occasionally take longer.
No serious long-term safety concerns were identified over the five-year follow-up period.
What does this mean for patients?
This study is a useful addition to the evidence base for foam sclerotherapy. The key conclusions are:
- UGFS is effective for the majority of patients, with over three quarters remaining free of recurrent venous disease at five years.
- It is safe, with serious complications being rare.
- Quality of life improves meaningfully after treatment.
- Vein diameter is an important factor: patients with smaller veins tend to have more durable results.
- Retreatment is possible and effective if needed.
UGFS is a cornerstone treatment we offer at Southwest Veins. It requires no general anaesthetic, no incisions, and no hospital admission. Patients are encouraged to walk immediately after the procedure and can return to their normal activities the same day.
Talk to us about your varicose veins
If you have varicose veins and would like to understand whether foam sclerotherapy might be right for you, I would be very happy to discuss your options at a free, no-obligation assessment. Every patient receives a full duplex ultrasound scan so that we can assess the anatomy of your veins carefully before recommending any course of treatment.
Book your free assessment online, or contact us if you have any questions about foam sclerotherapy or any other aspect of your vein health.
Jamie Barwell is a Consultant Vascular Surgeon who has treated over 1000 patients with varicose vein problems, using open surgical techniques and, since 2007, foam sclerotherapy. He is a graduate of Guy’s Hospital Medical School and a fellow of Royal College of Surgeons of England.