t LBCL Surgery & Vein Practice, we have chosen to use sclerotherapy, which has been known for 150 years, to treat spider veins and occasionally varicose veins. The latest developments in this field are modern techniques such as ultrasound-guided sclerotherapy or foam sclerotherapy.
Why did you decide to use foam therapy as a supportive therapy measure?
Dr Salama: Foam sclerotherapy is a supportive sclerotherapy, in combination with endovenous laser therapy, helps to treat the side branches so that a treatment that interferes with an organ, such as bloodletting, is not necessary. We keep an accurate record of the entire treatment using foam sclerotherapy. An innovative mixture of carbon dioxide and oxygen as a medical gas as well as the use of a local anaesthetic intensify the contact of the diseased veins with the foam and thus optimise the Eﬀect.
Are there any innovations in foam sclerotherapy at the moment?
Dr Salama: We have continued to pursue research into the preparation of the foam in order to optimise the effect of the foam according to the latest medical developments. Crucially, a ratio of one part ﬂuid sclerosant to one part sclerosant is required to four parts air or gas is considered optimal for producing a dense, durable foam. We have looked in depth at various aspects in the pharmacological structure of the foam and studied its action. We have investigated which details are important for the desired interaction with the body. Decisive for the optimal and desired effect are the structure and stability of the foam as well as a good, automated preparation of the sclerotherapy.
Can you please explain in more detail what is important? Dr Salama: These three essential points are
These three essential points are very closely connected with each other and only result in an optimal effect of the sclerosis foam when they interact in a coordinated manner.
The optimal effect of the application already starts with the stability of the foam and its concentration. If the concentration of the sclerosing agent is less than 1 %, the effect of the foam on the one hand very quickly already after a preparation time of a few seconds to a few minutes. On the other hand, the low concentration is very crucial in the treatment of smaller spider veins.
An interesting finding of a study from 2013 has further shown that automating the foam preparation with a magnetic stirrer, where the mixing of the proportions takes place at a speed between 1500 and 4000 revolutions per minute, can greatly improve the stability of the foam and that even at low concentrations of the sclerosant below 1%.
With automated preparation of the sclerosant foam, in contrast to manual preparation, the bubbles are smaller and more uniform. This in turn allows better contact with the veins and spider vein and results in a better effect.
The preparation time for automated sclerosant foam preparation is significantly shorter than for manual preparation.