Synopsis: Foam injections to treat varicose veins cause less pain for patients and could save money compared with a popular alternative treatment.
A procedure used to treat blood vessels or blood vessel malformations (vascular malformations) and also those of the lymphatic system. A medicine is injected into the vessels, which makes them shrink. It is used for children and young adults with vascular or lymphatic malformations. In adults, sclerotherapy is often used to treat varicose veins and hemorrhoids. Sclerotherapy has been used in the treatment of varicose veins for over 150 years. Like varicose vein surgery, sclerotherapy techniques have evolved during that time. Modern techniques including ultra-sonographic guidance and foam sclerotherapy are the latest developments in this evolution.
Varicose veins develop when the valves in veins stop working properly, causing the veins to swell. About one in three people have varicose veins when they reach retiring age, with women affected more than men. In most people, they do not present a serious health problem, but in severe cases they can cause aching, itching, swelling or leg ulcers.
Patients requiring treatment often undergo surgery to strip out the affected vein. Under general anesthetic, the vein is tied off through a cut in the groin and pulled out by a wire passed through a cut lower in the leg. 36,209 varicose vein procedures are carried out in the NHS each year.
In the last decade, new non-surgical treatments have been introduced that cause less scarring and do not require general anesthetic. Endovenous Laser Ablation (EVLA) involves a laser wire, inserted into the vein through a catheter, which delivers short bursts of energy that seal the vein closed. It is usually carried out under local anesthetic. Foam sclerotherapy involves injecting foam into the vein that inflames the lining of the wall and seals the vessel.
The new study compared these two treatments in terms of benefit to the patient and cost. One hundred patients were randomly assigned to laser or foam treatment. The two treatments were found to be equally successful at closing off varicose veins. However, foam therapy procedures were more than twice as quick and cost over four times less than laser treatment on average. Patients who had foam therapy experienced less pain in the week following treatment and could return to normal activity in three days, compared with eight days for patients who had laser therapy.
Mr Christopher Lattimer, from the Department of Surgery and Cancer at Imperial College London, said: "This is the first time that anyone in the NHS has compared foam and laser treatments to see which is better value for money. We found that foam was 4.2 times cheaper, taking into account their effectiveness. Foam treatment was also quicker, less painful, and had people back to normal activity in a shorter time."
Mr George Geroulakos, from the Department of Surgery and Cancer at Imperial College London, said: "Because varicose veins are so common, the NHS has to spend a lot of money on treatments each year. If more people are treated with foam injections instead of surgery or laser treatment, the potential savings could be enormous. This sort of research is hugely important at a time when budgets are under such strain."
The number of patients receiving these treatments is increasing each year, with the NHS performing 6,327 foam procedures and 6,005 EVLA procedures in England in 2009-10.
Closing the veins that run near the skin does not impair circulation as blood can still return to the heart through the larger veins inside the leg.
The research was funded by Ealing Hospital NHS Trust and STD Pharmaceuticals.
1. C.R. Lattimer et al. 'Cost and Effectiveness of Laser with Phlebectomies Versus Foam Sclerotherapy in Superficial Venous Insufficiency. Early Results of a Randomized Controlled Trial.' European Society for Vascular Surgery, Athens 2011.
2. About Imperial College London - Consistently rated amongst the world's best universities, Imperial College London is a science-based institution with a reputation for excellence in teaching and research that attracts 14,000 students and 6,000 staff of the highest international quality. Innovative research at the College explores the interface between science, medicine, engineering and business, delivering practical solutions that improve quality of life and the environment - underpinned by a dynamic enterprise culture.