Ultrasound Guided Foam Sclerotherapy for Leg Varicose Veins: How We Do It with Tricks and Tips

[@rgrisoli]

Great discussion in every way!

[@VeinCareAcademy]

Thank you for your kind feedback. Are you a "foamaholic" or a "phlebectaholic"

[@sabrinaracelly]

Muchas gracias Dr. Gajraj por abrir el espacio de VCA a temas tan apasionantes como la Esclero con espuma, ecoguiada. Saludos desde Colombia con sentimiento de aprecio por su labor.

[@VeinCareAcademy]

Thank you very much @sabrinaracelly for your feedback and kind comments. Best wishes for the New Year.

[@rgrisoli]

I lean way more in favor of foam, but I also do AP’s when I feel it’s best for that individual. When I do foam and if they return with a tender lump, I tell them their options. I can simply add more foam to the area, or I could add foam and do a needle evacuation to relieve pressure and some liquidfied coagulum. The 3rd option is just to do needle evacuation alone. The 4th option is just reassurance that it will resolve over time with no intervention. Some patients simply don’t want another needle if it will go away over time.

[@VeinCareAcademy]

Thank you for your feedback. I like your patient-centred approach!

[@jimmymohsin9903]

Awesome discussion..

[@VeinCareAcademy]

Thank you for your feedback

[@Vein911]

Thank you, Dr. Haroun Gajraj, for the honor and privilege of the opportunity to share our insights on Ultrasound Guided Foam Sclerotherapy (UGFS) with you. Your lucid and informative vein care videos are watched and admired by hundreds of thousands of people worldwide. Now, if I could only deliver a video with a fraction of your incredibly professional delivery, I am certain everyone would do foam sclerotherapy the way I prescribe!

[@VeinCareAcademy]

Thank you @Vein911 . I really enjoyed discussing UGFS with you. Thank you for generously sharing your expertise, Dr Chris Pittman.

[@jguzzomdqb]

How can u inject more foam at a follow up visit, without prior insurance authorization? When they come back for follow up, you wont know if they have partial response, and need for more, and certainly no prior insurance auth to do more. Do comp them or charge them out of pocket?

[@VeinCareAcademy]

In the UK, we would need insurance authorisation. I decided a few years ago, to become a cash-only clinic. Maybe, @vein911 can answer your question from a UK perspective @vein911.com

[@Vein911]

Insurance companies in the USA typically allow two to three foam sessions per extremity. Regardless of cost a patient cannot be comprehensively treated without foam sclerotherapy part of their treatment protocol. That's not debatable. Furthermore, a provider who doesn't perform foam routinely can't meet the needs of their patients for the rest of their lives. Watch the video!

[@toma.6942]

Why is this preferred over a phelebectomy? If phelbitis isn't a complication. Why is it a concern before sclerotherapy? Also isn't there a concern of foam traveling to the sfj? Is there a size limit to the varicose vein that foam would cause too much phelbitis or clot that a phelebectomy would be preferable. Some surgeons will not treat larger veins with foam. There must be a reason. I know Pittman doesn't do phelebectomys

[@VeinCareAcademy]

Great questions! Thank you @toma.6942 We debated these and other topics in the video. I have a surgical background and Dr Pittman has an Interventional Radiology background. Chris also aims to provide vein care at scale. The video gives the impression that we disagree, when in reality we are looking at treatment from different perspectives. Foam will travel to the SFJ, but it is inactivate at this location. Any size of vein can be treated by foam sclerotherapy. Yes some surgeons will not treat very large veins by foam, but it can be done safely and effectively. @vein911 may wish to reply in more detail. Thank you for contributing to the debate. I am curious, are you a healthcare professional? The reason I ask is that your questions suggest that you are.

[@toma.6942]

@@VeinCareAcademy Thank you Sir. No I am not. Just a regular Guy with a regular job.

[@Vein911]

Watch the video! Many of these questions are already answered.