UGFS

UGFS – ultrasound-guided foam sclerotherapy is a minimally invasive treatment procedure effectively applied in the management of chronic venous insufficiency. At Dr. Vein, this method is typically indicated for cases such as incompetent tributary veins, peri-ulcer regions, or locations that cannot be treated with endovenous laser. This article will help you clearly understand the nature of the procedure, indications, and treatment efficacy according to guidelines from professional societies such as ESVS, SVS, and Phlebology.

I. Overview of UGFS – Ultrasound-Guided Foam Sclerotherapy

1. What is UGFS?

UGFS (Ultrasound-Guided Foam Sclerotherapy) is a procedure for treating chronic venous insufficiency by injecting a foam sclerosant into the vein under Doppler ultrasound guidance. The sclerosant foam comes into direct contact with the endothelium, causing localized chemical inflammation, fibrosis, and the sealing of the refluxing blood vessel, thereby improving circulation and reducing symptoms.

According to the European Journal of Vascular and Endovascular Surgery (2015), UGFS allows for the precise treatment of incompetent veins by tracking the path and distribution of the foam via ultrasound, which increases efficacy and reduces complications. This method has been widely applied in Europe since the early 2000s and remains a preferred choice for many venous insufficiency treatment indications today.

2. Mechanism of UGFS

The foam sclerosant (usually polidocanol) creates microbubbles capable of displacing blood from the vessel lumen, allowing the foam to remain in contact with the vein wall longer than traditional liquid solutions. This contact destroys the endothelial layer, leading to phlebitis and the formation of fibrotic tissue after a few weeks—resulting in the permanent closure of the vein lumen.

A study by Rabe et al. (2010) showed that foam sclerosant is 5 times more effective in causing fibrosis than the liquid form, due to its larger contact area and better controllability via ultrasound. Thanks to this mechanism, UGFS is not only effective for superficial veins but can also be applied to treat incompetent perforating veins and complex varicose tributaries.

3. Advantages of UGFS 

The UGFS procedure provides numerous benefits thanks to its safety, efficacy, and flexible application in treating varicose veins:

1. Does not require general anesthesia, reducing the risk of cardiovascular and respiratory complications or deep vein thrombosis (DVT), especially in the elderly or those with underlying medical conditions.
2. No skin incisions, leaving no scars, ensuring cosmetic appeal post-treatment.
3. Short procedure time (15–30 minutes), can be performed on an outpatient basis without the need for hospitalization.
4. Rapid recovery; patients can walk gently on the same day without affecting daily activities.
5. Accesses hard-to-treat veins, such as tortuous tributaries, peri-ulcer areas, or below-the-knee segments—where endovenous laser cannot be used.
6. Performed under ultrasound guidance, helping doctors precisely control the injection site and the spread of the foam, thereby increasing efficacy and minimizing complications.

According to the EJVES Guidelines (2022), UGFS is a highly effective and safe option when performed by a specialist and when adhering strictly to indications.

II. UGFS Procedure – Ultrasound-Guided Foam Sclerotherapy at Dr. Vein

At Dr. Vein, the UGFS treatment protocol is tailored to each pathological condition, ensuring criteria for safety, efficacy, and shortened recovery time. The medically standardized procedure includes the following steps:

1. Pre-Procedure Preparation

Before performing UGFS, the doctor will conduct an examination and Doppler ultrasound to evaluate the entire venous system. This helps precisely identify the incompetent vein locations, the degree of reflux, and select the appropriate treatment plan.

To ensure a safe procedure and optimal results, patients will be instructed to:

1. Stop taking anticoagulants (if currently in use) as prescribed by the doctor, usually about 3 to 5 days prior to the procedure.
2. Refrain from applying lotions, topical medications, or skincare products to the legs on the day of the procedure.

The sclerosant commonly used is Polidocanol. The medication is whipped into a foam using the Tessari technique, then used immediately to ensure optimal therapeutic efficacy.

2. Steps of the UGFS Procedure

The procedure takes place quickly at the clinic. The patient remains completely awake and relaxed on the examination bed throughout the process:

Step 1: The doctor uses ultrasound to precisely identify the incompetent vein and select the needle insertion site.

Step 2: After disinfecting the treatment area, the needle is inserted into the vein lumen under ultrasound guidance.

Step 3: The foam sclerosant is slowly injected into the vein. The ultrasound image helps the doctor observe the foam’s path and control the appropriate dosage, increasing treatment efficacy and limiting the risk of complications.

Step 4: Upon completing the injection, the treated area is gently compressed to support the closure of the vein and reduce blood backflow.

Step 5: Finally, the patient is immediately bandaged post-procedure to maintain pressure on the treated vein wall.

The entire process usually lasts about 15 to 30 minutes, depending on the number of veins requiring intervention. Once completed, the patient can go home the same day and engage in light activities as guided by the doctor.

3. Post-Procedure Monitoring and Care

After the ultrasound-guided foam sclerotherapy, the treated area will be continuously bandaged for the first 24 hours. The compression bandage helps the vein walls stick together, supporting an effective fibrotic process and reducing the risk of venous recanalization.

Subsequently, the doctor will instruct the patient to wear medical compression stockings of the correct size and pressure level. This is a crucial part of the treatment process, helping to improve venous circulation and reduce the risk of long-term recurrence (Phlebology, 2021).

For a smooth recovery, patients should note:

1. Avoid standing or sitting continuously for long periods, especially in the first 24 hours.
2. If working in an office or driving for a long time, change positions and walk lightly after certain intervals.
3. Maintain light activities such as walking, ankle rotations, or elevating the legs while resting to support better blood circulation.
4. Avoid excessively hot baths, massages, hot compresses, or applying oils to the treated area for at least the first week.

Typically, patients are scheduled for a follow-up appointment after about 2 to 4 weeks. The doctor will perform a Doppler ultrasound to check the extent of vein closure and evaluate the treatment efficacy, establishing an appropriate follow-up plan if necessary.

Adhering strictly to post-procedure care instructions not only helps maintain treatment efficacy but also contributes to reducing the risk of complications such as skin hyperpigmentation or superficial thrombophlebitis during the recovery phase.

III. Efficacy and Potential Complications After UGFS

1. Success Rate and Long-Term Efficacy

Multiple studies have confirmed the effectiveness of UGFS (Ultrasound-Guided Foam Sclerotherapy) in eliminating venous reflux and improving symptoms of chronic venous insufficiency. According to the European Journal of Vascular and Endovascular Surgery (EJVES, 2018), vein occlusion rates at 12 months range from 85% to 90%, provided the procedure is performed with proper indication and technique.

In patients with dilated tributaries, incompetent perforator veins, or veins around ulcerated areas, UGFS has shown significant improvement in symptoms such as leg heaviness, mild edema, and aching or burning discomfort after prolonged standing. Many patients report a noticeable feeling of lightness and pain relief within the first few days after injection.

However, long-term outcomes depend heavily on adherence to post-procedure care, especially the consistent use of compression (bandaging or stockings), appropriate physical activity, and scheduled follow-up appointments.

2. Common Complications

Although UGFS (Ultrasound-Guided Foam Sclerotherapy) is a minimally invasive and generally well-tolerated procedure, it may still cause certain local or systemic reactions. Most complications are mild and fully reversible if promptly recognized and appropriately managed.

Common complications include:

• Bruising at the injection site: Usually appears within the first 1–3 days and fades spontaneously within 1–2 weeks without intervention.
• Mild tightness or burning sensation at the injection site: A temporary inflammatory response of the vein wall upon contact with sclerosant foam; symptoms typically subside quickly with proper compression bandaging or stocking use.
• Skin hyperpigmentation: Caused by residual blood trapped in the sclerosed vein. According to Phlebology (2021), this occurs in approximately 5–10% of patients and often resolves within 3–6 months. It may persist longer in patients with thin skin, superficial veins, or inadequate post-procedure care.
• Mild superficial thrombophlebitis (SVT): Presents as localized pain, redness, and tenderness at the injection site without deep vein involvement. Management includes anti-inflammatory medications, cold compresses, and continued use of compression stockings.
• Allergic reactions to sclerosants (Polidocanol or STS): Rare, usually mild (e.g., itching or urticaria). Patients with a history of drug allergies should disclose this in detail prior to treatment.

Less common but important complications to be aware of:

• Transient visual disturbances: Patients may experience temporary blurred vision or photopsia (flashing lights), particularly when foam is injected in the upper thoracic or cervical regions, or when large volumes are used. These symptoms usually resolve spontaneously within minutes to a few hours; rest and monitoring are advised.
• Deep vein thrombosis (DVT): Extremely rare when proper pre-procedural screening is conducted. Risk increases in patients with underlying coagulation disorders, prolonged immobility, or improper injection technique. Diagnosis should be confirmed via duplex ultrasound and managed by a vascular specialist if detected.

Most UGFS-related complications can be prevented through precise injection technique, adherence to post-procedure care, and compliance with follow-up visits. Physicians at Dr Vein closely monitor for abnormal signs during the initial days to ensure timely intervention if necessary.

3. Strategies to Minimize Complications

The efficacy and safety of Ultrasound-Guided Foam Sclerotherapy (UGFS) largely depend on the technical execution of the procedure and the quality of post-procedure care. To minimize the risk of complications, both physicians and patients should consider the following:

• The procedure should be performed by a vascular surgeon with experience in ultrasound-guided techniques and foam distribution control.
• Use appropriate sclerosant volumes, not exceeding recommended dosage limits.
• Apply compression bandaging correctly for the first 24–48 hours, followed by graduated compression stockings with the appropriate pressure.
• Adhere to scheduled follow-up visits, including ultrasound evaluation of vein closure.
• Maintain regular light physical activity; avoid prolonged immobility.
• Do not perform UGFS in cases of untreated deep vein thrombosis (DVT).

According to the ESVS Guidelines (2022), UGFS is a safe and effective procedure when performed with proper indication, close monitoring, and adequate post-treatment care.

Conclusion

UGFS (Ultrasound-Guided Foam Sclerotherapy) is a minimally invasive treatment that allows for precise targeting of incompetent veins. This technique is particularly effective in managing recurrent varicosities, perforator veins, or periwound areas — anatomical sites that are often challenging to treat with endovenous laser ablation.

To ensure optimal outcomes and minimize complications, UGFS should be performed with proper indications by a qualified vascular surgeon, accompanied by appropriate post-procedure care, including compression bandaging, graduated compression stockings, and regular physical activity.