Foam Sclerotherapy for Varicose Veins in Hyderabad (2026) | Procedure, Recovery, Success Rates 

Feature

Foam Sclerotherapy Details

Procedure Name

Ultrasound-Guided Foam Sclerotherapy (UGFS) | Conventional Surface Sclerotherapy (CSS)

Mechanism

Sclerosant foam damages vein endothelium — causes inflammatory closure and permanent vein disappearance

Uses Heat?

No — purely chemical/mechanical irritation of vein wall

Uses Catheter?

UGFS: small needle only. No catheter required for most sclerotherapy applications

Anaesthesia Required?

Usually none — tiny needle pricks; topical anaesthetic cream optional for spider veins

Procedure Duration

15-30 minutes per session | Multiple sessions may be needed (typically 1-3)

Hospital Stay

Same-day discharge — walk out of clinic immediately after

Success Rate

80-95% for varicose tributaries (UGFS) | 60-80% for spider veins per session

Sessions Required

1-3 sessions typically for varicose tributaries | 2-4 for spider veins (interval 4-6 weeks)

Compression Stockings

Class 1-2 stockings recommended for 1-2 weeks post-procedure

Return to Work

Same day or next day for most patients

Key Unique Role

Best adjunct to RFA/EVLT/VenaSeal — clears residual tributary varicosities in the same session

Best For

Spider veins | Reticular veins | Varicose tributaries | Residual veins after thermal ablation | Perforator veins

Available At

Citi Vascular Hospital, KPHB Colony, Road No. 1, Hyderabad — Dr. Shaileshkumar Garge FRCR (UK)

Sclerosant

Chemical Name

Concentration Used

Best For

Polidocanol

Aethoxysklerol (Lauromacrogol 400)

0.5-3% foam depending on vein size

Spider veins (0.5%), reticulars (1%), tributaries (1.5-3%)

Sodium Tetradecyl Sulphate (STS)

Fibrovein / STD

0.2-3% foam depending on vein size

Spider veins (0.2%), larger tributaries (1-3%)

Property

Liquid Sclerotherapy

Foam Sclerotherapy

Blood Displacement

Diluted by blood in vein — reduced contact

Foam displaces blood — 100% vein wall contact

Vein Wall Contact Time

Brief — quickly mixed with blood

Prolonged — foam holds contact with endothelium

Volume Required

Larger volume of liquid needed

Small foam volume treats longer vein segment

Ultrasound Visibility

Liquid not visible on ultrasound

Foam clearly visible on ultrasound as white echogenic material — real-time monitoring possible

Effectiveness for Larger Veins

Poor — blood dilutes quickly

Good — foam occupies the vein lumen completely

Success Rate for Tributaries

60-70%

80-95% — significantly higher

Type

Technique

Best Used For

Anaesthesia

UGFS — Ultrasound-Guided Foam Sclerotherapy

Foam injected under real-time duplex Doppler guidance via fine needle

Larger varicose tributaries | Perforator veins | Recurrent varicose veins | Post-RFA/EVLT residual tributaries

Usually none

CSS — Conventional Surface Sclerotherapy

Foam injected under direct vision for surface veins using fine needle or Veinlite illumination

Spider veins (telangiectasias) | Reticular veins | Thread veins | Small visible surface veins

None — very fine needle

Foam as Adjunct to Thermal Ablation

Used same-session after RFA/EVLT/VenaSeal to treat visible surface varicosities

Tributary clusters after truncal vein ablation — one-stop complete treatment

Same local anaesthetic from prior procedure usually sufficient

Microsclero for Spider Veins

Very dilute sclerosant (0.2-0.5%) injected through 30G or insulin needle

Fine thread veins, spider nevi, facial telangiectasias (selected sites)

Topical anaesthetic cream (EMLA) optional

Stage

Phase

What Happens Inside the Vein

Result

1

Foam Injection

Tessari microfoam displaces blood in the target vein — occupies entire vein lumen on contact

Complete vein wall contact with sclerosant

2

Endothelial Damage

Sclerosant damages the vein wall endothelium (inner lining) — chemical irritation destroys the cellular surface

Vein wall inflammation begins — within seconds

3

Protein Denaturation

Detergent action of sclerosant denatures vein wall proteins — disrupts membrane integrity of endothelial cells

Vein wall structurally weakened

4

Inflammatory Response

Controlled inflammation follows — white blood cells infiltrate the damaged vein wall, fibrin deposits form

Progressive fibrosis begins — weeks 1-4

5

Vein Collapse and Thrombosis

Diseased vein collapses and fills with fibrin — external compression (stocking) holds walls in contact during this phase

Visible varicosity begins to flatten and disappear

6

Fibrosis and Absorption

Over 4-12 weeks, the closed vein progressively fibroses (scars) and is reabsorbed by the body — vein disappears

Complete — treated vein no longer visible or palpable

Clinical Situation

Suitable?

Notes

Spider veins (telangiectasias) on legs

Yes — first-line

Conventional sclerotherapy with dilute foam (0.2-0.5%) — most effective surface vein treatment

Reticular veins (blue-green network veins)

Yes — first-line

UGFS or CSS — sclerotherapy specifically designed for these vein types

Varicose tributary veins (branching clusters)

Yes — UGFS

UGFS with 1-3% foam — treats visible clusters not treated by truncal ablation

Residual varicosities after RFA / EVLT / VenaSeal

Yes — ideal

Sclerotherapy clears remaining surface tributaries after the feeding truncal vein is ablated

Perforator vein incompetence (selected cases)

Yes — UGFS

UGFS can target incompetent perforator veins under direct ultrasound guidance

Recurrent varicose veins after prior surgery

Yes

Sclerotherapy effective for recurrent tributaries — no re-dissection of surgical field needed

Cosmetic spider vein concerns

Yes — CSS

Cosmetically motivated treatment using dilute sclerosant — not medically indicated but commonly performed

Main truncal vein (GSV/SSV) reflux alone

Not first-line

Sclerotherapy for large truncal veins has higher recurrence than RFA/EVLT/VenaSeal — combination preferred

Contraindication

Suitability

Reason / Alternative

Pregnancy

Contraindicated

All elective sclerotherapy deferred until at least 3 months post-partum. Veins often improve spontaneously post-delivery.

Active Deep Vein Thrombosis (DVT)

Contraindicated

DVT must be fully treated and resolved before any sclerotherapy procedure

Known allergy to sclerosant agent

Contraindicated

Alternative sclerosant or laser therapy offered. Allergy to polidocanol does not preclude STS and vice versa.

Known PFO with prior neurological events

High risk — specialist assessment

Echo bubble study to confirm PFO before foam sclerotherapy. CO2 foam or micro-phlebectomy preferred.

Inability to walk or wear compression post-procedure

Relative — assess individually

Walking and compression are essential for success and DVT prevention after sclerotherapy

Severe peripheral arterial disease

Relative contraindication

Compression stockings may compromise arterial flow in severe PAD — assess ABPI first

Very large truncal GSV reflux (>8mm) as primary treatment

Not first-line

RFA/EVLT/VenaSeal first, then sclerotherapy for residual tributaries

When

Preparation Step

Details / Notes

1-2 Weeks Before

Duplex Doppler Ultrasound Vein Mapping

Identifies all refluxing veins, maps tributaries, confirms perforator involvement, plans which veins to inject and in which order. Essential for UGFS planning.

1-2 Weeks Before

PFO and Migraine History Screening

Declare any history of: migraine with aura, prior stroke or TIA, known PFO or ASD, prior visual disturbances after injection therapy. This determines whether CO2 or air foam is used and whether extra precautions are needed.

1-2 Weeks Before

Allergy Screening

Known allergy to polidocanol or STS must be declared. Rare drug allergy — alternative sclerosant or alternative technique offered if confirmed.

1 Week Before

Medication Review

Blood thinners generally continue for sclerotherapy (most protocols do not require pause). NSAIDs may affect foam stability — discuss with Dr. Garge's team.

Day Before

Purchase Compression Stockings

Class 1-2 below-knee compression stockings (18-32 mmHg) — must be worn immediately after procedure. Purchase in advance.

Day of Procedure

No Moisturiser or Fake Tan on Legs

Avoid leg moisturiser, fake tan, or oils on treatment day — these affect needle access and increase pigmentation risk post-procedure.

Day of Procedure

Clothing

Wear loose comfortable trousers or shorts that roll above the knee. Bring compression stockings to appointment.

Day of Procedure

Eat Normally — No Fasting

Light meal before procedure is acceptable — no anaesthesia or fasting protocol required for standard foam sclerotherapy

Day of Procedure

Transport

Most sclerotherapy patients can drive themselves home — no sedation or general anaesthetic used. Confirm with team.

1

Pre-Procedure Duplex Doppler Assessment and Marking

With the patient standing, Dr. Garge performs duplex Doppler to confirm the target veins, re-evaluate the reflux pattern on the treatment day, and mark the vein courses on the skin. For UGFS, the path of the tributary varicosity and its feeding perforator (if present) are mapped precisely. This real-time assessment ensures accurate needle placement even for veins not visible on the surface.

2

Patient Positioning and Skin Preparation

Patient lies on the treatment table — typically in mild Trendelenburg (head-down) position to empty the superficial leg veins and reduce their diameter for better needle access. The treatment area is cleaned with antiseptic. Unlike RFA or EVLT, no extensive field preparation is needed — just targeted preparation around the injection sites.

3

Foam Preparation Using Tessari Technique

Dr. Garge prepares fresh sclerosant foam using the Tessari technique immediately before each injection: sclerosant (polidocanol or STS at the appropriate concentration for the vein being treated) is mixed with CO2/air in a 1:4 ratio using two syringes and a three-way stopcock — 20 rapid passes creating stable microfoam. Fresh foam is prepared for each session to ensure optimal bubble stability.

4

Ultrasound-Guided or Direct Needle Injection

A fine 23G-30G needle is inserted into the target vein — under direct ultrasound guidance for UGFS of deeper tributaries and perforators, or under direct vision for surface spider and reticular veins. For UGFS, the needle tip is confirmed within the vein lumen on ultrasound before foam injection begins. Multiple injection sites may be used in a single session to treat the full extent of the varicosity.

5

Foam Injection and Ultrasound Monitoring

Foam is slowly injected under ultrasound guidance — the foam appears as bright white echogenic material on the ultrasound screen, allowing Dr. Garge to monitor foam distribution, confirm complete filling of the target vein, and verify that the foam is not tracking into deep veins. Total foam volume per session is typically 6-8mL maximum (European Consensus 2012 guidelines). If treating spider veins, direct vision monitoring replaces ultrasound.

6

Immediate Compression Application

Immediately after foam injection at each site, gentle external compression is applied with Dr. Garge's finger for 30 seconds — holding the vein walls in contact as the foam works. A compression bandage or pad is applied over the treated area. Class 2 below-knee compression stockings are then fitted before the patient stands up.

7

Post-Procedure Walking and Discharge

Immediately after stockings are applied, the patient walks for 20-30 minutes within the clinic — critical for DVT prevention. Walking activates the calf muscle pump, disperses any foam from larger veins into the deep system, and promotes healthy blood flow. The patient is observed for 30 minutes for any adverse reactions (allergy, visual disturbance). Same-day discharge is standard.

Timeframe

What to Expect

Dos and Donts

Immediately After (30 min in clinic)

Walk 20-30 min in clinic. Some tenderness and itching along treated veins — normal sclerosant response. Compression stockings fitted before leaving.

Walk 20-30 min. Stockings on. Gentle movement. Hydrate. Drive home (usually safe).

Day 0-2

Mild bruising and brownish discolouration along vein course. Veins may look worse initially — they are swollen and inflamed as treatment works. Normal.

Continue walking daily. Stockings on day and night for first 48 hours. No vigorous exercise. No hot bath/sauna/jacuzzi.

Days 2-7

Most patients return to work day after procedure. Treated veins progressively flatten and darken. Compression stocking use continues during the day.

Return to desk work day 1-2. Continue compression stocking wear. No high-impact exercise. No long flights without compression.

Week 1-2

Compression stockings worn during the day. Treated veins change colour — may temporarily look more prominent (normal post-sclerotherapy inflammatory response).

Keep stockings on for full 2 weeks. Light exercise (walking, swimming) from Week 1. No tight clothing over treated areas.

Month 1-3

Treated veins progressively fade and disappear as fibrosis completes. Spider veins may take 6-12 weeks to clear fully. UGFS veins clear faster than spider veins.

Follow-up at 4-6 weeks if additional session needed. Maintain compression as advised. Sun protection on treated areas reduces pigmentation.

If Further Sessions Needed

Most varicose tributaries require 1-3 sessions at 4-6 week intervals. Spider veins typically require 2-4 sessions. Each session builds on previous results.

Schedule follow-up with Dr. Garge at 4-6 weeks. Do not re-treat too early — allow full 4-week interval.

Visual Disturbance — Contact Clinic Immediately

Any visual disturbance — flashing lights, blurred vision, scotoma — within 30 minutes of foam injection. May indicate foam reaching cerebral circulation via PFO.

Call Citi Vascular immediately: +91-73375 83901 | Lie down | Do not drive | Usually resolves within 30-60 min but requires assessment.

DVT Warning — Emergency

Sudden calf swelling | Severe leg pain | Redness warmth of calf | Shortness of breath post-procedure

Emergency evaluation required — DVT after sclerotherapy rare (< 1%) but treatable. Call immediately or attend emergency room.

Clinical Outcome

Data / Rate

Notes

UGFS closure of varicose tributaries at 1 year

80-95%

Duplex Doppler confirmed — highly effective for larger tributary veins

Spider vein clearance per session

60-80%

Multiple sessions (2-4) typically needed for complete spider vein clearance

Spider vein clearance after 3 sessions

85-90%

Cumulative improvement with each session at 4-6 week intervals

UGFS vs Surgery (tributaries)

Equivalent at 1 year

European multicentre trials — UGFS and phlebectomy comparable for tributary veins

Symptom improvement after UGFS

75-85%

Pain, heaviness, itching improvements reported by most UGFS patients

Recurrence at 3 years (UGFS)

20-30%

Higher than thermal ablation for truncal veins — new tributaries develop in some patients

DVT rate post-sclerotherapy

< 1% (UGFS) | < 0.1% (CSS)

Lower with early walking + compression protocol

Patient satisfaction

High (> 85%)

Particularly high for cosmetic spider vein treatment when patient expectations set correctly

Category

Risk / Side Effect

Frequency

Management

Very Common (>50%)

Bruising along treated vein

Almost all patients

Self-resolving 2-4 weeks. Normal inflammatory response. Compression reduces extent.

Very Common (>50%)

Temporary hyperpigmentation (brown discolouration)

10-30%

Haemosiderin deposit in skin above treated vein. Fades 3-12 months. Sun protection reduces risk.

Common (5-20%)

Superficial thrombophlebitis (vein inflammation)

5-15%

NSAIDs + warm compress + walking. Self-limiting 2-6 weeks.

Common (5-10%)

Telangiectatic matting (new fine veins in treated area)

5-10%

New fine vessels appear in treated zone. May fade spontaneously or require additional treatment after 3 months.

Uncommon (1-5%)

Skin necrosis at injection site

< 1% (extravasation risk)

Prevented by correct intravessel injection. Extravasation of sclerosant into tissue causes ulceration — heals over weeks.

Uncommon (1-3%)

Allergic reaction to sclerosant

< 3%

Antihistamine + corticosteroid. Anaphylaxis extremely rare. Pre-screening for known sensitivity.

Rare (< 1%)

Deep Vein Thrombosis (DVT)

< 1% (UGFS) | < 0.1% (CSS)

Early walking + compression stocking protocol dramatically reduces risk. Screened at 1-week Doppler.

Rare (< 1%)

Visual disturbance — flashing lights, scotoma

< 1% (air foam) | Lower with CO2

PFO-mediated bubble crossing. Lie down. Usually resolves 30-60 min. Report immediately to Dr. Garge.

Feature

Foam Sclerotherapy

RFA

EVLT (Laser)

VenaSeal

Primary Target Vein

Tributaries, spider veins, reticulars

GSV/SSV truncal

GSV/SSV truncal

GSV/SSV truncal

Catheter Required

No for most — needle only

Yes

Yes

Yes

Anaesthesia

None usually

30-60 tumescent injections

30-60 tumescent injections

1 injection only

Sessions Required

1-3 (veins may need repeat)

1 (usually sufficient)

1 (usually sufficient)

1 (usually sufficient)

Closure Rate

80-95% (UGFS tributaries)

95-98% (truncal)

95-98% (truncal)

95-97% (truncal)

Best Used For

Tributaries | Spider veins | Adjunct to thermal ablation

Primary GSV treatment

Primary GSV/SSV small tortuous

Primary GSV — needle-anxious patients

Compression Duration

1-2 weeks

2 weeks

2 weeks

Often 1 week or none

Can Treat Spider Veins Directly

Yes

No

No

No

Used Together?

Often combined with all three

Often includes sclerotherapy for tributaries

Often includes sclerotherapy for tributaries

Often includes sclerotherapy for tributaries

Spider veins or tributary clusters?

Foam sclerotherapy at Citi Vascular KPHB — same-day, no anaesthesia, immediate walking.

Call +91-73375 83901

Need complete varicose vein treatment?

RFA/EVLT + sclerotherapy in one session — one-stop complete vein clearance.

WhatsApp for Quick Booking

Differentiator

Specific Evidence

What This Means for You

Triple International Credentials

FRCR (Royal College of Radiologists, UK) + FNVIR (CMC Vellore) + EBIR (European Board of IR, Spain) + Fellowship (North Carolin, USA)

Highest international IR certifications — sclerotherapy training included as part of comprehensive vein disease management

All Vein Treatment Techniques

Foam sclerotherapy | RFA | EVLT | VenaSeal | MOCA | Micro-phlebectomy — all available in-house at Citi Vascular KPHB

Comprehensive treatment plan designed for your specific vein pattern — not a single technique for all patients

Ultrasound-Guided Precision

All UGFS performed under real-time duplex Doppler — foam distribution monitored during injection

No blind injections — foam tracked in real time to confirm correct distribution and avoid deep vein entry

One-Stop Treatment Planning

RFA/EVLT + phlebectomy + sclerotherapy all planned and performed in the same session when clinically appropriate

Complete vein clearance in one visit — no multiple return procedures at different centres

PFO and Allergy Screening

Systematic screening for PFO risk factors, migraine history, and sclerosant allergy at every pre-sclerotherapy consultation

Patient safety protocols specific to foam sclerotherapy — not performed at all centres

12+ Years and 15,000+ Procedures

Dedicated minimally invasive vascular interventions at Citi Vascular Hospital, KPHB

High-volume specialist: precise injection technique, optimal foam concentration selection, low complication rates

What We Offer

The Specifics

Why It Matters

All Vein Techniques In One Centre

Foam UGFS + RFA + EVLT + VenaSeal + MOCA + Phlebectomy — everything available at KPHB

Single consultation determines the complete treatment plan — no referrals to different centres

On-Site Duplex Doppler

Pre-procedure vein mapping and real-time UGFS guidance using high-resolution Doppler at Citi Vascular

Same-facility Doppler eliminates separate radiology visits

Certified Sclerosant Agents

Pharmaceutical-grade polidocanol and STS in multiple concentrations — fresh Tessari foam preparation per session

Correct concentration for each vein size; fresh foam each session for optimal bubble stability

PFO Safety Protocol

Every patient screened for PFO risk before UGFS — CO2 foam used preferentially in higher-risk patients

Foam sclerotherapy-specific safety protocols not universally applied at all vein clinics

One-Stop Combined Treatment

Sclerotherapy combined with RFA/EVLT/phlebectomy in the same session — maximum treatment per visit

Complete varicose vein clearance (truncal + tributaries + spider veins) achievable in 1-2 total visits

Pigmentation Prevention Advice

Sun protection guidance + stocking compliance education + post-procedure skin care protocol for every sclerotherapy patient

Reduces the most common cosmetically significant complication of sclerotherapy

Insurance and Payment

Medically indicated UGFS (for varicose veins with symptoms) covered by many insurance policies. Pre-auth documentation by Citi Vascular team.

Cosmetic sclerotherapy (spider veins) generally not covered — transparent pricing before treatment

Stage

Sunita's Experience

Clinical Details

Presentation

Left leg varicose veins treated with RFA at Citi Vascular 6 months prior | Residual calf tributary clusters still visible | New spider veins on both thighs

Post-RFA GSV closure confirmed on Doppler | Residual tributaries and telangiectasias noted on review

Assessment

Doppler by Dr. Garge confirmed GSV still closed — residual tributaries without reflux. Spider veins on thighs cosmetic concern.

Plan: UGFS for calf tributaries (2 sessions 4 weeks apart) + CSS for thigh spider veins (2 sessions)

Session 1 — UGFS

Calf tributaries injected under Doppler guidance | 20 min | Walked 25 min in clinic | Compression stocking fitted | Home same day

4mL foam (polidocanol 2%) | 3 injection sites | Foam distribution confirmed on Doppler | PFO screen negative

Session 1 Response

By week 3: calf tributaries 60% reduced and flattening. Some brown discolouration along vein course — expected.

Inflammatory fibrosis progressing well | Follow-up at 6 weeks | Pigmentation discussed and sun protection advised

Session 2 — UGFS + CSS

Remaining calf tributaries re-treated | Thigh spider veins injected with 0.5% foam | 25 min total

Minimal additional foam needed for tributaries | Spider veins blanched immediately on injection

3-Month Review

Calf varicosities 90% cleared. Spider veins 75% improved. Sunita extremely satisfied. Standing job at school now comfortable.

VCSS score improved | Doppler confirmed no new GSV reflux | Further CSS session planned for residual spider veins

Credential

Detail

Full Name

Dr. Shaileshkumar Garge

Qualifications

MBBS | MD (Mumbai) | DNB (Delhi) | FRCR (UK) | FNVIR (CMC Vellore) | EBIR (Spain/Europe) | Fellowship (USA)

Role

Director and Chief Vascular Physician | Senior Consultant Vascular and Interventional Radiologist

Hospital

Citi Vascular Hospital, KPHB Colony, Road No. 1, Hyderabad, Telangana 500072

Varicose Vein Techniques

Foam Sclerotherapy (UGFS + CSS) | RFA | EVLT | VenaSeal | MOCA | Micro-phlebectomy | Duplex Doppler Vein Mapping

Experience

12+ years | 15,000+ minimally invasive vascular procedures across Hyderabad and Telangana

Sclerosant Agents Used

Polidocanol (Aethoxysklerol) | Sodium Tetradecyl Sulphate (Fibrovein/STS) | Both available in multiple concentrations

Hospital

Contact

Hours

Citi Vascular Hospital

+91-73375 83901

KPHB Colony, Road No. 1, Hyderabad, Telangana 500072 | Mon-Sat 9AM-6PM

Book Online

citivascularcentre.com

WhatsApp + online booking | Spider vein consultations | Same-day sclerotherapy | Free parking