Sclerotherapy for Reticular Leg Veins: Foam vs. Liquid

Abstract

Introduction: Sclerotherapy for reticular leg veins (1-3 mm diameter) commonly uses liquid or foam sclerosants. This review compares efficacy and safety of foam vs. liquid polidocanol. Methods: Eight RCTs (n=892 legs) with 6-month follow-up. Sclerosant: polidocanol 0.5-1%. Outcome: complete vessel closure on ultrasound and cosmetic improvement. Results: Foam achieved 86% closure vs 64% for liquid (p=0.001). Number of sessions required: 1.4 for foam vs 2.3 for liquid. Adverse events: transient visual aura (2.5% with foam, none with liquid); hyperpigmentation (12% foam, 9% liquid). Discussion: Foam displaces blood more effectively, increasing sclerosant contact. Higher foam concentration increases risk of neurologic events (rare). Studies excluded patients with deep vein incompetence. Conclusions: Foam sclerotherapy is more effective but carries a small risk of visual disturbances. Liquid remains safer for small, isolated veins.