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Foam Sclerotherapy Study for Varicose Veins supports Whiteley Protocol

by – March 31, 2016

A recent study has shown that ultrasound guided foam sclerotherapy treatment fails in 47% of patients by 2 years.

Ultrasound guided foam sclerotherapy is a technique used to inject varicose veins. Some vein surgeons, clinics and companies have suggested that ultrasound guided foam sclerotherapy can replace surgery for the treatment of varicose veins. Some of the biggest enthusiasts even claim that it can replace endovenous laser ablation and the other new varicose vein techniques.

Foam sclerotherapy made using Whiteley-Patel Technique - The Whiteley Clinic

Example of foam sclerotherapy used for the treatment of varicose veins

However the Whiteley Protocol® does not agree with this. Based on considerable research which will be outlined below, the Whiteley Protocol only recommends ultrasound-guided foam sclerotherapy for small veins with thin walls. As such, although ultrasound guided foam sclerotherapy is very useful as part of the treatment for varicose veins, we only rarely use it as the only treatment for varicose veins.

The following brief explanation will show how the new research supports the Whiteley Protocol.

Which veins need treatment in patients with varicose veins?

Although patients with varicose veins see bulging veins on the surface, these usually arise from a long vein hidden deeper in the leg called the great saphenous vein (previously called the long saphenous vein). This vein runs from ankle to groin up the inside of the leg. In patients with varicose veins, the valves fail in the great saphenous vein and blood falls back down this vein – called venous reflux.

To stop inflammation at the ankle, the body opens up “shock absorbers” in the form of bulging veins. These are the varicose veins that patients dislike. (For a full understanding of this please see the book “Understanding Venous Reflux – the cause of varicose veins and venous leg ulcers“).

Before 1999, surgeons used to strip this vein away under a general anaesthetic.

Prize-winning research in 2005 from the The Whiteley Clinic, published in 2007 with a follow up in 2014, showed that stripping the great saphenous vein resulted in it growing back again in the majority of cases. When it grew back, it grew back without any valves, meaning the same problem recurred as if no operation had ever been done.

In 1999, Mark Whiteley of the The Whiteley Clinic introduced endovenous thermoablation surgery to the UK. Using radiofrequency ablation, Mark and his team showed that destroying the great saphenous vein by heat permanently stopped the problem of venous reflux. Following this, the The Whiteley Clinic has spent the last decade and a half suggesting that endovenous thermoablation such as endovenous laser ablation (EVLT) is the Gold standard for treating varicose veins.

Foam sclerotherapy or endovenous ablation for the great saphenous vein?

Over the last 15 years or so, ultrasound guided foam sclerotherapy has become a very important part of treating varicose veins. Many doctors and clinics use this treatment exclusively and do not use the heat methods such as endovenous laser and endovenous radiofrequency ablation. They often point out advantages such as being a simple injection treatment without needing local anaesthetic, and that is often cheaper than using laser or radiofrequency devices.

Award winning research rosette However research recently published from the The Whiteley Clinic has shown that sclerotherapy does not destroy larger veins with thick walls such as the great saphenous vein. It appears that in these big veins, such as the great saphenous vein, ultrasound guided foam sclerotherapy is likely to cause a clot (thrombus) rather than destroy the vein. This means that the vein appears to be closed in the short term, but as the clot dissolves, the varicose vein returns.

This is why the Whiteley Protocol® does not allow ultrasound guided foam sclerotherapy to be used to treat the great saphenous vein.

In contrast, The Whiteley Clinic research that won the national prize in the UK in 2015 showed that endovenous laser using the Whiteley Protocol® settings, completely destroys the great saphenous vein, reducing the risk of any recurrence in the future to the lowest possible chances.

As such, the Whiteley Protocol® uses endovenous thermoablation such as endovenous laser ablation to permanently treat the great saphenous vein. Ultrasound guided foam sclerotherapy is reserved for the small tributaries or other veins that might need to be treated in the leg as part of the same process.

How the latest research supports the Whiteley Protocol®

A recent large randomised, controlled study was published from a group of doctors working in the Netherlands (http://www.ncbi.nlm.nih.gov/pubmed/24474721). They aimed to treat varicose veins in a group of patients using ultrasound-guided foam sclerotherapy. All patients in the study had the great saphenous vein treated with ultrasound-guided foam sclerotherapy.

Follow-up of the patients showed that within two years, 47% of patients had recurrent reflux in the “treated” great saphenous vein.

In contrast, our own prize-winning research looking at our patients 12 years after treatment by the Whiteley Protocol, 0% had failure of treatment of the great saphenous vein and only 6.5% had partial failure (see https://thewhiteleyclinic.co.uk/research/prize-winning-varicose-vein-treatments/).


The Whiteley Protocol® is a system of investigating and treating varicose veins and other venous conditions based upon research and experience from the experts at the The Whiteley Clinic. We constantly perform research and audit to ensure that the Whiteley Protocol is the optimal way to treat varicose veins and other venous diseases, but we also consider all other relevant research performed elsewhere to ensure that our patients get the very best possible results.

It is very pleasing that this is yet another large research study supporting one of the basic principles that the Whiteley Protocol® has followed over many years.


Shadid N, Nelemans P, Lawson J, Sommer A.
Predictors of recurrence of great saphenous vein reflux following treatment with ultrasound-guided foamsclerotherapy.
Phlebology. 2015 Apr;30(3):194-9. doi: 10.1177/0268355514521183. Epub 2014 Jan 28.

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