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Echotherapy Treatment (SONOVEIN® HD)

AI Classification Score - A11 Non-Invasive

Sonovein® HD- Echotherapy or high intensity focused Ultrasound (HIFU)

Sonovein® is the first totally non-invasive treatment for varicose veins and venous leg ulcers.

Echotheray Treatment Screening


Sonovein® is the tradename for High Intensity Focused Ultrasound (HIFU) or Echotherapy treatment. This is the most revolutionary way of doing surgery. Unlike endovenous laser, radiofrequency and even foam sclerotherapy, this treatment is 100% non-invasive.

Ultrasound is beamed across the skin, and focused onto the vein to be treated.

The original Sonovein® was introduced into the UK in 2019 by Prof Mark Whiteley at The Whiteley Clinic.

The new and much upgraded Sonovein® HD was introduced into the UK in October 2020 at The Whiteley Clinic. It was the first Sonovein® HD machine in the world.

Published papers on SONOVEIN®

In 2019, Prof Mark Whiteley et al. published a paper on Pubmed based on the very first SONOVEIN® technology which has since upgraded to Sonovein® HD. This paper can be viewed here:
High intensity focused ultrasound (HIFU) for the treatment of varicose veins and venous leg ulcers – a new non-invasive procedure and a potentially disruptive technology

Recently, October 2022, One year results of Echotherapy treatment were published on the CoP preprints server. This paper by Prof Mark Whiteley et al. can be viewed here:
One-year results of treatment of incompetent truncal veins and incompetent perforators using 8 and 4 second pulses of High Intensity Focused Ultrasound (HIFU)

How does Sonovein® HD work?

Sonovein® (HIFU – High Intensity Focused Ultrasound) – First case in UK performed by Prof Mark Whiteley in May 2019 – Sonovein® (HIFU – High Intensity Focused Ultrasound)

Echotherapy treatment (SONOVEIN®) – First case in UK performed by Prof Mark Whiteley in May 2019

The principle of High Intensity Focused Ultrasound (HIFU) is that ultrasound can pass through the skin and human tissues without damaging it at all. This is why we can use ultrasound machines to look at babies in the womb, gallbladders and many other sensitive things in the body.

However, if the ultrasound is beamed in to the body in a cone, it can be focused at a specific point deep inside the body. At this point, all of the energy of the ultrasound is focused into one point.

By making sure that the power is exactly right, this point can be heated to 90°C. This is the temperature that will kill cells and contract protein.

The Sonovein® machine uses HIFU. The Sonovein® machine has one ultrasound that is used to identify the vein to be treated. Once identified, this first ultrasound can then be used to aim the HIFU beam.

The HIFU beam is generated by a second ultrasound system. This is not only far more powerful, but as outlined above, the ultrasound is generated in a cone shaped been to focus at exactly the right point.

With the original Sonovein®, it took eight seconds of heating for the HIFU to destroy the target tissue and then 40 or 50 seconds to cool everything down again. This made the procedure very long. It also meant that local anaesthetic was needed around the vein.

The treatment has been revolutionised by the Sonovein® HD.

Why Sonovein® HD is different

The scientists at Theraclion (the company that makes Sonovein® HD) have now modified the technique to be very much faster, and also to be possible without any anaesthetic at all.

Instead of eight seconds of heating, each time the HIFU beam is fired, the heating occurs within half a second. This is so fast that in many cases, the patient doesn’t feel any heat or pain at all. In some cases, the patient can feel a brief discomfort which most people find bearable. Occasionally, and in some tender areas, a little local anaesthetic might be needed.

Because the treatment is so much quicker, it is now possible to treat much longer sections of veins. Therefore Echotherapy treatment with Sonovein® HD is starting to get much more like endovenous laser or radiofrequency ablation – but without injecting large amounts of local anaesthetic tumescence fluid, and without putting anything inside the vein!

This means that there is a much reduced risk of any infection, absolutely no scars at all, and most patients get up off the table and walk home without even having to wear support stockings.

Echotheray Treatment Screening

Are any other treatments needed after Sonovein® HD?

Sonovein® (HIFU – High Intensity Focused Ultrasound) – Are there any drawbacks from Sonovein?

Echotherapy Treatment – Prof Mark Whiteley adjusting the Sonovein® (HIFU – High Intensity Focused Ultrasound)

The Whiteley Protocol is based upon treating every patient as an individual. Decades of research has shown that it is very hard to generalise vein treatments, as patients have so many different sorts of patterns of disease.

Before the advent of The Whiteley Protocol, doctors used to think that varicose veins, venous leg ulcers and other venous diseases were due to valve failure in either the great saphenous vein, the small saphenous vein or both.

Prof Whiteley and his team have spent years showing that there are large numbers of other vein patterns that cause varicose veins and other venous disorders including anterior accessory saphenous vein, poster accessory saphenous vein, accessory systems, any one or more of 150 different perforators above or below knee, as well as pelvic vein reflux.

Because any one or more of these veins can be involved in venous disease, the potential combinations are huge. Therefore each patient has to be investigated individually, and a treatment plan made for each individual patient using the best combinations possible as proven by our research.

Sonovein S® is a major advance in the treatment of the great and small saphenous veins and many incompetent perforators.

However there are some vein patterns where it is not the optimal treatment.

In many cases, Sonovein® HD can be used by itself as a single treatment.

In many other cases, Sonovein® HD can be used and then at a later date, ultrasound guided foam sclerotherapy can clear up residual veins that have not regressed.

Hence every patient needs to be taken as an individual and a plan for treatment will be made on the results of the high resolution duplex ultrasound scan performed by one of The Whiteley Clinic trained vascular technologists.

Are there any drawbacks with SONOVEIN® HD?

We are now much more experienced with HIFU and are starting to find exactly which patients get the optimal results from this new technology.

There are some patients in whom the pattern of veins is too complex or would take too long to be treated with Sonovein® HD, and by following The Whiteley Protocol these patients would be advised on alternative treatments which should be optimal for them.

However, as with endovenous thermal ablation in 1999, we will continue to develop the Sonovein® HD technology and will continue to improve the results of those patients that we treat, as well as increase the sorts of vein patterns that are treatable by this technique.

This was predicted in the paper by Prof Mark Whiteley in 2019 “High intensity focused ultrasound (HIFU) for the treatment of varicose veins and venous leg ulcers – a new non-invasive procedure and a potentially disruptive technology” (https://www.tandfonline.com/doi/full/10.1080/03007995.2019.1699518).

Sonovein® HD is currently exclusively available in the UK at The Whiteley Clinic. If you are interested in HIFU Echotherapy treatment of your varicose veins using Sonovein S®, please contact us so that we can arrange for you to have consultation and venous duplex ultrasonography to determine your suitability for the technique.

If you have any questions about Sonovein® HD, please do not hesitate to contact us.


  1. Whiteley, M. S., Davey, S. E., & Placzek, G. M. The AI classification (access and invasiveness) of medical procedures to clarify non-invasive from different forms of minimally invasive and open surgery. CoP Preprints. 2023:43.