Foam Sclerotherapy and Stroke Risk: Understanding a Rare Concern
It's completely understandable to have questions about the risks associated with any medical procedure, and foam sclerotherapy is no exception. Many of our elderly patients, in particular, have expressed concerns about the possibility of stroke after foam sclerotherapy. Let's dive into what the literature and our extensive experience tell us about this.
The Real Risk: Rarer Than You Think
Based on years of experience and a thorough review of medical literature, the incidence of stroke-like symptoms after foam sclerotherapy is incredibly low. In fact, in over 7,000 cases we've personally managed, we've only encountered one instance of transient visual disturbance followed by a headache.
This type of reaction, while concerning at the moment, is a theoretical side effect that is exceedingly rare, occurring in less than 1% of cases.
How Does This Happen? (The Science Behind It)
To understand this rare occurrence, let's briefly explain the mechanism of foam sclerotherapy. When the foam sclerosant agent is injected, the microbubbles are active for only a few seconds, irritating the vein wall to activate the clotting cascade, and then circulate back to the right side of the heart.
In some individuals, there's a small opening in the heart called a patent foramen ovale (PFO). Think of it as a tiny, congenital shortcut between the right and left sides of the heart. If a patient has a PFO, these microbubbles can, in very rare instances, pass from the right side of the heart to the left and then enter the cerebral circulation (the arteries supplying the brain and eye). When this happens, a small bubble can temporarily disrupt blood flow, leading to transient visual symptoms.
The good news is that these symptoms typically resolve on their own within a couple of hours, without any lasting effects.
Our Commitment to Minimizing Risk
While this complication is rare, we take every precaution to minimize any potential risks during your foam sclerotherapy procedure. Here's what I do:
Limited Sclerosant Volume: I carefully limit the amount of sclerosant agent used always keeping it under 10 mL for a 75kg patient.
"Wet-to-Wet" Injection Technique: Before injecting the sclerosing agent, I ensure the catheter is half filled with blood. This eliminates any air gap, preventing the introduction of unnecessary bubbles.
Rigorous Foam Quality Checks: We meticulously double-check the quality of the sclerosing agent before and during injection. If the foam quality deteriorates even during injection, I immediately discard it and prepare a fresh batch.
Time-Sensitive Application: The optimal quality of the sclerosing agent lasts only about 90 seconds in the syringe, our team is trained to be highly efficient and mindful of this time limit.
Your Safety is Our Priority
Fortunately, if this exceptionally rare complication does occur, it almost always happens right in our office, soon after the procedure. This means you'll be with your physician and our staff, enabling immediate communication and observation.
We're here to answer all your questions and ensure you feel comfortable and confident throughout your treatment journey. Don't hesitate to reach out if you have any further concerns!
