Foam sclerotherapy safe and effective for varicose veins

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NEW YORK (Reuters Health), Aug 30 - Ultrasound-guided foam sclerotherapy safely achieves complete occlusion in 91% of legs with varicose veins, according to a report in the British Journal of Surgery for August. Still, longer follow-up is needed to determine if the benefits are lasting.

A study reported in 1944 provided the first evidence that adding air to liquid sclerosants enhanced their efficacy in treating varicose veins. However, this concept received little attention until about a decade ago when researchers showed that sclerotherapy with foam was more effective than with liquid sclerosants, particularly under ultrasound guidance.

Previous reports looking at foam sclerotherapy for varicose veins have focused largely on the saphenous system, study authors Dr. S. G. Darke and S. J. A. Baker, from the Royal Bournemouth Hospital in the U.K., note. In the present study, the researchers assessed the outcomes of a consecutive series of patients, many of whom had extra-saphenous disease.

A total of 192 patients were referred for varicose vein treatment over a 15-month period. Eleven of these patients selected surgery, while the remainder chose ultrasound-guided foam sclerotherapy.

Ultrasound-guided foam sclerotherapy involved the use of polidocanol in a 1:3 mixture with air. Under ultrasound guidance, 1% foam was injected into superficial veins, while 3% was used for saphenous trunks. The maximum permitted foam volume was 14 mL.

Of the 220 legs treated with ultrasound-guided foam sclerotherapy, 163 showed complete occlusion of varicosities after one intervention. With a second treatment, 32 additional legs achieved complete occlusion and with a third, one more responded. Thus, overall rate of complete occlusion was 91%.

With the exception of two legs with great saphenous vein incompetence that failed ultrasound-guided foam sclerotherapy, the remaining legs without complete occlusion did achieve partial blockage.

The presence of small saphenous vein varicosities rather than great saphenous vein incompetence predicted treatment success after one session. Likewise, direct cannulation of the vein with Seldinger technique was more often successful than indirect butterfly cannulation.

Ultrasound-guided foam sclerotherapy was generally well tolerated and was not associated with any serious complications. Several patients experienced phlebitis and pigmentation, which could have cosmetic implications, but further follow-up is needed, the authors note.

While encouraging, "the results reported here are very early," the researchers point out. "It remains uncertain whether these early results will translate into similarly satisfactory longer-term outcomes, even if further injections are necessary."

Last Updated: 2006-08-29 12:57:41 -0400 (Reuters Health)

Br J Surg 2006;93:969-974.

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