Ultrasound-guided catheter-directed foam sclerotherapy can be safely applied for the treatment of great saphenous varicose veins in elderly patients (original) (raw)
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European Journal of Vascular and Endovascular Surgery
This paper adds information on a new, effective, and safe approach in varicose vein treatment, which is based on duplex guided foam sclerotherapy, with additional use of a catheter to release the foam, perivenous tumescence infiltration, and flushing of the vein before foam injection. The inclusion of these three technical additions to the usual foam sclerotherapy (mostly performed by direct injection or cannula) significantly improved clinical and duplex based outcomes up to 3 years after treatment. Objectives: This was a prospective observational study to assess the short-to mid-term efficacy and safety of catheter foam sclerotherapy (CFS) of the great saphenous vein (GSV), including peri-saphenous tumescence infiltration (PST) and intra-saphenous saline irrigation (ISI), in combination with phlebectomy of the varicose tributaries. Methods: Eighty-eight limbs in 82 patients (19 male, 63 female, mean age 55.7 years) affected by varices related to GSV incompetence were submitted to CFS of the refluxing GSV segment after PST and ISI, combined with phlebectomy of the varicose tributaries. Sodium tetradecylsulfate (STS) 3% þ CO 2 /O 2 sclerosant foam (SF) (median 7 mL) was injected in the GSV trunk (median caliber 7.1 mm) by means of a 4F catheter. Clinical and colour duplex ultrasound (CDU) investigation was performed pre-operatively, and 40 days, 6, 12, and 36 months post-operatively. A visual analogue scale (VAS) was used to assess procedure related symptoms and venous symptoms before and 40 days after the treatment. Results: Clinical recurrence (visible varices) at 40 days, 6 and 12 months was 0%, whereas at 36 months it was 4.7%; VAS pre-operative score of heaviness, pain, and cramps/paraesthesiae decreased from 6 (IQR 6e8) to 1 (IQR 0e3), from 3 (IQR 0e7) to 0 (IQR 0e1), and from 3 (IQR 0e7) to 0 (IQR 0e1) respectively at 40 days. The CDU based occlusion rate at 40 days, 6, 12, and 36 months was 100% (88/88), 100% (88/88), 94.3% (83/88), and 89.4% (76/85) respectively. Six of the nine patent saphenous veins (average diameter 1.4 mm) had anterograde flow (overall 96.5% reflux free GSVs). One superficial venous thrombosis was recorded without any further relevant complication. Conclusions: GSV treatment by means of CFS and adjuvant PST þ ISI, combined with phlebectomy of varicose tributaries, proved to be safe and effective in terms of clinical and duplex based outcomes at short/mid-term follow-up.
Videosurgery and Other Miniinvasive Techniques, 2016
Introduction: Ultrasound-guided foam sclerotherapy (UGFS) of varicose veins is a useful treatment option. It is a relatively safe method in the case of limited, small varicose veins. In theory, a justified concern could be raised that the injection of an active drug into the large superficial venous vessels may potentially cause life-threatening consequences. Aim: To assess the safety and efficacy of UGFS using a 2% solution of polidocanol (Aethoxysklerol 2%) in the case of great saphenous vein incompetence. Material and methods: Fifty-two patients with great saphenous vein incompetence underwent ultrasound-guided foam sclerotherapy. The efficacy criterion was the elimination of reflux measured ultrasonographically and withdrawal or decrease of complaints: 1 week, and 1, 3, 6 and 12 months after the treatment. Complications of sclerotherapy were reported during follow-up. Results: Decrease or withdrawal of complaints of chronic venous insufficiency was reported in 96% of cases (50 patients). Disappearance or decrease of varicose veins was noted in all patients (100%). During examination after 12 months, full success of ultrasound was achieved in 38 (73%) cases, and 11 (21%) patients presented a partial desired effect according to the consensus from Tegernsee. Persistence of reflux longer than 1 s in the treated great saphenous vein was reported in 3 (6%) cases. Serious complications, such as deep vein thrombosis, pulmonary embolism, dyspnea, anaphylaxis, or neurological abnormalities, were not recorded. Conclusions: Ultrasound-guided foam sclerotherapy of incompetent great saphenous vein and varicosities with 2% polidocanol was found to be an effective and safe method of treatment during 1 year of observation. However, longer observation is necessary.
Ultrasound-guided foam sclerotherapy for the treatment of varicose veins
British Journal of Surgery, 2006
Background The aim was to assess the early efficacy and complications of ultrasound-guided foam sclerotherapy (UGFS) in a cohort of patients with varicose veins. Methods Of 192 consecutive patients referred with varicose veins over 15 months, only 11 chose surgery; the rest underwent UGFS treatment. Polidocanol was foamed 1:3 with air. Under ultrasound control via butterfly or Seldinger cannulation, 1 per cent foam was injected into superficial veins and 3 per cent foam into saphenous trunks, up to a total volume of 14 ml. Outcome was defined as complete when occlusion of the saphenous trunk and/or over 85 per cent of the varicosities was achieved, and partial closure when less. Results In 163 legs, complete occlusion occurred after one intervention, a further 32 after a second, and one after a third (overall 91 per cent). Of the remainder, all other legs achieved partial occlusion after up to three interventions, apart from two legs with great saphenous vein (GSV) incompetence, whi...
European Journal of Vascular and Endovascular Surgery, 2009
This study aims to compare venous clinical severity scores in patients with healed venous ulcers due to varicose veins of the lower limbs (the clinical, etiologic, anatomic, and pathophysiologic data (CEAP) classification: C 5 EpAsPr) treated by saphenous stripping and phlebectomy or by ultrasound-guided foam sclerotherapy. Method: Sixty patients were included: 29 underwent saphenous stripping and phlebectomy for varices in saphenous tributaries and 27 were treated by ultrasound-guided foam sclerotherapy; four cases were lost to follow-up. The main outcome measure was venous clinical severity scores (pain, oedema, inflammation, hyperpigmentation and lipodermatosclerosis). An ultrasound examination was carried out prior to treatment and 30, 60 and 180 days after the procedure to assess the relative efficacy of the methods in obliterating the saphenous trunk. Results: The mean venous clinical severity scores measured before and after 180 days were as follows: Surgery group e pain: before 1.97 standard deviation (SD) 0.19, 180 days 0.72 SD 0.53; oedema: before 1.66 SD 0.48, 180 days 0.55 SD 0.63; inflammation: before 1.55 SD 0.63, 180 days 0.72 SD 0.45. Foam sclerotherapy group e pain: before 1.81 SD 0.40, 180 days 0.56 SD 0.51; oedema: before 1.70 SD 0.47, 180 days 0.48 SD 0.64; inflammation: before 1.67 SD 0.68, after 0.89 SD 0.32. All scores showed statistically significant reductions in both patient groups. The saphenous vein had been obliterated, 180 days after treatment, in 78% of the surgery group, compared with 90% in the foam sclerotherapy group. Conclusions: Ultrasound-guided foam sclerotherapy is a safe and effective option for patients with chronic venous disorders.
Ultrasound Guided Foam Sclerotherapy for the Treatment of Primary Varicose Vein of Lower Limb
International Journal of Medical Arts, 2020
Background: Veins have one-way valves that prevent blood from backing up into the legs when we stand or sit. When the valves become incompetent [or begin to have reflux], blood pools and causes an increase in pressure in the leg veins. Leg veins become enlarged and twisted. Aim of the work: The aim of the current study was to evaluate safety and efficacy of ultrasound guided foam sclerotherapy for the treatment of primary varicose vein. Patients and methods: The current trial is a prospective observational cohort study. It had been carried out at Al-Azhar University Hospital [New Damietta], Egypt. It included Fifty patients who had great saphenous vein [GSV] reflux associated with saphenofemoral junction [SFJ] incompetence. They had been offered foam sclerotherapy as an alternative to standard surgical treatment or conservative management. The duration of the study extended between November 2019 to January 2020. Results: results revealed that post intervention; duplex assessment revealed a radiologic success with complete obliteration of GSV and collaterals in 40 patients [80%]. six patients [12%] underwent direct re-injection for further one or two injection sessions over the following two weeks until complete occlusion of GSV and collaterals was obtained. Conclusion: Foam sclerotherapy is effective & safe in treatment of primary varicose veins.
Indian Journal of Vascular and Endovascular Surgery, 2015
Objective:The purpose of this study was to determine the outcome and rate of recurrence for varicose veins treated with ultrasound-guided foam sclerotherapy (UGFS). Methods: Data was collected from hospital records. Patients treated with UGFS for superficial venous insufficiency were included in the study. Total 361 legs in 241 patients, out of which 121 patients with unilateral limbs and 120 patients with bilateral limbs were found to be treated by this method. Results: Out of these 361 legs great saphenous vein (GSV) varicosity was found in 88 legs, short saphenous vein (SSV) in 76, GSV & SSV both in 63, others 134. 264 legs with primary varicosity while 97 were with recurrent. In 294 legs clinical CEAP was 2-3 while in 67 legs it was 4-6. Saphenofemoral junction (SFJ) incompetence was found 60 legs, saphenopopliteal junction (SPJ) incompetence in 68, only perforator's incompetence was in 56, SFJ with perforator's incompetence 61, SPJ with perforator's 29 and no incompetence was noted in 87 legs.Outcome at 6 months was 96.23% while treatment failure and recurrences were noted in 2.77 % of legs. Complications which were noted at 1 week were superficial skin necrosis in 3.04%, pain at injection sites in 15.23%, superficial thrombophlebitis in 16.62%, bruising in 12.18%, skin staining in 11.08%, superficial vein thrombosis (SVT) in 9.97% while no DVT was noted in any of the treated legs. Conclusion: On conclusion it was found that UGFS is a popular office based treatment modality, safe, effective, easy and improvement in venous signs and symptoms. Even on recurrence patients easily accepts retreatment with this method. Furthermore it is associated with lesser pain, anesthesia requirements; time off work and driving gives it additional advantages.
Phlebology: The Journal of Venous Disease, 2020
Objectives To compare the effectiveness of two foam sclerotherapy techniques of the great saphenous vein. Methods Fifty subjects with varicose veins, edema, and great saphenous vein incompetence (diameter 6–10 mm) were randomly categorized into two equal groups and were treated with different foam sclerotherapy techniques: A (usual ultrasound-guided) and B (catheter-directed with tumescence). Concomitant phlebectomy was performed in all patients. Patients were seen on days 7 and 28, and at six and 12 months. The primary outcomes were the full success rate of the treated great saphenous vein and the number of patients who required retreatment sessions performed at 28-day follow-up. The secondary-assisted outcomes were the full success rates of the treated great saphenous vein after the retreatment sessions at six- and 12-month follow-up. Secondary outcomes were changes in quality of life and side effects and complications of the intervention. In case of reflux, retreatment sessions w...
Ultrasound guided foam sclerotherapy for varicose veins using two needle technique — A case series
Indian Journal of Surgery, 2010
Introduction Varicose veins are one of the most common vascular problems encountered. Ultrasound guided foam sclerotherapy is one such option it was introduced in 2001. We present our two needle technique of ultrasound guided foam sclerotherapy along with our short term results. Materials and methods Patients presenting us between January 2009 to October 2009 with symptomatic primary varicose veins were selected for this procedure.Ultrasound guided foam sclerotherapy was done using the two needle technique using sodium tetra decyl sulphate. Results Fifteen patients and 19 legs were treated. Complete closure of veins was achieved with a single injection at 1 month follow up in 17 legs. One leg required one additional injection and one leg required two injections. No recurrence has been noted at the end of a follow up of 1-6 months. Conclusion Foam sclerotherapy is an effective, less expensive day care procedure with minimal complication rates.
Veins and Lymphatics, 2013
Ultrasound guided foam sclerotherapy (UGFS) constitutes a valid ablative treatment for superficial vein diseases for the great saphenous vein (GSV), but no standardized protocol for its execution has yet been defined. Different variable factors involved in this procedure influence the final outcome and clinical results. The aim of our study was to analyze the respective influence on efficacy and side effects of three variable factors (foam volume, foam concentration, and contact time between the foam and the endothelium) for UGFS procedures for GSV insufficiency in order to select the best protocol for treatment. A retrospective analysis was made of UGFS procedures (190 patients, 201 legs) performed for GSV insufficiency in our institute from January 2007 to January 2010. All great saphenous veins included in our study exhibited a trans-ostial reflux and caliber range was 7-11 mm. In all cases, foam was prepared according to the Tessari method, using polidocanol (POL) and a gas mixture of CO 2 (70%) and filtered room air (30%), in a proportion of 1:4. A single injection procedure in the GSV was performed under Doppler ultrasound guidance at mid to lower third of the thigh. Legs were randomly assigned to one of three different treatment protocols:-Group A (71 legs): POL 3%, mean foam volume 4.5 cc, intermittent groin pressure 5 min, supine bed rest 10 min;-Group B (61 legs): POL 2%, mean foam volume 9 cc, intermittent groin pressure 5 min, supine bed rest 10 min;-Group C (69 legs): POL 2%, mean foam volume 9 cc, continuous groin pressure 5 min followed by intermittent groin pressure 5 min, continuous leg compression 5 min, supine bed rest 10 min. Efficacy of treatment and occurrence of side effects were evaluated in each group at two weeks and again at two years after the procedure and the cumulative results compared. Analysis of outcomes did not show any significant difference between the complete obliteration rate (P=0.825) or occurrence of local inflammatory reactions (P=0.883) between legs in Group A and in Group B. However, a significantly better outcome was observed between the complete obliteration rates and the local inflammatory reaction for legs in Group C compared to both legs in Group A (P=0.020 and P=0.015, respectively) and legs in Group B (P=0.013 and P=0.018, respectively). The type of procedure did not seem to have any effect on the extent of recanalization (over or less than 50% of the original lumen). No major adverse events such as deep vein thrombosis, significant allergic reactions, or serious neurological events occurred in any patient in any group. Further studies are still necessary to identify the best concentration ratios, volumes and length of contact time between foam and endothelium according to class size of specific veins to promote possible standardization of the procedure. However, measures to increase the contact time between foam and endothelium were shown to improve late results. In addition, the same efficacy and side effects are observed with lower POL concentration if foam volumes are increased.
Ultrasound guided foam sclerotherapy in Varicose veins -Is it necessary?
IOSR Journals , 2019
Varicose veins affect up to 25% of women and 15% of men in the western world 3 and incidence is apparently low in India. 4 Male preponderance was observed with male to female ratio 14:1 in Indian scenario. 5 Sclerotherapy involves the injection of a sclerosing agent directly into the superficial veins. The most commonly used is sodium tetradecyl sulphate. The direct contact with detergent causes cellular death and initiates an inflammatory response, aiming to result in thrombosis, fibrosis and obliteration (sclerosis). Blood deactivates the action of the sclerosing agent and the doses administered need to be limited to avoid adverse effects, causing a trade-off between poor efficacy and safety. 11 In this study outcomes of non usg guided injection sclerotherapy were studied and analyzed among patients coming to RIMS, Ranchi which is a tertiary care centre in Jharkhand. A total of 50 cases who underwent non usg guided foam sclerotherapy were studied out of which, all had obliteration of Varicose Veins. The secondary outcomes were symptomatic improvement, ulcer healing, recurrence, and adverse events. Adverse effects were pain (86%), pruritis (32%), swelling (14%), thrombophlebitis (16%) and skin ulceration (2%). Complete obliteration was achieved after one injection in all cases. Thrombosis and neurologic events were not seen. Hence, Foam Sclerotherapy, even non USG guided, appears to be a safe and effective outpatient therapy for the treatment of Varicose Veins and hence can be used even in setups lacking the facility of USG.