Multiple Small-Dose Injections Can Reduce the Passage of Sclerosant Foam into Deep Veins During Foam Sclerotherapy for Varicose Veins (original) (raw)
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Pakistan Journal of Medical and Health Sciences
Background: Foam injection sclerotherapy for treating varicose veins is a newly emerging and minimally invasive technique. Its safety profile needs to be investigated. Objective: We documented the adverse effects associated with foam injection sclerotherapy occurring in the first 24 hours and then at 2 and 4 weeks of follow up visits. Material and Methods: This cross-sectional study was conducted at Department of Surgery in Benazir Bhutto Hospital, affiliated with Rawalpindi Medical University, Rawalpindi from 1st July 2021 till 30th June 2022; on 50 patients of varicose veins. A duplex ultrasound was done in all patients. Varicose veins were classified using the CEAP system. Patients having C1 and/or C2 varicose disease with isolated GSV incompetence on duplex ultrasound were included. Results: Only minor complications were encountered and no serious complication was seen. The minor side effects included nausea, hyperpigmentation, matting, headache, vomiting, pruritus around inject...
Treatment of varicose veins by foam sclerotherapy: Two clinical series
Phlebology, 2002
Objective: To assess the efficacy and safety of sclerotherapy of varicose veins (VV) with sclerosing foam (SF) made using Tessari's method (three-way tap and two plastic syringes). Design: Two multi-centre prospective clinical series were documented (CS1 and CS2). In CS1, which ran from March to December 2000, 177 patients (39 men, 138 women), mean age 56 years, were treated in three centres for VV related to incompetence of saphenous veins, recurrence, perforators or collaterals. Conventional or duplex-guided sclerotherapy was performed using SF made of purified sodium tetradecyl sulphate (PSTS) 0.2-3% (Fibro-vein, STD Pharmaceuticals, UK) and air. An average of 1.6 (SD 0.8) sessions per patient were performed and 2.9 (SD 1.0) ml of SF (i.e. 0.6 ml of PSTS) per session was employed. An elastic stocking providing 20-30 or 30-40 mmHg compression was worn by patients following treatment. All the patients were reviewed (clinical examination and colour duplex ultrasonography) at 1 month. Sixty-six patients had a further follow-up 45-370 days after treatment. The 17 patients in CS2, a multi-centre study, were treated in March and April 2001. An independent observer assessed patients with major VV (CEAP and VV type distribution similar to CS1) before and after the treatment, and also observed the treatment, which was carried out using the technique employed in CS1. Results: In CS1 at 1 month follow-up there was: (A) obliteration of the vessel or antegrade flow in 161 (91%) patients, (B) minimal retrograde flow in the treated vein, without visible VV, in 15 (8.4%) cases and (C) persistence of vessel patency with retrograde flow and visible VV (failure) in 1 (0.6%) case. At 45-370 days (mean 138 days) follow-up results were: type A in 44 (67%) cases, type B in 17 (26%) cases and type C in 5 (8%) cases. The main complications were extension of sclerothrombus from superficial to deep veins (n = 2), allergy (n = 1), malaise (n = 1) and scotoma (n = 1). In CS2 at 30 days follow-up 100% of the treated venous segments had a type A outcome after an average of 1.4 sessions. No relevant complication occurred in this series. Conclusions: Sclerotherapy of major VV by means of SF prepared by Tessari's method is a safe and effective form of treatment. Low doses and a low concentration of drug may be successfully employed. Further studies are needed to establish the long-term results and overall safety of this form of foam sclerotherapy.
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.
Systematic review of foam sclerotherapy for varicose veins
British Journal of Surgery, 2007
Background and method Foam sclerotherapy is a potential treatment for varicose veins. A systematic review was undertaken to assess its safety and efficacy. Results Sixty-nine studies were included. The median rates of serious adverse events, including pulmonary embolism and deep vein thrombosis, were less than 1 per cent. The median rate of visual disturbance was 1·4 per cent, headache 4·2 per cent, thrombophlebitis 4·7 per cent, matting/skin staining/pigmentation 17·8 per cent and pain at the site of injection 25·6 per cent. The median rate of complete occlusion of treated veins was 87·0 per cent and for recurrence or development of new veins it was 8·1 per cent. Meta-analysis for complete occlusion suggests that foam sclerotherapy is less effective than surgery (relative risk (RR) 0·86 (95 per cent confidence interval (c.i.) 0·67 to 1·10)) but more effective than liquid sclerotherapy (RR 1·39 (95 per cent c.i. 0·91 to 2·11)), although there was substantial heterogeneity between st...
Role of foam sclerotherapy in management of varicose veins
IOSR Journals , 2019
Varicose veins affect up to 25% of women and 15% of men in the western world3 and incidence is apparently low in India.4Male preponderance was observed with male to female ratio 14:1 in Indian scenario.5 Sclerotherapy is a medical procedure used to eliminate varicose veins and spider veins which involves an injection of a solution (generally a salt solution) directly into the vein. The most commonly used is sodium tetradecyl sulphate. The solution irritates the lining of the blood vessel, causing it to swell and stick together, and the blood to clot.10 In this study various outcomes of injection sclerotherapy were studied and analyzed among patients coming to RIMS, Ranchi which is a tertiary care centre in Jharkhand. A total of 40 cases who underwent foam sclerotherapy were studied out of which, all had obliteration of VaricoseVeins. The secondary outcomes were symptomatic improvement, ulcer healing, recurrence, and adverse events. Adverse effects were pain (85%), pruritis (40%), swelling (17.5%) and thrombophlebitis (15%). Complete obliteration was achieved after one injection in all cases. Thrombosis and neurologic events were not seen. Hence,Foam Sclerotherapy appears to be a safe and effective outpatient therapy for the treatment of VaricoseVeins and hence can be used routinely.
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.
Foam Sclerotherapy-Alternative/Adjunct Treatment in Varicose Veins
IOSR Journals , 2019
Varicose veins is a growing menace in general population which commonly present with varicosities , pigmentation and relentless non healing ulceration. Ulcers range from small waxing and waning ulcers to circumferential deep ulcers which are adamant. Common modalities like surgery(including Trendlenburg's, stripping and microphlebectomy), EVLT and RFA address the problem of main veins leaving behind small veins like reticular veins and ankle flare. This leads to recurrence of varicosities and ulceration. In this study,we evaluated 58 cases of Varicose veins treated with Foam sclerotherapy(FS) either as primary modality (n.34)or as an adjunct to surgery(n.24). Materials and methods:All patients are evaluated by colour Doppler and DVT is excluded 1. Among the 34 patients treated with FS 2. 7(20.5%) patients are treated for varicosities alone. a. 21(61.7%) patients are treated for venous ulcer. b. 6 (17.8%) patients-reticular veins and ankle flare with pigmentation and ulceration. 2. In all cases, sodium tetradecyl sulphate is used (to avoid drug bias) as sclerosant. 3. Foam is created with 2ml of STDS, and 8ml of air making 10 ml of foam by TESSARI s method and is injected into veins after cannulating with scalp vein needle/ 26 G needle to a maximum of 15ml foam. Post operatively crepe bandage applied. All injections are given under MAC(monitored anaesthesia care) 4.In case of venous ulcers treated with sclerotherapy alone all veins in the vicinity of ulcer are injected.In cases where FS is used as an adjunct it is done on a second visit after 20 days post operatively into the residual blow outs. Results: a. In all cases the veins occluded completely, confirmed clinically and sonologically. b. In ulcer patients 16 ulcers healed completely and in 5 patients there is regression of ulcer size from 40-60% of pre FS stage. c. In cases where there is pigmentation there is improvement in pigmentation. In all patients there is subjective improvement in dragging pain of the legs and tiredness of calf muscles. Complications included pain in the course of veins extravasation of drug with pigmentation at injection site and temporary dizziness during the procedure. Conclusion: Though further evaluation is needed Foam sclerotherapy appears to be cheap and reliable adjunct treatment for varicose veins particularly in patients having reticular vein, ankle flare with pigmentation and ulceration. Moreover , it appears to be an adjunctive treatment for post operative residual veins.
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.
Complications of Sclerotherapy with Sclerosing Foam in Lower Extremity Varicose Veins
Background: Using sclerotherapy with foam has caused a great change in treatment of varicose veins. Although, it is more than a century that it is being used, no exact and comprehensive knowledge of its complications has been published yet with regard to the existing facilities in Iran. Materials and Methods: Patients with varicose veins of lower extremity referred to cardiology clinic of Razi hospital, Rasht were included in the study after doppler sonography and in case of presence of varicose veins with more than 2 mm diameter in lower extremities without inadequacy of saphenofemoral and saphenopopliteal valve. They then underwent sclerosing with foam treatment. The total number of patients was 156 who were examined 2 weeks and 3 months after sclerotherapy in terms of complications such as pain, pigmentation, recurrence, phlebitis, deep vein thrombosis and skin necrosis. Results: Out of 156 patients, 47 were men and 109 women whose mean±SD age was 46.5±12.2 years. Two weeks after...
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.