An observational study to evaluate efficacy and safety of ultrasound guided foam sclerotherapy for treatment of varicose veins
DOI:
https://doi.org/10.18203/2349-2902.isj20230265Keywords:
Foam sclerotherapy, Polidocanol, Varicose veinAbstract
Background: There are various minimally invasive techniques for varicose veins. Tessari has invented simple method to create sclerosant foam that has become popular nowadays as treatment for varicose veins. Aim was to describe the efficacy and safety of ultrasound guided foam sclerotherapy for treating varicose veins.
Methods: The observational study was carried out in 50 patients between July 2020 to June 2021. Sclerosant foam was made by Tessari method using polidocanol was introduced under ultrasound guidance in to affected veins. After 3 days looked for any residual varicosities and complications. All patients were followed up at 3 days, 1 month, 3 month and 6 months after treatment.
Results: 37 patients were treated with 3.0% of polidocanol. Rest 13 patients (26.0%) were treated with 1.0% of polidocanol. Six (12.0%) and eight patients (16.0%) received three and four sessions of sclerotherapy respectively. After 1 month, 41 patients (82.0%) achieved complete occlusion, in 5 patients (10%) partial occlusion was seen. After 3 months, 47 patients (94%) achieved complete occlusion without any symptom and three patients (6.0%) had partial occlusion. At the end of 6 months 48 patients (96.0%) achieved complete occlusion without any symptoms. Four patients (8.0%) developed SVT blurred vision in 3 patients (6.0%) and pain with redness at injection site was observed in one patient (2.0%).
Conclusions: Ultrasound guided foam sclerotherapy is safe and effective in obliterating varicosities of lower limb including perforators using polidocanol sclerosant agent with less complication, low recurrences and good cosmetic outcome.
References
Shankar KH. Clinical study of varicose veins of lower limbs. Int Surg J. 2017;4:633-6.
Verma V, Mohil RS, Kumar S, Gupta A. Comparing ultrasound guided foam sclerotherapy with surgical treatment in patients of varicose veins. Int Surg J. 2016;3:2239-45.
Davies AH, Steffen C, Cosgrove C, Wilkins DC. Varicose vein surgery: Patient satisfaction. J R ‘CollSurg Edinb. 1995;40:298‑9.
Mishra S, Ali I, Singh G. A study of epidemiological factors and clinical profile of primary varicose veins. Med J Dr. DY Patil University. 2016;9(5):617.
Madhu BS, HB SK, Kalabhairav S, Reddy A. Efficacy and safety of ultrasound guided foam sclerotherapy with sodium tetradecyl sulphate for residual and minor varicosities. Int Surg J. 2017;4(2): 751-6.
SK Dwivedi. Role of foam sclerotherapy in management of varicose vein. Command Hospital (Air force). Rajiv Gandhi University, Bangalore, Karnataka. MS thesis. 2012.
Singh M, Kola A, Katyayan I, Manwatkar S. Outcome following ultrasound guided foam sclerotherapy treatment for varicose veins in a tertiary care centre. Int J Contemp Med Surg Radiol. 2018;3(4):C82-6.
Mosley JG. Gupta I. The clinical and histological effects of ethanolamine in varicose vein. Phlebology. 1998;13(1):29-30.
Gamal WM, Mohamed AF. Duplex Guided Foam Sclerotherapy Versus Surgery in Management of Primary Varicose Veins. J Vasc Med Surg. 2017;5(325):2.
O'Hare JL, Parkin D, Vandenbroeck CP, Earnshaw JJ. Mid term results of ultrasound guided foam sclerotherapy for complicated and uncomplicated varicose veins. Eur J Vasc Endovasc Surg. 2008;36:109-13.
Thomasset SC, Butt Z, Liptrot S, Fairbrother BJ, Makhdoomi KR. Ultrasound guided foam sclerotherapy: factors associated with outcomes and complications. Eur J Vasc Endovasc Surg. 2010;40(3):389-92.
Jia X, Mowatt G, Burr JM, Cassar K, Cook J, Fraser C. Systematic review of foam sclerotherapy for varicose veins. British Journal of Surgery: Incorp Eur J Surg Swiss Surg. 2007;94(8):925-36.
Cabrera, J., Cabrera, J., Garcia-Olmedo, M.A. Treatment of varicose long saphenous veins with sclerosant in microfoam: long-term outcomes. Phlebology. 2000;15:19-23.
Smith PC. Chronic venous disease treated by ultrasound guided foam sclerotherapy. Eur J Vasc Endovasc Surg. 2006;32(5):577-83.
Myers KA, Jolley D, Clough A, Kirwan J. Outcome of ultrasound-guided sclerotherapy for varicose veins: medium-term results assessed by ultrasound surveillance. Eur J Vasc Endovasc Surg. 2007;33(1):116-21.
Chapman-Smith P, Browne A. Prospective five-year study of ultrasound-guided foam sclerotherapy in the treatment of great saphenous vein reflux. Phlebology. 2009;24(4):183-8.
Van den Bos R, Arends L, Kockaert M, Neumann M, Nijsten T. Endovenous therapies of lower extremity varicosities: a meta-analysis. J Vasc Surg. 2009;49(1):230-9.
Hahn M, Schulz T, Jünger M. Outcome four years after transcatheter foam sclerotherapy of the greater saphenous vein. Phlebologie. 2008;37(05):237-40.
Leopardi D, Hoggan BL, Fitridge RA, Woodruff PW, Maddern GJ. Systematic review of treatments for varicose veins. Ann Vasc Surg. 2009;23(2):264-76.
Pang KH, Bate GR, Darvall KA, Adam DJ, Bradbury AW. Healing and recurrence rates following ultrasound-guided foam sclerotherapy of superficial venous reflux in patients with chronic venous ulceration. Eur J Vasc Endovasc Surg. 2010;40(6):790-5.
Jones L, Braithwaite BD, Selwyn D, Cooke S, Earnshaw JJ. Neovascularisation is the principal cause of varicose vein recurrence: results of a randomised trial of stripping the long saphenous vein. Eur J Vasc Endovasc Surg. 1996;12(4):442-5.
Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, Schuller-Petrovic S, Sessa C. Prospective randomized study of endovenous radiofrequency obliteration (closure procedure) versus ligation and stripping in a selected patient population (EVOLVeS Study). J Vasc Surg. 2003;38(2):207-14.
Guex JJ, Schliephake DE, Otto J, Mako S, Allaert FA. The French Polidocanol Study on Long‐Term Side Effects: A Survey Covering 3,357 Patient Years. Dermatol Surg. 2010;36:993-1003.
Gillet JL, Guedes JM, Guex JJ, Hamel-Desnos C, Schadeck M, Lauseker M, et al. Side-effects and complications of foam sclerotherapy of the great and small saphenous veins: A controlled multicentre prospective study including 1,025 patients. Phlebology. 2009;24 (1):131-8.
Frullini A, Felice F, Burchielli S, Di Stefano R. High production of endothelin after foam sclerotherapy: a new pathogenetic hypothesis for neurological and visual disturbances after sclerotherapy. Phlebology. 2011;26(5):203-8.
Breu FX, Guggenbichler S, Wollmann JC. 2nd European Consensus Meeting on Foam Sclerotherapy 2006, Tegernsee, Germany. VASA. Zeitschrift fur Gefasskrankheiten. 2008;37:1-29.
Hamel-Desnos C, Allaert FA. Liquid versus foam sclerotherapy. Phlebology. 2009;24(6):240-6.
Coleridge Smith P. Sclerotherapy and foam sclerotherapy for varicose veins. Phlebology. 2009;24(6):260-9.
Scurr JR, Fisher RK, Wallace SB, Gilling-Smith GL. Anaphylaxis following foam sclerotherapy: a life threatening complication of non invasive treatment for varicose veins. EJVES Extra. 2007;13(6):87-9.
Brzoza Z, Kasperska-Zajac A, Rogala E, Rogala B. Anaphylactoid reaction after the use of sodium tetradecyl sulfate: a case report. Angiology. 2007;58(5):644-6.
S. C. Cotton, G. MacLennan, J. Brittenden, M. Prior and J. Francis. Behavioural recovery after treatment for varicose veins. BJS. 2016;103:374-81.
Brittenden J, Cotton SC, Elders A, Ramsay CR, Norrie J, Burr J, Campbell B, Bachoo P, Chetter I, Gough M, Earnshaw J. A randomized trial comparing treatments for varicose veins. N Engl J Med. 2014;371(13):1218-27.
Figueiredo M, Araújo S, Barros Jr N, Miranda Jr F. Results of surgical treatment compared with ultrasound-guided foam sclerotherapy in patients with varicose veins: a prospective randomised study. Eur J Vasc Endovasc Surg. 2009;38(6):758-63.
Subramonia S, Lees T. Sensory abnormalities and bruising after long saphenous vein stripping: impact on short-term quality of life. J Vasc Surg. 2005;42(3):510-e1.
Vasquez MA, Wang J, Mahathanaruk M, Buczkowski G, Sprehe E, Dosluoglu HH. The utility of the Venous Clinical Severity Score in 682 limbs treated by radiofrequency saphenous vein ablation. J Vasc Surg. 2007;45(5):1008-15.
Lurie F, Creton D, Eklof B, Kabnick L, Kistner R, Pichot O, et al. Prospective randomized study of endovenous radiofrequency obliteration (Closure procedure) versus ligation and stripping in a selected patient population (EVOLVeS Study). J Vasc Surg. 2003;38:207-14.
Rasmussen LH, Lawaetz M, Bjoern L, Vennits B, Blemings A, et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011;98:1079-87.
Kalodiki E, Lattimer CR, Azzam M, Shawish E, Bountouroglou D, Geroulakos G. Long-term results of a randomized controlled trial on ultrasound-guided foam sclerotherapy combined with saphenofemoral ligation vs standard surgery for varicose veins. J Vasc Surg. 2012;55(2):451-7.
Shadid N, Ceulen R, Nelemans P, Dirksen C, Veraart J, Schurink GW, Van Neer P, Vd Kley J, de Haan E, Sommer A. Randomized clinical trial of ultrasound‐guided foam sclerotherapy versus surgery for the incompetent great saphenous vein. Br J Surg. 2012;99(8):1062-70.
