Sclerotherapy and foam sclerotherapy for varicose veins

2009 ◽  
Vol 24 (6) ◽  
pp. 260-269 ◽  
Author(s):  
P Coleridge Smith
Keyword(s):  
Recent Literature ◽  
Varicose Veins ◽  
Visual Disturbance ◽  
Optimum Ratio ◽  
Foam Sclerotherapy ◽  
Serious Adverse Events ◽  
Systemic Complications ◽  
Published Evidence ◽  
Early Results ◽  
Clinical Series

Objectives To review published evidence concerning treatment of varicose veins using ultrasound-guided foam sclerotherapy (UGFS) to assess the safety and efficacy of this treatment. Methods Medical literature databases including MedLine, Embase and DH-DATA were searched for recent literature concerning UGFS. Papers describing the early results and later outcome have been assessed and their main findings were included in this summary. Results Few randomized studies have been published in this field and much of the available data come from clinical series reported by individual clinicians. It is clear that foam sclerotherapy is far more effective than liquid sclerotherapy and that ultrasound imaging allows the treatment to be delivered accurately to affected veins. There is evidence that 3% polidocanol foam is no more effective than 1% polidocanol foam. The optimum ratio of gas to liquid is 4:1, although a range of ratios is reported in the published work. There is a wide variation in the volume used as well as the method by which it is injected. The use of carbon dioxide foam reduces the systemic complications, particularly visual disturbance, as compared with air foams. Very few serious adverse events have been reported in the literature despite the widespread use of this method. Rates of recanalization of saphenous trunks following UGFS are similar to those observed after endovenous laser and endovenous RF ablation of veins, as well as the residual incompetence after surgical treatment. Conclusion UGFS is a safe and effective method of treating varicose veins. The relative advantages or disadvantages of this treatment in the longer term have yet to be published.

Foam and liquid sclerotherapy for varicose veins

2009 ◽  
Vol 24 (1_suppl) ◽  
pp. 62-72 ◽  
Author(s):  
P Coleridge Smith
Keyword(s):  
Medical Literature ◽  
Recent Literature ◽  
Varicose Veins ◽  
Visual Disturbance ◽  
Optimum Ratio ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Serious Adverse Events ◽  
Diverse Range ◽  
Systemic Complications

Objective The objective of this study is to review the methods and outcome of ultrasound-guided foam sclerotherapy (UGFS) for the treatment of superficial venous incompetence. Method Medical literature databases including Medline were searched for recent literature concerning UGFS. Papers describing methods and outcome have been assessed and their main findings included in this summary. A detailed description of the methods used by the author has been included as an example of how successful the treatment may be achieved. Results A diverse range of practice is described in published literature in this field. Each group of authors used their own variation of the methods, described in the published literature, with good results. It is clear that foam sclerotherapy is far more effective than liquid sclerotherapy and that ultrasound imaging allows the treatment to be delivered accurately to affected veins. There is evidence that 3% policocanol foam is no more effective than 1% polidocanol foam. The optimum ratio of gas to liquid is 4:1, although a range of ratios is reported in published work. There is a wide variation in the volume used as well as the method by which it is injected. The use of carbon dioxide foam reduces the systemic complications, particularly visual disturbance, when compared with air foams. Very few serious adverse events have been reported in the literature despite the widespread use of this method. Rates of recanalization of saphenous trunks following UGFS are similar to those observed after endovenous laser and endovenous radiofrequency ablation of veins, as well as the residual incompetence after surgical treatment. Conclusions UGFS is a safe and effective method of treating varicose veins. The relative advantages or disadvantages of this treatment in the longer term are yet to be published.

Can foam sclerotherapy be used to safely treat bilateral varicose veins?

2011 ◽  
Vol 27 (1) ◽  
pp. 19-24 ◽  
Author(s):  
R H Bhogal ◽  
C E Moffat ◽  
P Coney ◽  
I K Nyamekye
Keyword(s):  
Varicose Veins ◽  
Visual Disturbance ◽  
Complication Rates ◽  
Treatment Episode ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Systemic Complications ◽  
Complete Occlusion ◽  
Vein Occlusion ◽  
Significant Difference

Objective We assessed the use of ultrasound guided foam sclerotherapy (UGFS) to treat bilateral varicose veins either as synchronous or interval procedures. We specifically assessed total foam volume usage and its influence on early outcome and complications. Methods We reviewed our prospectively compiled computerised database of patients with bilateral varicose veins who have undergone UGFS. Duplex findings, foam volumes used and clinical outcome were assessed. Results One hundred and twelve patients had undergone UGFS for bilateral varicose veins. Sixty-one had bilateral UGFS (122 legs) and 51 had interval UGFS (102 legs). Seventy-eight percent bilateral and 60% interval procedures were for single trunk disease. Median foam volumes per treatment episode were: 17.5 mls bilateral, and 10 mls interval FS. At two weeks 81% of legs had complete occlusion after bilateral UGFS compared to 70% after interval UGFS. One patient in the bilateral UGFS developed transient visual disturbance. There was no systemic complications in the interval UGFS. Conclusions Bilateral foam sclerotherapy treatment did not adversly affect vein occlusion rates and there was no significant difference in complication rates between the two groups. Bilateral UGFS can be safely performed in selected patient presenting with bilateral varicose veins.

scholarly journals ClariVein® – Early results from a large single-centre series of mechanochemical endovenous ablation for varicose veins

2016 ◽  
Vol 32 (1) ◽  
pp. 6-12 ◽  
Author(s):  
TY Tang ◽  
JW Kam ◽  
ME Gaunt
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Single Centre ◽  
Foam Sclerotherapy ◽  
Early Results ◽  
Endovenous Ablation ◽  
The Uk

Objectives This study assessed the effectiveness and patient experience of the ClariVein® endovenous occlusion catheter for varicose veins from a large single-centre series in the UK. Methods A total of 300 patients (371 legs) underwent ClariVein® treatment for their varicose veins; 184 for great saphenous vein (GSV) incompetence, 62 bilateral GSV, 23 short saphenous vein (SSV), 6 bilateral SSV and 25 combined unilateral great saphenous vein and SSV. Patients were reviewed at an interval of two months post procedure and underwent Duplex ultrasound assessment. Postoperative complications were recorded along with patient satisfaction. Results All 393 procedures were completed successfully under local anaesthetic. Complete occlusion of the treated vein was initially achieved in all the patients, but at eight weeks’ follow-up, there was only partial obliteration in 13/393 (3.3%) veins. These were all successfully treated with ultrasound-guided foam sclerotherapy. Procedures were well tolerated with a mean pain score of 0.8 (0–10). No significant complications were reported. Conclusions ClariVein® can be used to ablate long and short saphenous varicose veins on a walk-in–walk-out basis. Bilateral procedures can be successfully performed, and these are well tolerated as can multiple veins in the same leg. Early results are promising but further evaluation and longer term follow-up are required.

Treatment of varicose veins by foam sclerotherapy: Two clinical series

2002 ◽  
Vol 17 (1) ◽  
pp. 13-18 ◽  
Author(s):  
A. Cavezzi ◽  
A. Frullini ◽  
S. Ricci ◽  
L. Tessari
Keyword(s):  
Varicose Veins ◽  
Foam Sclerotherapy ◽  
Clinical Series

Adverse neurological events after sodium tetradecyl sulfate foam sclerotherapy – A prospective, observational study of 8056 treatments

2021 ◽  
pp. 026835552110514
Author(s):  
Huw OB Davies ◽  
Mike Watkins ◽  
Richard Oliver ◽  
Sarah Berhane ◽  
Andrew W Bradbury
Keyword(s):  
Logistic Regression ◽  
Adverse Events ◽  
Varicose Veins ◽  
Past History ◽  
Statistical Significance ◽  
Adjunctive Treatment ◽  
Sodium Tetradecyl Sulfate ◽  
Foam Sclerotherapy ◽  
Serious Adverse Events ◽  
Foam Volume

Background Ultrasound guided foam sclerotherapy (UGFS) is a flexible and highly utilised tool in the treatment of varicose veins (VVs), both as a primary treatment and as an adjunct to other treatments. Concern remains regarding the risk of neurological adverse events (AEs) such as migraine, visual disturbance and serious adverse events (SAEs) such as cerebrovascular accident that have been reported after UGFS treatments. Aim To determine the incidence of neurological AEs and SAEs after UGFS. Methods A prospective, multicentre, post-authorisation safety study across Europe (both private and government) was performed between January 2015–2020. Neurological adverse events after UGFS with Fibrovein® (Sodium Tetradecyl Sulfate) 1 and 3% physician generated foam. Results 8056 patients underwent treatment. There were 46 AE (including 5 SAEs), 30 (65%) SAEs were in female patients. Mean age was 55 years with mean body mass index (BMI) of 27. Univariable logistic regression demonstrate that UGFS only treatment (i.e. no adjunctive treatment), liquid-to-gas ratio, gas type and total foam volume (1% sodium tetradecyl sulfate, STS) were significantly associated with the odds of experiencing the outcome. Multivariable logistic regression model exhibits that migraine and total foam volume (1% STS) maintained statistical significance thus associated with the odds of adverse events. Conclusions This study demonstrates that UGFS with Fibrovein is safe with a very low incidence of neurological AEs and SAEs. Past history of migraine, use of physiological gas (O2/CO2) and increasing volumes of 1% foam increase the risk of AEs.

Technical Feasibility and Early Results of Radiologically Guided Foam Sclerotherapy for Treatment of Varicose Veins

2011 ◽  
Vol 37 (7) ◽  
pp. 992-998 ◽  
Author(s):  
LONG LI ◽  
XUAN-YANG HONG ◽  
XIN-QIAO ZENG ◽  
PEI-LIN LUO ◽  
QIONG YI
Keyword(s):  
Varicose Veins ◽  
Foam Sclerotherapy ◽  
Technical Feasibility ◽  
Early Results

Visual disturbance following sclerotherapy for varicose veins, reticular veins and telangiectasias: a systematic literature review

2013 ◽  
Vol 28 (3) ◽  
pp. 123-131 ◽  
Author(s):  
T Willenberg ◽  
P C Smith ◽  
A Shepherd ◽  
A H Davies
Keyword(s):  
Randomized Trials ◽  
Varicose Veins ◽  
Case Reports ◽  
Case Series ◽  
Underlying Mechanism ◽  
Visual Disturbance ◽  
Inclusion Criteria ◽  
Foam Sclerotherapy ◽  
Underlying Mechanisms ◽  
Foam Production

The objective of the study was to review the literature reporting visual disturbance (VD) following sclerotherapy for varicose veins. Underlying mechanisms will be discussed. A literature search of the databases Medline and Google Scholar was performed. Original articles including randomized trials, case series and case reports reporting VD in humans following sclerotherapy for varicose veins were included. Additional references were also obtained if they had been referenced in related publications. The search yielded 4948 results of which 25 reports were found to meet the inclusion criteria. In larger series with at least 500 included patients the prevalence of VD following sclerotherapy ranges from 0.09% to 2%. In most reports foam sclerotherapy was associated with VD (19); exclusive use of liquid sclerosant was reported in two cases, some reports included foam and liquid sclerosant (4). There were no persistent visual disorders reported. VD occurred with polidocanol and sodium tetradecyl sulphate in different concentrations (0.25–3%). Various forms of foam preparation including various ways of foam production and the liquid – air ratio (1 or 2 parts of liquid mixed with 3, 4 or 5 parts of air) were reported in association with the occurrence of VD. VDs following sclerotherapy for varicose veins are rare and all reported events were transient. Bubble embolism or any kind of embolism seems unlikely to be the only underlying mechanism. A systemic inflammatory response following sclerotherapy has been suggested. Further research to clarify the mechanism of action of sclerosants is required.

Treatment of Varicose Veins by Foam Sclerotherapy: Two Clinical Series

2002 ◽  
Vol 17 (1) ◽  
pp. 13-18 ◽  
Author(s):  
A. Cavezzi ◽  
A. Frullini ◽  
S. Ricci ◽  
L. Tessari
Keyword(s):  
Varicose Veins ◽  
Type A ◽  
Long Term Results ◽  
Retrograde Flow ◽  
Foam Sclerotherapy ◽  
Multi Centre Study ◽  
Independent Observer ◽  
Clinical Series ◽  
Antegrade Flow

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 W 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 W (CEAP and W 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 W, in 15 (8.4%) cases and (C) persistence of vessel patency with retrograde flow and visible W (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.

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