Chemical and mechanochemical catheter-directed sclerotherapy in varicose vein ablation

Abstract

Background Varicose vein, as well as the accompanied venous insufficiency, is a frequent disorder, affecting ∼30% of the Western population. Chronic venous insufficiency has a major effect on patients’ health-related quality of life, similar to different chronic disorders, including diabetes mellitus as well as cardiovascular diseases. Aim The aim of this study was to assess and compare the applicability, technique, and results of catheter-directed foam sclerotherapy in the management of varicose vein with and without mechanical injury to the vein wall. Patients and methods The study was conducted on 104 patients with primary varicose vein between November 2017 to October 2019. All patients were admitted to Vascular Surgery Department in Mansoura University hospitals. They were divided into two groups: group A (chemical ablation) included 79 patients, and group B (mechanochemical ablation) included 25 patients. Technique In chemical ablation group, catheter-directed foam sclerotherapy of great saphenous vein was done using Aethoxysklerol 3% by ureteric catheter. In mechanochemical ablation group, catheter-directed foam sclerotherapy of the great saphenous vein was done using Aethoxysklerol 3% through Flebogrif catheter. This was a nonrandomized prospective comparative study. Results Complete occlusion was reported at 3 months for all cases of group A (100%) and 19 (76%) of cases in group B, and after 6-month follow-up, occlusion occurred in 43 (54.43%) cases among group A and 22 (88%) of cases among group B and long-segment recanalization in 36 (45.56%) of cases among group A and three (12%) of cases among group B. Complications developed in 22 cases in group A and five cases in group B. In group A, 20 cases developed painful thrombophlebitis, one case reported DVT, and only one case reported respiratory distress. However, in group B, four cases developed painful thrombophlebitis and one case reported hyperpigmentation along the course of the vein. Patients in group B were more satisfied than group A patients, with significant difference, and also group B patients has less pain sensation than group A patients, with significant difference. Conclusions Catheter-directed foam sclerotherapy is accepted in the treatment of primary varicose vein with short-term and mid-term success in varicose vein ablation and has a low incidence of complications. Mechanochemical occlusion is preferred than catheter-directed foam sclerotherapy, with better results and fewer complications.