Randomized Clinical Trial of Different Bandage Regimens after Foam Sclerotherapy for Varicose Veins

Abstract

Conclusion: There are no differences between sclerotherapy results in patients treated for truncal varices with foam sclerotherapy regardless of whether compression therapy after the procedure is used for 1 or 5 days. Summary: There are no data on the optimal bandaging regimen after foam sclerotherapy for truncal varices. In Great Britain, 80% of the members of the Vascular Society of Great Britain and Ireland responding to a questionnaire, and who treated patients with sclerotherapy, indicated they used compression bandages, and 90% subsequently used compression stockings after compression bandaging. Duration of treatment ranged from 1 to 7 days for initial bandages, with compression stockings used for 7 to 14 days, with some surgeons recommending compression stockings for up to 3 months. The authors sought to determine whether duration of bandaging could be reduced after foam sclerotherapy for truncal varices. Patients with primary uncomplicated varicose veins were randomized after foam sclerotherapy treatment to wearing compression bandaging for 24 hours or 5 days. In each case after compression bandages were removed, thromboembolism deterrent (TED) stockings then used for a total of 14 days of compression after foam sclerotherapy. The primary end point of the study was the 6-week Aberdeen Varicose Vein Severity Score (AVVSS) and Buford pain score. The study randomized 124 legs, of which 61 were randomized to 24 hours of compression bandaging and 63 to 5 days of compression bandaging. Venous occlusion rates at 6 weeks were 90% and 89%, respectfully (P = .842). There were no differences in phlebitis after 2 weeks (P = .445), skin discoloration after 6 weeks (46% vs 40%; P = .546). There were no differences between groups in the AVVSS from baseline to 2 weeks (–0.29 vs –0.80; P = .717) or to 6 weeks (–5.89 vs –5.14; 95% confidence interval [CI] for the difference, –3.29 to 1.8; P = .563). There were also no differences between groups in changes in the Buford pain score from baseline to 2 weeks (–9.04 vs –2.80, P = .248) or to 6 weeks (–17.32 vs –8.46; 95% CI for the difference, –19.06 to 1.33; P = .088). Finally, the two groups also did not demonstrate any differences in changes in the Short Form-36 score from baseline to 6 weeks (2.02 vs. 1.74; P = .903). Comment: Foam sclerotherapy is replacing liquid sclerotherapy as the preferred method of sclerotherapy for patients with truncal varicosities. Compression after treatment is essential to optimal results. However, as the authors point out with respect to foam sclerotherapy, the optimal duration of compression after treatment has not been adequately studied. This study is good news for patients. Compression bandages are not comfortable, and the results indicate that 24 hours of compressive bandaging, followed by a TED stocking for a total of 2 weeks, is just as efficacious as 5 days of compressive bandaging, followed by a TED stocking for a total of 2 weeks. The study provides practical guidance for post-therapy bandaging of patients undergoing foam sclerotherapy.