Catheter-directed Foam Sclerotherapy Research Articles

Customizing foam sclerotherapy of the great saphenous vein: A proposed algorithm to enhance technical efficacy.

The catheter-directed foam sclerotherapy (FS) and the suggested perivenous tumescent application for great saphenous vein (GSV) diameter reduction are suggested to improve technical and clinical results; yet, their use is reported rather indiscriminately. Our aim is to introduce an algorithm categorising the use of technical modalities accompanying ultrasound-guided FS of the GSV and present the technical efficacy of FS through a 5 F × 11 cm sheath placed at the knee level. Representative cases of GSV insufficiency were chosen to describe our methodology. Sole sheath-directed FS can achieve complete GSV occlusion proximally at a level comparable to the catheter-directed technique. We apply perivenous 4°C cold tumescent to GSV >6mm even in the standing position to ensure diameter reduction of the proximal GSV as close to the saphenofemoral junction. We use long catheters only to overcome large varicosities above the knee level that could otherwise compromise the adequate foam infusion from the sheath tip. When GSV insufficiency extends along the entire limb and severe skin lesions preclude the antegrade distal catheterisation, the sheath-directed FS in the thigh can be concomitantly combined with retrograde FS from catheterisation just below the knee. A topology-oriented methodology with sheath-directed FS is technically feasible and avoids indiscriminate use of more complex modalities.

Treatment of Recurrent Symptomatic Saphenous Trunk Reflux with Catheter Directed Foam Sclerotherapy and Tumescent Anaesthesia

ObjectiveThe aim was to assess short and midterm efficacy and safety of catheter directed foam sclerotherapy (CDFS) with tumescent anaesthesia in patients with recurrent symptomatic saphenous reflux.MethodsThis was a prospective observational study (February 2018 to February 2019) including 21 consecutive patients referred with recurrent symptomatic varicose veins. Standing duplex ultrasound (DUS) with saphenous vein diameter measurement 3 cm from the terminal valve was performed pre-operatively. All the patients were operated on under local anaesthesia. By ultrasound guided puncture a hydrophilic 0.035″ guidewire and 5F Berenstein catheter were inserted through a 5F introducer sheath. Peri-saphenous tumescent anaesthesia (PSTA) was performed under ultrasound guidance. Sclerosant foam was prepared with sodium tetradecyl sulphate 3% or polidocanol 3% using the Tessari method. Concomitant phlebectomies were performed in 52%. Clinical evaluation and DUS were performed pre- and post-operatively at one week, six months, and 12 months.ResultsThere were 11 men and 10 women (median age 52 years; interquartile range [IQR] 43 – 61). The great saphenous vein was treated in 18 patients. The median vein diameter was 6.8 mm (IQR 4.7 – 8.9). Previous procedures were Cure conservatrice et Hemodynamique de l'Insuffisance Veineuse en Ambulatoire (CHIVA), mechanochemical ablation, thermal ablation, and cyanoacrylate closure. The distribution of the clinical class (Clinical Etiology Anatomy Pathophysiology [CEAP] classification) was 16 C2, three C3, and two C4 limbs. Immediate technical success was 100%. There were no complications in the early post-operative period. The median follow up was eight months (IQR 5 – 10). The occlusion rate demonstrated by DUS was 100% (21/21) at one week, 100% (21/21) at six months, and 86% (18/21) at 12 months. The median post-procedural vein diameter at one week, six months, and 12 months was 4.8 mm (IQR 3.9 – 6), 4.3 mm (IQR 3.5 – 5.5), and 4 mm (IQR 3 – 4.9), respectively.ConclusionCombination CDFS with PSTA achieves good short and medium term venous occlusion rates, associated with few complications in patients with recurrent symptomatic saphenous reflux.

Catheter-Directed foam Sclerotherapy in Chronic Venous Insufficiency Patients with Active Ulcer Single-Center Experience

Introduction: Varicose vein and chronic venous insufficiency (CVI) is one of the most prevalent health problems in Europe and the United States; in some studies, it may reach 60% of population. Patients and Methods: This prospective study involving on 51 patients (C6) is to assess the efficacy and tolerance of sclerotherapy foam in the treatment of great saphenous vein incompetence and ulcer healing in CVI patients at 6 and 12 months and to report our experience regarding the diagnosis and treatment of CVI by catheter directed sclerotherapy (CDS). Results and Conclusion: In our experience, CDS safely can contribute to good ulcer healing rate up to 73% at 6 months for a reasonable cost of money and time which might be considered an attractive strategy for providing efficient vascular service in clinical practice.

Chemical and mechanochemical catheter-directed sclerotherapy in varicose vein ablation

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.

Catheter-directed foam sclerotherapy: a new technique for treating varicose veins

Objectives This was an observational prospective study to assess the safety and efficacy of catheter-directed foam sclerotherapy (CDFS) in the treatment of axial reflux and incompetence of saphenous veins with short-term to mid-term follow-up. Patients and methods A total of 20 patients [11 (55%) male and nine (45%) females] with either reflux of the long saphenous vein and/or short saphenous vein were subjected to CDFS. Overall, 10 ml of foam using polidocanol 2% was injected via long catheter into the saphenous vein. Then patients were followed up on 1 day after procedure, 1 month, 3 months, 6 months, and 1 year by duplex and clinically using visual analog scale (assess satisfaction of the patients which is related to improvement of their symptoms). Results After 1 year, 90% of the patients were satisfied by using visual analog scale, 85% (17 patients) had total ablation of the saphenous vein and 15% (three patients) had partial recanalization, with resultant reflux in two (10%) patients and one (5%) patient had competence of the saphenous vein owing to reduction of its diameter. One patient had deep venous thrombosis (5%), one patient had superficial thrombophlebitis (5%), and one patient had hyperpigmentation of the skin (5%). Conclusion CDFS is a safe and cost-effective procedure for treating axial reflux and incompetence of saphenous veins in terms of clinically and duplex-based outcome at short-term and mid-term follow-up.

Catheter-directed foam sclerotherapy, an alternative to ultrasound-guided foam sclerotherapy for varicose vein treatment: A systematic review and meta-analysis.

Catheter-directed foam sclerotherapy is a new addition to the treatment modalities available for varicose veins. As a modification of ultrasound-guided foam sclerotherapy, catheter-directed foam sclerotherapy has been purported to offer higher complete ablation rates and an improved safety profile. The aim of this study is to appraise the current literature on the outcomes of catheter-directed foam sclerotherapy compared to ultrasound-guided foam sclerotherapy in chronic venous insufficiency. The review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data from studies that reported the outcomes of catheter-directed foam sclerotherapy and ultrasound-guided foam sclerotherapy were extracted, to determine the pooled proportion of complete ablation rates, using a random effect meta-analysis model. A total of 62 studies, involving 3689 patients, were included in the systematic review. Higher rates of complete ablation were reported in catheter-directed foam sclerotherapy compared to ultrasound-guided foam sclerotherapy during the short- and medium-term follow-ups (Relative Risk = 1.06, Relative Risk = 1.15, Relative Risk = 1.19, p < 0.05). Fewer major and minor complications were also reported in patients who underwent catheter-directed foam sclerotherapy (Relative Risk = 0.23, Relative Risk= 0.43-0.76, p < 0.05). Catheter-directed foam sclerotherapy has been demonstrated to have many advantages over ultrasound-guided foam sclerotherapy, offering superior complete ablation rates in the short-, medium- and long-term follow-ups. It also has a better safety profile, conferring a lower risk of major and minor complications. The conclusions should however be viewed in the context of significant limitations imposed by limited study data.

Four-year Duplex Ultrasound Follow-up of Trunk Incompetent Saphenous Veins Treated with High Ligation and Reversed Catheter-directed Foam Sclerotherapy

Introduction: Ultrasound-guided foam sclerotherapy (UGFS) is an alternative and supplementary method for endovenous thermal ablation (EVTA) to treat incompetent saphenous reflux (ISR) and branch varicose veins (BVV).[1] The long-term result is not as satisfactory as EVTA, even while administered by catheter-directed method with or without tumescent local anesthesia.[2,3,4] Combined high ligation(HS) of sapheno-femoral junction(SFJ)/ sapheno-popliteal junction (SPJ) and reversed catheter-directed foam sclerotherapy (rCDFS) to treat ISR is an idea to assure SFJ/SPJ closure, avoid foam leaking into deep vein and enhance foam-endothelium interaction to improve safety and surgical results in less invasive and lower cost way. Midterm sonographic changes of target saphenous veins (TSV), clinical severity improvement and re-intervention rate are our concerns. Methods: From Jan. 2015 to Nov. 2018, 37 patients, 38 limbs treated with HS+rCDFS were retrospectively reviewed. The TSVs, CEAP severity, life quality scores, presence of venous leg ulcers (VLU), previous procedures for ISR or BVV, ongoing surgical procedures and following procedures were recorded. All enrolled patients were called back for re-evaluation of CEAP severity, life quality scores and VLU healing. The sonographic changes of TSV and BVV were focused. Results: 37 patients, 70.3% female, aged 29-85(mean 62.4), received HS+rCDFS because of unsatisfactory results of previous interventions (UGFS 21%, others 22.2%) or reluctant to EVTA. The severity above C4a was 76.3% (figure 1), including 26.3% with VLU. The TSVs included 30 great saphenous veins(GSV), 1 anterior accessory great saphenous vein (AAGSV) and 7 small saphenous veins (SSV). 71.1% surgeries were proceeded under local anesthesia. 23.7% surgeries combined with miniphlebectomy and 28.9% with sclerotherapy to BVV and 10.5% with sclerotherapy to reticular/spider veins. 63.2% patients needed following sclerotherapy, 18.4% needed following miniphlebectomy. 70.3% patients were followed from 57 to 1316 (mean 248) days. 76.9% TSVs were fibrotic or sealed. There were 4 small caliber recanalization, 1 large caliber recanalization(LCR), 1 neovasculization and 1 collateralization.(table 1) The VLU healing rate was 100%. The mean AVVQ and VCSS were 2.4, 1.9 respectively. There was one re-intervention for LCR with 1% polidocanol microfoam, Varithena. Conclusion: The severity of this series of patients was high but HS+rCDFS still permitted satisfactory midterm results to treat de novo or relapsed ISR and BVV and achieved 100% VLU healing, not inferior to EVTA or open saphenous vein stripping. The follow-up sonographic findings were surprisingly well without evident neovasculization as expected. Only 4% significant collateralization or LCR might need re-intervention. Disclosure: Nothing to disclose

Catheter-directed foam sclerotherapy with tumescence of the great saphenous vein versus ultrasound-guided foam sclerotherapy: A randomized controlled trial.

To compare the effectiveness of two foam sclerotherapy techniques of the great saphenous vein. Fifty subjects with varicose veins, edema, and great saphenous vein incompetence (diameter 6-10 mm) were randomly categorized into two equal groups and were treated with different foam sclerotherapy techniques: A (usual ultrasound-guided) and B (catheter-directed with tumescence). Concomitant phlebectomy was performed in all patients. Patients were seen on days 7 and 28, and at six and 12 months. The primary outcomes were the full success rate of the treated great saphenous vein and the number of patients who required retreatment sessions performed at 28-day follow-up. The secondary-assisted outcomes were the full success rates of the treated great saphenous vein after the retreatment sessions at six- and 12-month follow-up. Secondary outcomes were changes in quality of life and side effects and complications of the intervention. In case of reflux, retreatment sessions were performed at 28 days and six months in both groups. Full success rate of the treated great saphenous vein was 36% in group A vs. 80% in group B ( p = 0.012) and the number of patients who required retreatment sessions were n = 14 in group A vs. n = 3 in group B at 28-day follow-up ( p = 0.002). Both were statistically significant. At six and 12 months, the success rates were not statistically significant between the groups. Complication rates were similar between the groups. Quality of life improved in both groups with statistical difference ( p < 0.001). Catheter-directed foam sclerotherapy with tumescence was better than usual ultrasound-guided foam sclerotherapy as it reached higher full success rate of the treated great saphenous vein and as a lower number of patients required retreatment sessions in the short-term. Both methods proved to be safe and improved the quality of life.

LEV 3. Outcomes of Ultrasound-Guided Catheter-Directed Foam Sclerotherapy With or Without Perivenous Tumescent Enhancement in the Treatment of Great Saphenous Vein Reflux

LEV 3. Outcomes of Ultrasound-Guided Catheter-Directed Foam Sclerotherapy With or Without Perivenous Tumescent Enhancement in the Treatment of Great Saphenous Vein Reflux

Feasibility and Safety of Catheter Directed Foam Sclerotherapy Combined with Tumescent Local Anesthesia for Treatment of Axial Varicose Vein

Background: Varicose veins is a common health problem, with an estimated prevalence of greater than 20% (range 21.8% to 29.4%). Approximately 5% (range 3.6% to 8.6%) have venous oedema, skin changes or ulceration. Chronic venous disease (CVD) is the most common venous disorder. It is caused by venous hypertension due to either reflux, outflow obstruction or both. Aim of the Work: The aim of the work was to review the feasibility and efficacy of catheter-directed foam sclerotherapy in treatment of saphenous vein incompetence. Patients and Methods: This clinical trial was conducted at vascular surgery department at Al Azhar University Hospital. The study included 25 patients suffering from primary varicose vein. All patients were belonging to class C2 to C4 Ep as Pr according to CEAP classification. This mean: C2 to C4 clinically stage to stage venous disease in which there were uncomplicated, moderate to severe varicosities. Ep etiologically the disease was primary with well functioning deep system. Anatomically, the varicosities affected the superficial system mainly the great saphenous vein. Results: Between March 2017 and March 2018, 25 patients (25 limbs) were treated with CDFS at vascular department – Al-Azhar University hospitals. Demographic data and severity of venous disease are shown in Table below. Conclusion: The use of this catheter based technique facilitated foam sclerotherapy with a high primary and acceptable short-term occlusion rates, and low numbers of complications. Further studies are required to evaluate how the migration of foam into the common femoral vein can be diminished and whether the techniques used in this study of leg elevation and manual compression provide any advantage.

Is catheter-directed foam sclerotherapy more effective than the usual foam sclerotherapy for treatment of the great saphenous vein?

Objective This retrospective study presents the long-term results of catheter-directed foam sclerotherapy of the great saphenous vein. Method From January 2003 to June 2017, 277 patients with varices and great saphenous vein incompetence were treated with echo-guided foam sclerotherapy. Forty-six patients were treated with long-catheters guided by foam sclerotherapy. Foaming was carried out with sodium-tetra-decyl-sulphate. Results Results were examined in the two groups: A (long-catheters) and B (other procedures). The median overall follow-up was 52.1 months. In the A-group, the complete occlusion rate was 34/46 pts (73.9%) and partial occlusion was 10/46 (21.7%). In the B-group, respectively, 130/231 (56.2%) and 90/231 (38.9%). Comparisons between groups were statistically significant (p = 0.023; p = 0.021). Failures involved, respectively, 2/46 (4.3%) and 11/231 (4.7%) with no statistical significance. The complication rates were similar in the two groups. Conclusions In this long-term experience (median follow-up exceeding four years), foam-guided sclerotherapy of the great saphenous vein with a long-catheter turned out to be more effective than the usual foam-guided sclerotherapy.

Contemporary Management of Civilian Trauma

The purpose of this prospective study was to evaluate the occlusion rate, clinical severity, disease specific health related quality of life (HRQoL), and safety in patients with great saphenous vein (GSV) reflux 3 years after a single treatment session of catheter directed foam sclerotherapy (CDFS) combined with peri-saphenous infiltration of tumescent local anaesthesia (TLA).A total of 249 patients with symptomatic unilateral GSV incompetence underwent CDFS combined with TLA and were followed up for 3 years. The primary outcome was complete obliteration of the treated segment of the GSV. Secondary outcomes were changes in Venous Clinical Severity Score (VCSS) and Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ) score, absence of above knee GSV reflux, and safety of treatment.Three years after CDFS, the estimated cumulative proportion of persistently obliterated above knee GSV was 81.5%. Freedom from above knee GSV reflux was demonstrated in 89.6% of patients. Both the VCSS and CIVIQ score improved significantly (p < .0001 and <.0001, respectively). No major adverse events were encountered. Thrombophlebitis, skin pigmentation/matting, and transient scotomata were reported in 2%, 7.8%, and 0.8% of cases, respectively.CDFS combined with TLA for treatment of GSV incompetence yields good mid-term results in terms of occlusion rate, clinical severity, patients' QoL, and safety.

Mid-term Results of Catheter Directed Foam Sclerotherapy Combined with Tumescent Local Anaesthesia for Treatment of Great Saphenous Vein Incompetence

The purpose of this prospective study was to evaluate the occlusion rate, clinical severity, disease specific health related quality of life (HRQoL), and safety in patients with great saphenous vein (GSV) reflux 3 years after a single treatment session of catheter directed foam sclerotherapy (CDFS) combined with peri-saphenous infiltration of tumescent local anaesthesia (TLA). A total of 249 patients with symptomatic unilateral GSV incompetence underwent CDFS combined with TLA and were followed up for 3 years. The primary outcome was complete obliteration of the treated segment of the GSV. Secondary outcomes were changes in Venous Clinical Severity Score (VCSS) and Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ) score, absence of above knee GSV reflux, and safety of treatment. Three years after CDFS, the estimated cumulative proportion of persistently obliterated above knee GSV was 81.5%. Freedom from above knee GSV reflux was demonstrated in 89.6% of patients. Both the VCSS and CIVIQ score improved significantly (p<.0001 and <.0001, respectively). No major adverse events were encountered. Thrombophlebitis, skin pigmentation/matting, and transient scotomata were reported in 2%, 7.8%, and 0.8% of cases, respectively. CDFS combined with TLA for treatment of GSV incompetence yields good mid-term results in terms of occlusion rate, clinical severity, patients' QoL, and safety.

Comparative Study of Outcome of Duplex Ultrasound-Guided, Catheter-Directed Foam Sclerotherapy and Radio-frequency Ablation in the Management of Great Saphenous Varicose Veins.

Chronic venous insufficiency of lower limbs is a common problem in adults. We compared the two modalities, namely duplex ultrasound-guided, catheter-directed foam sclerotherapy (UGFS) and radio-frequency ablation (RFA), in the management of great saphenous varicose veins using clinical assessment (Venous Clinical Severity Score, Venous Disability Score) and duplex imaging. Patients presenting with great saphenous vein (GSV) varicosity due to incompetent saphenofemoral junction (SFJ) were selected and randomly assigned in each arm, i.e., duplex UGFS group and RFA group. Patients were assessed on days 7, 30, and 90 both clinically and sonologically. Clinical assessment was based on the Venous Clinical Severity Score (VCSS) and Venous Disability Score (VDS). Obliteration of the treated GSV segment was noted in all the limbs of the RFA group (31/31) on duplex sonography on days 7, 30, and 90, while in the UGFS group, out of 30 limbs, obliteration was successful in 28 (28/30) and 2 had treatment failure. However, outcome of both the groups were statistically comparable (P value > 0.05). After the procedure, improvement in the VCSS was noted in both the study arms in every follow-up and both the modalities were found to be equally effective. Improvement in the Venous Disability Score was there on every follow-up, but maximum improvement was seen on the second visit, i.e., post-treatment day 30. Improvement was statistically significant and equal in both arms after the initial 1week. Foam sclerotherapy, especially catheter-directed, is as effective as radio-frequency ablation in achieving anatomical obliteration and yielding relief in clinical signs and symptoms in patients with GSV varicosity with SFJ incompetence.

Catheter-directed Foam Sclerotherapy of Great Saphenous Veins in Combination with Pre-treatment Reduction of the Diameter Employing the Principals of Perivenous Tumescent Local Anesthesia

Catheter-directed Foam Sclerotherapy of Great Saphenous Veins in Combination with Pre-treatment Reduction of the Diameter Employing the Principals of Perivenous Tumescent Local Anesthesia

Comment to: Catheter-directed foam sclerotherapy for insufficiency of the great saphenous vein: occlusion rates and patient satisfaction after one year, by Williamsson C, Danielsson P, Smith L. Phlebology 2012:1-6.

Between November 2007 and October 2008, 100 consecutive symptomatic patients with verified axial reflux in the GSV were treated with a catheter-directed foam sclerosation technique (CDS). CDS delivers the foam during a short period of time directly to the intended site, along the length of the GSV, with less impact from surrounding factors. The catheter induces a vasospasm which might further enhance drug interaction with the vein wall. Median age was 52.5 years (range 18&ndash;92), 28 men and 72 women. All patients had visible varicose veins. Twenty-three had recurrent varicose veins. The treatment was performed in the outpatient clinic by a team consisting of two vascular surgeons and two nurses. Exclusion criteria were allergy to polidocanol, a very tortuous vein (which could make the catheters impossible to advance) or a GSV diameter exceeding 10 mm at the terminal valve. The skin was infiltrated with local anesthesia. The vein was accessed by a micro-puncture introducer set and a 0.35 Fr guide wire was advanced proximally under US surveillance and positioned at the SFJ. A catheter was introduced over the guide wire and positioned approximately 2 cm distal to the SFJ and the guide wire was removed. The table was slightly tilted to elevate the leg to empty the GSV. Ten mL sclerosing foam (SF) was made by mixing 2 mL chilled 3% polidocanol and 8 mL air. The SFJ and site of puncture was compressed for five minutes and the thigh massaged to fill superficial varicosites with foam. No additional local injection of foam was given. All patients wore two-layer short stretch compression bandages for one to five days after treatment. Evaluation with US was performed at two weeks and at one year after treatment. Foam delivery along the GSV was technically successful in 94 of the 100 patients. The median time for the procedure was 22 (8&ndash;90) min. The complete treatment exceeded 30 min in 20 patients, but only in two patients following the 50th patient. At the US control two weeks after treatment, the GSV was completely occluded in 92 of the 94 successfully treated patients. At the one-year follow-up, 84% (79/94) were satisfied with the result. The one-year US showed that 70% (64/91) of the GSVs were completely occluded, 15% (14/91) of the GSVs were recanalized and 14% (13/91) were partly occluded. No major complications occurred such as visual disturbance, pulmonary embolism, DVT or infection. Two patients had superficial thrombophlebitis; at the one-year follow-up 26 patients had pigmentations to some extent. The cost for the drugs and the single-use medical material was calculated to be 106 EUR.

Catheter-directed Foam Sclerotherapy of Great Saphenous Veins in Combination with Pre-treatment Reduction of the Diameter Employing the Principals of Perivenous Tumescent Local Anesthesia

The aim of this study was to evaluate occlusion rates of great saphenous veins (GSV) with a diameter between 5-10 mm that received a pre-treatment size reduction via perivenous tumescent application (TA) followed by catheter-directed foam sclerotherapy (CDFS). A prospective blinded randomized clinical trial comparing the occlusion rates of GSV at 1-, 6-, and 12-month follow-up. Fifty patients were included and randomized into two groups. CDFS was performed accessing the GSV at knee level and applying 8 mL of 2% polidocanol-foam (EasyFoam) while the catheter was withdrawn. Strictly perivenous TA was performed in group 1 before applying the sclerosant agent. Occlusion rates and clinical scores were assessed by blinded examiners. After 12 months in group 1 full occlusion was achieved in 73.9%, partial occlusion in 8.7%, and 17.4% were classified as treatment failure. In group 2, 75% of the targeted GSV were fully occluded, 20% were partially occluded, and 5% were diagnosed as treatment failure. Both groups showed a significant reduction of the vein diameter. Patient's tolerance and satisfaction with the treatment was high in both groups. No benefit could be found using additional TA to reduce the vein diameter before the treatment.

Catheter-directed foam sclerotherapy for chronic venous leg ulcers

This study presents the results of catheter-directed foam sclerotherapy (CDS) for chronic venous ulcer refractory to compression treatment, four weeks and one year after treatment. In sum, 31 patients (32 limbs) with refractory chronic venous ulcer and duplex-verified superficial insufficiency were offered CDS. CDS was conducted with 10 ml of sclerosant foam of 3% polidocanol. Four weeks and one year after treatment, the patients were evaluated regarding ulcer healing and ultrasound appearance of the saphenous trunk. CDS was successfully performed in all patients. After one year, 65% of the ulcers were healed. Only two (6%) recurred. 86% of the treated saphenous trunk were completely occluded, 3% was partly occluded and 10% were recanalised. No serious side effects occurred. CDS is one alternative of eliminating superficial venous reflux when treating refractory venous leg ulcers. This study suggests that the treatment is safe and induce a quick ulcer healing.

Catheter-directed foam sclerotherapy for insufficiency of the great saphenous vein: occlusion rates and patient satisfaction after one year

This study aims to describe a technique for catheter-directed foam sclerotherapy (CDS) of great saphenous vein (GSV) insufficiency and report occlusion rate and patient satisfaction after a single treatment. About 100 patients were included. The GSV was accessed at knee level. With the method of Tessari 10 mL sclerosant foam was made (2 mL 3% polidocanol and 8 mL air) and delivered along the GSV while the catheter was withdrawn. At two weeks and at one year after treatment the patients were evaluated. CDS was successfully performed in 94 of the 100 patients. After one year, 84% of the patients were satisfied. Seventy percent of the GSV were completely occluded, 14% were partly occluded and 15% were recanalized. No serious side-effects occurred. CDS is safe. Patient satisfaction is very satisfying and the occlusion rate is promising after a single treatment. Repeated treatments and technical development may achieve higher occlusion rates.

Catheter-directed foam sclerotherapy treatment of saphenous vein incompetence

The aim of this study is to report the short-term results of catheter-directed foam sclerotherapy (CDFS) in the treatment of axial saphenous vein incompetence. Data of all patients undergoing CDFS for symptomatic primary incompetence of the great or small saphenous vein were prospectively collected. Treatment results in terms of occlusion rate and patients' grade of satisfaction were analysed. All successfully treated patients underwent clinical and duplex follow-up examinations one year postoperatively. Between September 2006 and September 2010, 357 limbs (337 patients) were treated with CDFS at our institution. Based on the CEAP classification, 64 were allocated to clinical class C3 , 128 to class C4, 102 to class C5 and 63 to class C6. Of the 188 patients who completed the one year follow up examination, 67 % had a complete and 14 % a near complete obliteration of the treated vessel. An ulcer-healing rate of 54 % was detected. 92 % of the patients were satisfied with the results of treatment. We registered six cases of thrombophlebitis and two cases of venous thromboembolism, all requiring treatment. The short-term results of CDFS in patients with axial vein incompetence are acceptable in terms of occlusion and complications rates.