Endovenous Foam Sclerotherapy Research Articles

Ultrasound-guided foam sclerotherapy is safe and effective in the management of superficial venous insufficiency of the lower extremity

BackgroundSuperficial venous disease of the lower extremity has a significant impact on quality of life. Both truncal and tributary vein reflux contribute to this disease process. Endovenous foam sclerotherapy is a widely used technique throughout the world for the management of superficial venous reflux and ultrasound guidance improves its safety and efficacy. MethodsA PubMed search for ultrasound-guided foam sclerotherapy (UGFS) was conducted and all abstracts were reviewed to identify clinical trials and systematic reviews for a full-text analysis. Additional articles were also identified through searching the references of the selected studies. ResultsThe production of foam for sclerotherapy in a 1:3 or 1:4 ratio of air to sclerosant is optimal in a low silicone, low-volume syringe system. Physiologic gas may decrease any side effects, with the trade-off of decreased foam stability. Proper technique with appropriate sterility and cleansing protocols are paramount for safe and effective treatment. The technical success of UGFS for great saphenous vein disease is inferior to endothermal and surgical modalities and retreatment is more common. However, the clinical improvement in patient-reported quality of life is similar between these three modalities. When used for tributary veins in combination with endothermal approaches of the truncal veins, UGFS has high rates of success with excellent patient satisfaction. UGFS has demonstrated an excellent safety profile comparable with or superior to other modalities. ConclusionsWith proper technique, UGFS is safe and effective for the management of superficial venous disease.

Endovenous Laser Ablation for Incompetent Saphenous Vein Combined With Fluoroscopy-Guided Endovenous Foam Sclerotherapy in Varicose Tributaries: Long-Term Follow-up Results

The aim of this study is to describe the long-term results of 980-nm endovenous laser ablation (EVLA) combined with fluoroscopy-guided endovenous foam sclerotherapy using a microcatheter into varicose tributaries. This report reviewed experiences with fluoroscopy-guided endovenous foam sclerotherapy using a microcatheter followed by EVLA, from July 2005 to November 2007. The sclerosing foam was injected through the microcatheter using 1% polidocanol or sodium tetradecyl sulfate. Patients were evaluated clinically and with duplex ultrasound from 1 week to 3 years to assess treatment efficacy and adverse reactions. Technical success was seen in 460 of 461 limbs (99.8%). Continued closure of the saphenous veins and complete sclerosis of varicose tributaries were noted in 351 of 408 limbs (86%) at 1-month follow-up, all 328 limbs at 3-month follow-up, all 299 limbs at 6-month follow-up, all 146 limbs at 1-year follow-up, all 94 limbs at 2-year follow-up, and all 32 limbs at 3-year follow-up. No serious complications were noted. Bruising was noted in 79.0%, and pain or tightness was noted in 68.4%. Hyperpigmentation was noted in 54.2%. EVLA for incompetent saphenous vein combined with endovenous foam sclerotherapy appears to offer the obvious benefits of less additional percutaneous sclerotherapy. However, many problems, like long-lasting pain and hyperpigmentation, can lessen the value of this procedure.

Evaluation of Clinical Characteristics and Biomarkers after Endovenous Foam Sclerotherapy for Venous Disorders

Objective: Endovenous foam sclerotherapy (EFS) is widely performed in the U.S, but there is a paucity of studies evaluating clinical predictors of outcomes, including biomarkers, in patients with venous disorders. Methods: Patients undergoing EFS monotherapy for venous disorders were enrolled. Evaluation at baseline, 1 week, 12 weeks, and 26 weeks included clinical characteristics and biomarker analysis. Results: 100 patients with venous disease were treated. At one week follow-up, 44% underwent a second injection. At 3 months, 100% of patients had obliteration of at least 80% of their affected veins, and 96% reported improved venous stasis symptoms. Adverse events were minor and deep vein thrombosis was found 4 patients at 3 months. D-dimer levels were significantly higher at week one, but returned to baseline by week 12; fibrin monomer decreased and PPL increased at one week and 3 months relative to baseline. Conclusion: EFS monotherapy is effective in treating signs and symptoms of venous disease with few adverse effects. D-dimer levels are significantly associated with obliteration of venous segments suggesting an association between vein obliteration and activation of coagulation.

Performance of endovenous foam sclerotherapy in the USA for the treatment of venous disorders: ACP/SVM/AVF/SIR quality improvement guidelines

This report summarizes the findings of the consensus panel based on the results of the comprehensive questionnaire of US American College of Phlebology annual congress attendees and results of the systematic meta-analysis of the literature and provides quality improvement guidelines for the use of endovenous foam sclerotherapy (EFS) for the treatment of venous disorders, as well as identifies areas of needed research. Based on the above data, quality improvement guidelines were developed and reviewed by the ten US consensus panel members and approved by their respective societies. EFS is effective for the treatment of truncal and tributary varicose veins, both as primary treatment and for treatment of recurrence. It may improve the signs and symptoms associated with varicose veins including pain and swelling. EFS is contraindicated in patients who have experienced an allergic reaction to previous treatment with foam or liquid sclerosant, and in patients with acute venous thrombosis events secondary to EFS. These guidelines for the use of EFS in the treatment of venous disorders provide an initial framework for the safe and efficacious use of this therapy, and the impetus to promote the evaluation of the questions remaining regarding the use of EFS through well-designed randomized and cohort studies.

Efficacy and safety of endovenous foam sclerotherapy: meta-analysis for treatment of venous disorders

Endovenous foam sclerotherapy (EFS) is used widely throughout the USA for the treatment of venous disorders. The purpose of the quantitative meta-analysis was to systematically and comprehensively evaluate the literature to provide accurate estimates of safety and efficacy outcomes for this procedure. A comprehensive electronic search of published literature in several databases was performed using a wide variety of MESH headings. In addition, meeting abstracts and bibliographies of selected references were reviewed for eligible papers. Two reviewers abstracted selected treatment-related data. Of 684 identified manuscripts and abstracts reviewed, 104 papers were abstracted and analysed. More than 50% were published between 2004 and 2008. EFS was found to be effective with similar vein occlusion rates to laser therapy, but less effective than surgery. In addition, major adverse effects were rare. EFS is a safe and effective therapy for the treatment of venous disorders.

Performance of endovenous foam sclerotherapy in the USA

To assess practice patterns of endovenous foam sclerotherapy (EFS) use in the USA. A multidisciplinary panel of US experts was convened and developed a questionnaire to assess use of EFS. US attendees at the American College of Phlebology 2009 Annual Congress were asked to complete the questionnaire. Of 776 questionnaires distributed, 239 were completed (31%). The majority of respondents (87%) reported using EFS for the treatment of venous disorders. Foam sclerotherapy was used by a wide variety of specialists in every region of the USA. The most common indication was sclerosis of recurrent truncal or tributary veins of the leg. There was variation among practitioners in the indications for use, pre- and postprocedural evaluation and procedure methodology. The results of this questionnaire show widespread usage of EFS and are important in the development of national quality improvement guidelines for the performance of EFS.

Effectiveness of foam sclerotherapy for the treatment of varicose veins

Varicose veins (VVs) are associated with lifestyle-limiting symptoms and complications. Patients who fail compression therapy are candidates for more invasive treatments. This study evaluates the efficacy and safety of endovenous foam sclerotherapy (EFS) for the treatment of VVs in a US academic center. We reviewed medical records of a consecutive cohort of patients who underwent EFS over a 2-year period. The primary outcome measure was obliteration of VVs. The secondary outcome measures were symptomatic improvement, ulcer healing, recurrence, and adverse events. A total of 166 patients (217 legs) underwent EFS for pain (81%), pruritus (41%), swelling (17%), ulcerations (17%), thrombophlebitis (14%), and varix rupture (3%). Complete (65%) or near-complete (34%) obliteration was achieved in 215 (99%) legs after one injection. Additional injections achieved complete obliteration in 39 of 53 legs. Ninety-three percent (27/29) of active ulcers healed or were decreasing in size. Five ulcers and 11 VVs recurred. Common adverse events included pain and hyperpigmentation. Thrombosis, hematoma, skin necrosis, and neurologic events were rare. In conclusion, EFS appears to be a safe and effective outpatient therapy for the treatment of symptomatic and complicated VVs.

Fluoroscopy-Guided Endovenous Foam Sclerotherapy Using a Microcatheter in Varicose Tributaries Followed by Endovenous Laser Treatment of Incompetent Saphenous Veins

To evaluate the technical feasibility and preliminary results of endovenous foam sclerotherapy using a microcatheter in varicose tributaries followed by endovenous laser treatment (EVLT) of incompetent saphenous veins. From July 2005 to August 2006, 312 patients (M:F=139:173, mean age 45.8) who presented with varicose veins with reflux in the saphenofemoral, saphenopopliteal junction or tributaries were enrolled. Under ultrasound or fluoroscopy guidance, selective microcatheterization and endovenous foam slcerotherapy were first performed in varicose tributaries, followed by EVLT (980 nm) of incompetent saphenous veins. Follow-up at 1-week and 1-, 3-, and 6-month intervals was done. Technical success was seen in 410 of 411 limbs (99%). Continued closure of the saphenous veins and the complete sclerosis of varicose tributaries were noted in 332 of 373 limbs (89%) at the 1-month follow-up, all 307 limbs (100%) at the 3-month follow-up, and all 274 limbs (100%) at the 6-month follow-up. No serious complication was noted. Endovenous foam sclerotherapy using a microcatheter in varicose tributaries followed by EVLT in incompetent saphenous veins is a safe, effective, and technically feasible treatment for varicose veins. It not only reduces additional sclerotherapy and technical failure, but also makes multiple therapeutic sessions unnecessary.

Treatment of varicose veins

Varicose veins (VVs) are the most common manifestation of chronic venous insufficiency, affecting 25% of women and 15% of men. Reticular veins and telangiectasias (spider veins) are found in more than 80% of the general population. VVs produce symptoms of pain, swelling, heaviness, fatigue, and pruritus and predispose patients to complications including bleeding, superficial thrombophlebitis, and ulcerations that interfere with activities of daily living and result in lost time from work. Current treatments for VVs include conservative measures, and when these are unsuccessful, more invasive surgical and endovenous interventions primarily aimed at reducing venous hypertension and preventing progression to chronic inflammation and ulcerations. Surgical procedures including saphenous vein stripping, ligation of the saphenofemoral junction, and ambulatory phlebectomy are effective in the treatment of VVs but are associated with a high complication rate and recovery time. Emerging endovenous therapies, including endovenous laser therapy, radiofrequency ablation, and endovenous foam sclerotherapy, have shown similar efficacy in the treatment of VVs compared with more invasive surgical procedures, with lower complication rates and less time lost from work.

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Consensus DocumentNo TitleBreu, Guggenbichler, and WollmannBreuSearch for more papers by this author, GuggenbichlerSearch for more papers by this author, and WollmannSearch for more papers by this authorPublished Online:March 14, 2013https://doi.org/10.1024/0301-1526.37.S71.3PDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit SectionsMoreFiguresReferencesRelatedDetailsCited byThromboembolieprophylaxe2 April 2022The effect of the calibre and length of needle on the stability of sclerosing foam25 November 2020 | Phlebology: The Journal of Venous Disease, Vol. 36, No. 4Leitlinie Sklerosierungsbehandlung der Varikose5 November 2020 | Der Hautarzt, Vol. 72, No. 1Consumer-based brand equity (CBBE) and the role of social media communications: Qualitative findings from the Malaysian automotive industry26 March 2018 | Journal of Marketing Communications, Vol. 25, No. 5Ultrasound-guided foam sclero -therapy of the small saphenous vein4 January 2018 | Phlebologie, Vol. 46, No. 02Preparation, Standardization, and Quality Control of Medicinal Plants in AfricaModelling and Assessment of Repairs Conducted on Composite MaterialsInternational Journal of Materials Science and Engineering, Vol. 3, No. 3Polidocanol foam stability in terms of its association with glycerin7 March 2013 | Phlebology: The Journal of Venous Disease, Vol. 29, No. 5Performance of endovenous foam sclerotherapy in the USA for the treatment of venous disorders: ACP/SVM/AVF/SIR quality improvement guidelines6 May 2013 | Phlebology: The Journal of Venous Disease, Vol. 29, No. 2Setting Up Sclerotherapy in a Phlebology Practice1 August 2012Varicose Veins: Comprehensive Management27 October 2012Cost and Effectiveness of Laser with Phlebectomies Compared with Foam Sclerotherapy in Superficial Venous Insufficiency. 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