Foam Sclerotherapy Group Research Articles

Comparison of Foam and Liquid Sclerotherapy for the Treatment of Lower Extremity Varicose Veins and Telangiectasia in Obese Patients.

Sclerotherapy is an accepted treatment modality for reticular varicose veins and telangiectasia. We aimed to compare the success and safety of foam and liquid sclerotherapy in obese patients with lower extremity varicose veins and telangiectasia. The present study was performed in a non-randomized prospective manner, and obese patients with lower extremity varicose veins (patients with anatomy and pathophysiology classification {CEAP} class C1) and telangiectasia treated with foam sclerotherapy and liquid sclerotherapy were enrolled into the study. Patients treated with foam sclerotherapy and liquid sclerotherapy were compared with regard to preoperative parameters, procedure success, Visual Analog Score (VAS), patient satisfaction, and complications. The VAS scores at the first hour and sixth hour were statistically higher in the foam sclerotherapy group (p=0.001 and p=0.001, respectively). The success rate after the first session was 88.2% in the foam sclerotherapy group and 69.4% in the liquid sclerotherapy group (p=0.008). After all sessions, the success rates were similar between groups (p=0.607). The foam sclerotherapy group required an average of 1.1 sessions, while the liquid sclerotherapy group required 1.4 sessions (p=0.001). At the third-month follow-up, the success rate was significantly higher in the foam sclerotherapy group thanliquid sclerotherapy group (91.2% and 77.4%; p= 0.030). In the foam sclerotherapy group, 80.9% of the patients were very satisfied, while this rate was 58.1% in the liquid group (p=0.012). The rates of ecchymosis and hyperpigmentation in the first week after the procedure were significantly higher in the foam sclerotherapy group (p=0.003 and p=0.040, respectively). Our findings showed that foam sclerotherapy had a significantly higher success rate after the first session, and third month follow-up with higher patient satisfaction. In contrast, liquid sclerotherapy had significantly lower VAS scores in the first and sixth hours following the procedureand had lower ecchymosis and hyperpigmentation in the first week after the procedure.

Strategies and challenges in treatment of varicose veins and venous insufficiency.

Patients with varicose veins can be treated with conservative or surgical approaches based on the clinical conditions and patient preferences. In the recent decade, the recommendations for managing symptomatic varicose veins have changed dramatically due to the rise of minimally invasive endovascular techniques. The literature was systematically searched on Medline without language restrictions. All papers on the treatment of varicose veins and venous insufficiency with different procedures were included and reviewed. Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) both are same safe and effective in terms of occlusion rate, and time to return to normal activity. In comparison with RFA or EVLT, Cure conservatrice et Hemodynamique de l'Insufficience Veineuse en Ambulatoire (CHIVA) may cause more bruising and make little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury, or hematoma. In terms of recurrence of varicose veins, there is little or no difference between CHIVA and stripping, RFA, or EVLT. Great saphenous vein recanalization is highest in the ultrasound-guided foam sclerotherapy (FS) group (51%) during 1 year of follow-up. The 2013 National Institute for Health and Care Excellence clinical guidelines recommend surgery as a third-line therapeutic option after EVLA or RFA and sclerotherapy. Although the mechanochemical endovenous ablation (MOCA) is a non-thermal, non-tumescent option and appears to be of similar efficacy to stab avulsion with no potential risk of nerve damage, the overall success rate of MOCA is lower than those of other procedures such as EVLA, RFA, or high ligation and stripping. EVLA is the most cost-effective therapeutic option, with RFA being a close second for the treatment of patients with varicose veins. Endovenous thermal ablation (EVLA or RFA) is recommended as a first-line treatment for varicose veins and has substituted the high ligation of saphenofemoral junctional reflux and stripping of varicose veins. Ultrasound-guided FS is associated with a high recurrence rate and can be used in conjunction with other procedures. MOCA and cyanoacrylate embolization appear promising, but evidence of their effectiveness is required.

FOAM SCLEROTHERAPY VERSUS MICRO STAB PHLEBECTOMY IN THE TREATMENT OF RECURRENT LEG VARICOSE VEINS

Background: Varicose veins are common in the adult population and about one in four develops the condition throughout life. Objective: To compare micro stab phlebectomy and foam sclerotherapy in the treatment of recurrent leg varicose veins regarding results of treatment, incidence of complications, and recurrence. Patients and methods: This was a prospective observational cohort study included fifty patients with recurrent varicose veins divided in two equal comparative groups: Group A underwent stab phlebectomy and group B underwent foam sclerotherapy. The study duration was between January 2020 and November 2020 at the Department of Vascular Surgery, Al-Azhar University Hospitals (Al-Hussein and Bab Al-Shaareia University Hospitals). Results: Thirty males and twenty females were included. Mean age (years) was 35 and 34 in phlebectomy and foam sclerotherapy groups, respectively. No significant difference between the two groups according to age and sex. The prevalence of recurrent lower limb varicose vein was found to be more common in males than in females in the vicinity of this study. Dilated veins were the most common involving in 60 % (n = 30/50) of the patients. The primary symptom of the patients relieved in 80 % and 56% in phlebectomy and foam sclerotherapy groups, respectively. Time taken in procedures was significantly different between the two groups. During the follow-up with duplex at 6 months, treated veins showed 92 % (n =23/25) removal of treated veins in the phlebectomy group, while only 72% (n=18/25) of the patients in the foam group showed evidence of complete occlusion. Recurrent varicose veins were found in 4 % (n = 1/25) of the patients in the phlebectomy group, while 16 % (n =4/25) of the patients in the foam sclerotherapy group had recurrence. Conclusion: Both micro stab phlebectomy and foam sclerotherapy were safe effective in treating recurrent varicose veins with advantage of micro stab phlebectomy regarding to lower recurrence, primary symptom relief and better post procedural outcomes.

Effect of Transluminal Injection of Foam Sclerotherapy Combined with Endovenous Thermal Ablation of Varicose Veins

ObjectiveThe combination of endovenous therapies with stab avulsion or ultrasound guided foam sclerotherapy is widely performed. However, these conventional techniques tend to result in incomplete avulsions or persistent varicosities.MethodsOne hundred and thirteen legs in 97 consecutive patients who underwent 1470 nm laser ablation for great saphenous varicose veins were enrolled. The foam sclerosing agent was injected via the sheath after endovenous laser ablation (EVLA). Patients were divided into two groups: EVLA only group (Control; n = 50) and EVLA and transluminal injection of foam sclerotherapy (TLFS) group (SCL; n = 63).ResultsAt three month follow up, reflux was abolished throughout all treated great saphenous veins (GSVs) when assessed with Duplex ultrasound. Thrombophlebitis was observed in two patients in the SCL group (p = .13). Additional second stage sclerotherapy was needed in the Control group (n = 33, 66%) vs. SCL group (n = 2, 3%; p < .0001). The venous clinical severity score (VCSS) was significantly improved in the SCL group (changes of VCSS, Control −3.3 ± 1.7 and SCL -4.4 ± 1.0; p < .0001). Univariable and multivariable analyses revealed that, among age, sex, Clinical-Etiology-Anatomy-Pathophysiology classification, linear endovenous energy density, and TLFS, TLFS was the only significant factor of improved VCSS (hazard ratio = −0.96; 95% confidence interval = −1.4 to −0.58; p < .0001).ConclusionsTLFS combined with EVLA may be an easy, safe, and effective procedure with acceptable complications vs. EVLA alone and reduces additional second stage interventions.

Therapeutic effects of endoscopic foam sclerotherapy for bleeding internal hemorrhoids

Objective To evaluate the safety and efficacy of foam sclerotherapy for bleeding internal hemorrhoids. Methods Consecutive adult patients (aged 18-60 years) with bleeding hemorrhoids were prospectively enrolled between March 2017 and March 2018. All patients were randomly assigned to the foam sclerotherapy (FS) group and the liquid sclerotherapy (LS) group. The foam and liquid sclerotherapy of hemorrhoids nucleus was performed by cap-assisted colonic endoscopy. Results A total of 108 patients were enrolled, including 62 males (57.4%) with mean age of 44.0±7.6 years. There was no significant difference in gender, age, or body mass index between the FS (n = 55) group and the LS (n =53) group. The total amount of lauromacrogol injection in the FS group was 3.7±0.9 mL, which was significantly lower than that in the LS group (8.0±2.2 mL, P<0.001). In the LS group, 8 patients (15.1%) developed bleeding after needle removal, which was significantly higher than that in the FS group [5.5%(3/53), P=0.022]. Significant pain was found in 2 patients (3.8%) in the LS group and 0 in the FS group (P= 0.025). The short-term cure rate and effective rate of the FS group were 87.3% (48/55) and 9.1% (5/55), while those were 69.8% (37/53) and 22.6% (12/53) in the LS group, respectively (P=0.046). Conclusion Foam sclerotherapy is safe and effective in the treatment of bleeding internal hemorrhoids. Key words: Hemorrhoids; Sclerosing solutions; Hemostasis, endoscopic; Sclerotherapy

Comparison of foam sclerotherapy versus radiofrequency ablation in the treatment of primary varicose veins due to incompetent great saphenous vein: Randomized clinical trial

Minimally invasive procedures such as foam sclerotherapy and radiofrequency ablation (RFA) have gained attention for treatment of incompetent great saphenous vein (GSV). The objective of this study was to compare recurrence rate and quality of life between foam sclerotherapy and RFA in patients with incompetent GSV varicose veins. In this parallel single-blinded randomized clinical trial, 60 adult patients with primary varicose veins due to incompetent GSV (CEAP classes C2-4EPAsPr) were included and randomly divided to receive RFA or foam sclerotherapy. Health-related quality of life (HRQOL) was assessed by the Short Form 36, and the Aberdeen Varicose Vein Questionnaire (AVVQ) was applied to assess the impact of varicose veins on quality of life of the patients. In addition, pain severity after the procedures was investigated by a visual analog scale (VAS) (range, 0 to 10). The patients were followed at 1week, 1month, 3months, and 6 months postoperation. GSV reflux and recurrence was assessed by color Doppler ultrasound examination after 6 months. Twenty-eight patients in RFA and 27 patients in foam sclerotherapy remained for the final analyses. The time interval from the procedure and recovery to daily normal activities was 1 day in both groups. Mean (±SD) pain VAS score in RFA group decreased from preintervention score of 7.35 (±3.28) to 1.21 (±0.68); P<.0001. Likewise, this score decreased from 6.64 (±2.04) to 1.29 (±0.91) in foam sclerotherapy group. HRQOL scores increased gradually at 1, 3, and 6months after the intervention. AVVQ scores decreased significantly 1 week postintervention in both groups. After 6 months, 17.9% (5 patients) in RFA group and 14.8% (4 patients) in foam sclerotherapy group had recurrence of GSV reflux (P=.52). Both foam sclerotherapy and RFA were effective in treatment of GSV reflux. Comparable findings were observed between the 2 groups regarding postoperative pain, recovery time, HRQOL, and AVVQ scores.

Evaluation of liquid or foam sclerotherapy in small varicose veins (ceap c1) with venous clinical severity score.

We aimed to evaluate the efficacy of liquid or foam sclerotherapy of varicose veins using venous clinical severity scores and possible complications. A total of 318 patients (268 females, 50 males) who were treated with liquid or foam sclerotherapy between January 2012 and December 2012 were included in this study. Skin necrosis was observed in only 6 patients (1. 8%), thrombophlebitis in 10 patients (3. 1%), and hyperpigmentation in 18 patients (5. 6%) in this study group. The mean venous clinical severity score was calculated as: pain score, 1. 23 ± 0.88; varicose vein score,1.85 ± 0. 8; edema score, 0.64 ± 0.77). Pain and edema decreased at the control examination, 1 month after completion of sclerotherapy sessions. Varicose veins completely disappeared after sclerotherapy. While the decrease in edema in the foam sclerotherapy group was significantly less (P<0.001), the decline in pain showed an increasing trend (P=0.069). While skin necrosis did not develop after foam sclerotherapy, rates of pigmentation and local thrombophlebitis were similar (P>0.05). In conclusion, we observed that both sclerotherapy methods are effective with a low rate of complications, alleviating the complaints of patients with small varicose veins, and providing considerable improvement in venous clinical severity scores.

Foam Washout Sclerotherapy, a single center experience

Introduction: The author has designed and implemented a modified method of foam sclerotherapy (FS) over some years which he believes lowers the rate of complications of the procedure while maintaining efficacy of the procedure as assessed clinically and by duplex ultrasound. This modified technique is termed Foam Washout Sclerotherapy (FWS) and involves the removal of the injected foam from a point distal to its administration level. This article compares the success rate and the rate of complications between FWS and FS of varicose veins. All procedures have been performed by the author over a period of 4 years. The basic principle of FWS is to inject a certain volume of a detergent-based foamed medication at the proximal part of the targeted vein and removing the injected foam from the same vein via a distally placed IV catheter within 5-10 seconds. The primary end point of the study was limited only to the comparison of the closure rate of treated vein segments (success rate) and complication rates. Materials and Methods: A retrospective review of FWS and FS cases performed between late 2008 to late 2012 was carried out. The review included only the cases that had regular follow-ups for one year consisting of 823 sclerotherapy treatments (292 in FS group and 531 in FWS group) among 657 patients. Studied veins were great saphenous (GSV), small saphenous (SSV), and anterior accessory saphenous vein (AASV) varicosities. Follow up included a phone call in 24 hours, re-exam and ultrasound studies in 2 months, 6 months, and 12 months. Most patients had additional follow up in 2-3 weeks at which time physical examination &amp; ultrasound study was performed. Some patients received sclerotherapy of unsightly spider veins of legs at time of follow-up visits. For better visual understanding of the FWS technique a clip on YouTube.com is available: https://www.youtube.com/watch?v=Usw9_d2uTvI&amp;t=4s Results: The cohort consisted of 823 incompetent veins in 657 patients. 505 patients were female and 152 were male. Mean age was 48.5 (23 - 76). Each case was followed for 12 months. Overall success rate of sclerotherapy in both the FS and FWS groups was similar at around 90% or above for different groups of veins treated. Overall complication rate was 20.2% in the FS group versus 6% in the FWS group. Discussion: The author presents the results of a retrospective analysis of success and complication rates between the standard method of foam sclerotherapy (FS) of varicose veins, as practiced at his vein clinic, with a modified method named foam washout sclerotherapy (FWS) that he implemented for the first time in late 2008. The author presents that by removing the injected foam from the lumen of targeted varicosity, complication rate is lowered while success rate is identical in both methods. Conclusion: The author suggests that the modified technique of FWS in the treatment of lower extremity varicose veins is associated with fewer complications compared to FS, is equally as effective as FS and in the future FWS may replace the current FS technique for chemical ablation of some cases of varicose veins of legs.

Outcome of Ultrasonography-Guided Foam Sclerotherapy Versus Stab Avulsion Ambulatory Phlebectomy in the Treatment of Varicosis in Small Veins of the Leg: A Single Blinded Randomized Clinical Trial

Background: In the intervening years, a few randomized clinical trials have confirmed that foam sclerotherapy is effective in managing great vein incompetence. However, no details have been published in its efficacy in comparison with conventional methods such as stab avulsion in the treatment of varicosis in small veins. Objectives: This randomized clinical trial was conducted to compare results and outcomes of the ultrasonography-guided foam sclerotherapy and conventional stab avulsion ambulatory phlebectomy in the treatment of varicosis in small veins of the leg. Patients and Methods: In a randomized single-blinded clinical trial, patients with varicosis in the small veins of the leg were randomly assigned for treatment with ultrasonography-guided foam sclerotherapy (n = 45) or with ambulatory phlebectomy (n = 45). Follow-up visits were done in 1 week, 1 and 6 months after operation and all patients were assessed regarding postoperative pain, need for analgesics, time to return to work, and level of satisfaction. Results: Postoperative pain was significantly lower in foam sclerotherapy group by VAS (P = 0.003). There was a significant difference in the morbidity rate between the two techniques (13.3%. in foam sclerotherapy, 37.8% in ambulatory phlebectomy, P = 0.008). The main predictors of the pain incidence included ambulatory phlebectomy, female gender, and advanced age. Satisfaction was significantly higher in foam sclerotherapy group (P = 0.024). Also, this group had shorter time to return to work (P < 0.001). Conclusion: Foam sclerotherapy is more preferred to ambulatory phlebectomy for treating varicosis in small veins of the leg because of its lower morbidity, less pain, more satisfaction, and shorter time to return to work.

Outcomes of Foam Sclerotherapy plus Ligation versus Foam Sclerotherapy Alone for Venous Ulcers in Lower Extremities

Foam sclerotherapy (FS) is a safe and effective approach for managing patients with varicose veins and venous ulcers in lower extremities. But, recanalization of the ablated varicose veins and phlebitis are common postoperative complications that jeopardize its clinical effects. We hypothesize that ligation of the ablated varicose veins after FS will improve the outcomes of patients with varicose veins and venous ulcer. This study was aimed to evaluate the clinical efficacy of ligation after FS in comparison with FS alone for the management of patients with varicose veins and venous ulcers in lower extremities. Eighteen patients underwent FS plus ligation (FSL) and 15 patients received FS alone. Aberdeen varicose veins questionnaire (AVVQ) and the revised venous clinical severity score (rVCSS), venous disability scores (VDSs), duplex sonography, ulcer healing rate, and ulcer healing time were documented to compare the outcomes in both groups. The ulcer healing time in patients treated with FSL was shorter than that in patients who received FS (P=0.022; log-rank test). The average healing time was significantly shorter in FSL group than in FS group (35.67±24.62days vs. 62.86±47.43, P=0.042). The mean rVCSS, VDS, and AVVQ at 3months after treatment in both groups decreased significantly in comparison with baseline, respectively. There were no severe complications or side effects in both groups. Ligation of the treated varicose veins after FS can improve the outcomes of patients with venous ulcers in comparison with FS alone. FSL is a safe, effective, and technically feasible procedure and can be used as a day surgery.

Study to compare open surgery, endovenous thermal ablation and ultrasound guided foam sclerotherapy for treatment of varicose veins

Introduction and Objective: To compare open surgery, Endovenous thermal ablation(EVTA) and ultrasound(USG) guided foam sclerotherapy for primary superficial venous insufficiency(PVI) with respect to obliteration of superficial venous system at 3 months, clinical outcome and cost.Materials and Methods: Between January 2015 to January 2016, all patients with symptomatic PVI of lower limbs who were willing for definitive management were randomized to open surgery (n=20), EVTA (n=40) or ultrasound guided foam sclerotherapy (n=20). In foam sclerotherapy group, review USG was done at 1 week and if necessary re-injection was done. The patients in all the groups underwent review USG at 3 months. Obliteration of superficial venous system, clinical outcome and costs were registered.Results: 5 patients in foam sclerotherapy group required re-injection at 1 week. Superficial venous system was obliterated in all the patients of all the groups at 3 months. Improvement in clinical score was similar in all groups. The foam sclerotherapy group had less frequent analgesia intake, earlier return to normal activity and lower cost. Local complication rate was slightly higher in foam sclerotherapy group.Conclusion: Foam sclerotherapy is a cheaper alternative to open surgery &amp; EVTA for PVI with respective to early measures of clinical outcome. USG guided sclerotherapy demonstrated to be a safe and effective procedure for the treatment of chronic venous insufficiency. The observed complications were minimal and most of the patients reported satisfaction with the treatment outcomes. If patient have no cost issue, endovenous thermal ablation of varicose veins is better than open surgery &amp; foam sclera in context of minimally invasive, cosmetic, less pain, no incisions, early ambulation &amp; same day discharge.

Endovenous laser ablation and sclerotherapy for incompetent vein of Giacomini

To retrospectively evaluate the feasibility and effectiveness of endovenous laser ablation or ultrasound-guided foam sclerotherapy for Giacomini vein insufficiency. This is the largest cohort of patients treated for Giacomini vein insufficiency with endovenous laser ablation or ultrasound-guided foam sclerotherapy. Over a three-year period, 23 females and nine males (age range, 19-67 years) treated for Giacomini vein insufficiency with or without saphenous vein insufficiency were retrospectively reviewed. Diagnosis of venous insufficiency was made by color Doppler ultrasonography. Symptomatic insufficiency of the Giacomini vein or the saphenous veins was treated with endovenous laser ablation. Ultrasound-guided foam sclerotherapy was used for tortuous incompetent Giacomini veins. The venous disease was categorized according to the clinical, etiological, anatomical, and pathological classification, and clinical severity was graded with the venous clinical severity score. Follow-up included clinical examination and color Doppler ultrasonography. Thirty-nine limbs in 32 patients were treated (25 endovenous laser ablation and seven ultrasound-guided foam sclerotherapy). All procedures were technically successful. One patient in the ultrasound-guided foam sclerotherapy group had a recurrence with successful repeated treatment. Recurrence was not seen in the endovenous laser ablation group. No complications were observed. All patients had resolution and improvement in 100% of their symptoms at 12 months of follow-up. Giacomini vein insufficiency is mostly seen with insufficiency of the great saphenous vein and can be effectively treated with endovenous laser ablation or ultrasound-guided foam sclerotherapy.

An Alternative Treatment for Varicose Veins: Ligation Plus Foam Sclerotherapy

Varicose vein treatment has been directed toward less-invasive yet lasting techniques. To compare the effectiveness of an alternative treatment (ligation plus foam sclerotherapy) with that of a classic stripping technique. The study included 216 and 156 patients who had undergone classic stripping and foam sclerotherapy, respectively, within the previous 5 years. Preoperative and postoperative CEAP class, symptoms, recurrence, and Doppler findings of the two groups were compared. There were no differences between treatments in terms of postoperative symptoms, Doppler findings, or CEAP class. The predictors of postoperative CEAP class were bilateral limb disease and prior deep vein thrombosis (DVT), whereas the predictors of symptom recurrence were bilateral limb disease, preoperative CEAP class, occupation, and familial or genetic predisposition. The predictors of postoperative perforator incompetence (PI) were occupation, aged 60 and older, preoperative CEAP class, and preoperative PI, whereas the only predictor of postoperative deep vein incompetence (DVI) was preoperative DVI. Five-year symptom-free survival rates were 51 ± 0.8% in the foam sclerotherapy group and 46 ± 0.9% in the stripping group. The safety and efficacy of ligation plus foam sclerotherapy as an alternative technique allowing for same-day surgery to treat varicose veins are the same as those of classic stripping. The predictors of postoperative outcome depend on individual patient characteristics.

Foam sclerotherapy of the great saphenous vein with sapheno-femoral ligation compared to standard stripping: a prospective randomized controlled trial

to compare the clinical outcome of foam sclerotherapy of the great saphenous vein (GSV) combined with sapheno-femoral junction (SFJ) ligation to standard stripping surgery. as a prospective randomized controlled trial, 60 consecutive patients with incompetence of the GSV resulting in varicose veins were prospectively randomized into 2 groups, treated by SFJ ligation and either foam sclerotherapy or standard stripping of the GSV. There were 26 male and 34 female with a median age of 49 years (ranging 37 to 66 years). Primary end points were patient recovery period, postoperative pain, quality of life and recurrence rate. Secondary end points were frequency of complications on the two arms of the trial. all treatments were completed as intended. The time taken to complete treatment was shorter in the foam sclerotherapy plus SFJ ligation group than the standard stripping (43 min vs. 65 min, P < 0.01). Less analgesic use postoperatively was recorded in the foam sclerotherapy group. Median time to return to normal activities was significantly reduced in the foam sclerotherapy group compared to the surgical group (3 d vs. 6 d, P < 0.01). After 3 months, median CEAP class dropped from four pre-operatively to one following treatment in both groups (P < 0.01). After 6 months, in the foam sclerotherapy group, 5 patients needed further sessions of foam sclerotherapy, resulting in a short-term closure rate of 80.0%. And the short-term obliteration rate was 89.5% in the conventional surgery group. foam sclerotherapy combined with sapheno-femoral ligation involves a shorter treatment time, less postoperative discomfort and results in more rapid recovery compared to conventional GSV stripping.

Results of Surgical Treatment Compared with Ultrasound-Guided Foam Sclerotherapy in Patients with Varicose Veins: A Prospective Randomised Study

This study aims to compare venous clinical severity scores in patients with healed venous ulcers due to varicose veins of the lower limbs (the clinical, etiologic, anatomic, and pathophysiologic data (CEAP) classification: C(5) EpAsPr) treated by saphenous stripping and phlebectomy or by ultrasound-guided foam sclerotherapy. Sixty patients were included: 29 underwent saphenous stripping and phlebectomy for varices in saphenous tributaries and 27 were treated by ultrasound-guided foam sclerotherapy; four cases were lost to follow-up. The main outcome measure was venous clinical severity scores (pain, oedema, inflammation, hyperpigmentation and lipodermatosclerosis). An ultrasound examination was carried out prior to treatment and 30, 60 and 180 days after the procedure to assess the relative efficacy of the methods in obliterating the saphenous trunk. The mean venous clinical severity scores measured before and after 180 days were as follows: Surgery group - pain: before 1.97 standard deviation (SD) 0.19, 180 days 0.72 SD 0.53; oedema: before 1.66 SD 0.48, 180 days 0.55 SD 0.63; inflammation: before 1.55 SD 0.63, 180 days 0.72 SD 0.45. Foam sclerotherapy group - pain: before 1.81 SD 0.40, 180 days 0.56 SD 0.51; oedema: before 1.70 SD 0.47, 180 days 0.48 SD 0.64; inflammation: before 1.67 SD 0.68, after 0.89 SD 0.32. All scores showed statistically significant reductions in both patient groups. The saphenous vein had been obliterated, 180 days after treatment, in 78% of the surgery group, compared with 90% in the foam sclerotherapy group. Ultrasound-guided foam sclerotherapy is a safe and effective option for patients with chronic venous disorders.

A Review of Current Treatment Strategies for Varicose Veins

To systematically review data to determine if endovenous laser ablation (EVLA), radio frequency ablation (RFA), and foam sclerotherapy (FS) have any advantages or disadvantages in comparison with conventional surgical ligation and stripping of great saphenous vein (GSV) varices. The failure rate of GSV closure after EVLA was between 0% to 34%. In comparison the recurrence rate after high ligation and stripping was up to 28% in a meta analysis of 7 studies. The overall complication rate after EVLA is about 20%. This showed no difference from that after primary LSV surgery which is between 17% and 20%. There was no significant difference between RFA and surgery in terms of symptoms improvement. However, the pain score was better in the RFA groups. Moreover, there was significant difference in the sick leave taken after each treatment with the mean of 6.5 days and 4.7 days for RFA, and 15.6 days and 12.4 days for surgery. RFA versus EVLT: Immediate technical success was obtained in all (100%) of EVLA procedures and in (96%) of RFA cases. The overall complication rate was (20.8%) after EVLA and 7.6% after RFA. The recurrence rate after sclerotherapy reached 30.5 % after one year, and 51% after 10 years. However, the rates were better for foam than the liquid sclerosants. When compared to surgery, sclerotherapy had higher recurrence rate than that after surgery. The median time to return to normal activities was significantly reduced in the foam sclerotherapy group (2 days) compared to the surgical group (8 days). When comparing the recurrence rate and overall complication rate and symptoms relief, surgery was not inferior to endovenous procedures. Reported follow up periods for the endovenous procedures were relatively short.

Ultrasound-guided Foam Sclerotherapy Combined with Sapheno-femoral Ligation Compared to Surgical Treatment of Varicose Veins: Early Results of a Randomised Controlled Trial

Aim This study is a prospective randomised controlled trial comparing sapheno-femoral ligation, great saphenous stripping and multiple avulsions with sapheno-femoral ligation and ultrasound guided foam sclerotherapy to the saphenous vein. Primary end points were patient recovery period and quality of life and secondary end points frequency of complications on the two arms of the trial and the cost of the treatment. Material and method Sixty patients with primary varicose veins due to GSV incompetence and suitable for day case surgery were randomly allocated to undergo ultrasound-guided sclerotherapy with sapheno-femoral ligation under local anaesthesia ( n=30) or sapheno-femoral ligation, stripping and multiple avulsions under general anaesthesia ( n=30). The study protocol included history, physical examination, assignment of CEAP class and assessment venous clinical severity score (VCSS), completion of the aberdeen vein questionnaire (AVQ) and colour duplex ultrasound. Results All treatments were completed as intended. Median time to return to normal activities was significantly reduced in the foam sclerotherapy group (2 days) compared to the surgical group (8 days) ( p<0.001, Mann–Whitney). AVQ score was also significantly reduced at 3 months by 46% in the sclerotherapy group, and by 40% in the conventional surgery group ( p<0.001, Wilcoxon). The time taken to complete treatment was shorter in the foam sclerotherapy plus SFJ ligation group: 45 vs. 85 min ( p<0.001, Mann–Whitney). The overall cost of the procedure in the sclerotherapy group (£672.97) was significantly less compared to conventional surgery (£1120.64). At 3 weeks, there was no statistical difference in the complication rate between the two groups. At 3 months, median CEAP class dropped from four pre-operatively to one following treatment in both groups and the median VCSS score dropped from five to one in group one and from seven to three in group two ( p<0.001, Wilcoxon test). In group one four patients (13%) had a recanalised vein which needed further sessions of foam sclerotherapy, resulting in a short-term closure rate of 87%. Conclusion Ultrasound guided sclerotherapy combined with sapheno-femoral ligation was less expensive, involved a shorter treatment time and resulted in more rapid recovery compared to sapheno-femoral ligation, saphenous stripping and phlebectomies.