Lower Limb Varicose Veins Research Articles

Protocol for prophylaxis of venous thromboembolism in varicose vein surgery of the lower limbs.

Pulmonary embolism is the most feared complication of venous thromboembolism (VTE) and the third leading cause of cardiovascular mortality in the world, after acute myocardial infarction and stroke. The risk of VTE is virtually universal in hospitalized patients, especially those with reduced mobility. Although variable in incidence between clinical and surgical patients, up to 66.6% of events related to hospitalizations can occur after discharge, with this risk remaining for up to 90 days. Despite all the investment made in VTE prophylaxis in recent decades, there is still no consensus or specific guidelines for its prevention in patients undergoing conventional surgery for varicose veins of lower limbs. The adoption of a validated risk assessment model for VTE prophylaxis, based on the current literature, may help in the implementation and standardization of VTE prophylaxis in conventional lower limb varicose vein surgery, in addition to this benefit, it may lead to a reduction in the length of hospital stay and the number of readmissions.

Tromboprofilaxia na cirurgia de varizes dos membros inferiores no Brasil

BackgroundDespite all the investment in primary venous thromboembolism (VTE) prophylaxis for surgical patients in recent years, there are still no specific guidelines for those who undergo procedures to treat lower limb varicose veins.ObjectivesTo evaluate the profile of VTE prophylaxis practices among Brazilian vascular surgeons conducting lower limb varicose vein procedures.MethodsSurvey design, sending an electronic questionnaire to Brazilian vascular surgeons. Respondents were divided between those who perform saphenous vein treatment with conventional surgery and those who perform thermoablation for the purpose of comparison between groups.ResultsOf 765 respondents, 405 (53%) treat saphenous veins with conventional surgery for, 44 (6%) with foam, and 199 (26%) with thermoablation (endolaser or radiofrequency). Surgeons who perform thermoablation prescribed more pharmacoprophylaxis after varicose vein surgery than those who perform conventional surgery (67/199, 34% vs. 112/405, 28%; p = 0.002). The thermoablation group stratifies patients for thromboembolism risk more frequently than the conventional surgery group (102/199, 51% vs. 179/405, 44%; p = 0.004). Both groups use enoxaparin as the most frequent drug for prophylaxis, but the thermoablation group uses proportionally more direct oral anticoagulants than the conventional surgery group (26% vs. 10%, p<0.001).ConclusionsBrazilian vascular surgeons who perform saphenous vein treatment by thermoablation prescribe pharmacoprophylaxis more frequently and for a longer period than those who use conventional surgery.

Опыт применения симультанных операций у больных с варикозной болезнью и грыжами передней брюшной стенки

Aim: to substantiate the feasibility of concurrent surgeries in patients with varicose vein disease and anterior abdominal wall hernias (ventral hernias). Patients and Methods: the paper presents the treatment results of 82 patients with ventrial hernias and lower limb varicose vein disease. The method choice and the scope of surgical intervention were determined on the basis of clinical and instrumental examination data. Commonly, Lichtenstein tension-free hernia repair in combination with crossectomy, endovasal laser coagulation (EVLC), varicose veins radiofrequency ablation (VVRFA) were performed. The long-term results were analyzed 1–2 years after the use of concurrent surgeries. The life quality before surgery and a year after was determined by the SF-36 questionnaire. Results: the patients consisted of 45 (54.9%) men and 37 (45.1%) women aged 19 to 69 years. In 20 (24.4%) of the admitted patients, work was associated with physical activity, and 56 (68.3%) patients were at the most capable age: 19 to 50 years. Upon admission to the clinic, 78 patients had complaints. Commonly, they had a combination of varicose vein disease with inguinal or umbilical hernias. After the use of concurrent surgeries, no specific complications were observed in this patient cohort, as well as complications associated with both diseases concomitantly. In the long-term period, patients noted an improvement in their general health by 23.2%. In the preoperative period, the indicator of physical functioning was 41.27 points; after the operation, there was an increase in this indicator according to patients’ estimates by 1.6 times — to 67.32 points. After surgery, the greatest positive trend of vital activity (42.8%) and role limitations due to emotional state (57.3%) were observed. There was an increase in all indicators of life quality by 18.2–53.9% in patients who underwent concurrent surgeries. Conclusion: the obtained results demonstrated the safety and high efficacy of concurrent surgeries in patients with varicose vein disease and ventral hernias. Thus, the use of concurrent surgeries is considered to be an alternative to the staged treatment of patients with varicose vein disease and ventral hernias KEYWORDS: concurrent surgeries, varicose vein disease, ventral hernias, life quality, postoperative complications. FOR CITATION: Chernookov A.I., Kuznetsov M.R., Kandyba S.I. et al. Concurrent surgeries in patients with varicose vein disease and ventral hernias. Russian Medical Inquiry. 2022;6(4):164–170 (in Russ.). DOI: 10.32364/2587-6821-2022-6-4-164-1.

Varicose veins: a clinical profile

Background: The CEAP classification includes classifying varicose veins on the basis of their clinical, etiological, anatomical and pathophysiological classification.Methods: It was a prospective study of 50 patients presenting to a tertiary care hospital, MGM Medical College and Hospital, Kamothe, Maharashtra with varicose veins over a period of 2 years (November 2019 to November 2021). Institute Ethics Committee approval was obtained before start of study. All patients clinically diagnosed of symptomatic or complicated primary lower limb varicose veins with saphenofemoral and/or sapheno-popliteal incompetence with or without perforator incompetence were included. All cases with recurrent varicose veins were excluded. Result was tabulated and analysed at the end of the study using IBM SPSS software.Results: The age group with maximum varicose vein was between 21-30 years and incidence being more common in male population. The majority of the patients had massive varicose veins (C2). Pain was the most frequent presenting symptom. The majority of the study group had both saphenofemoral junction and perforator incompetence. Primary varicose veins are far more common (76%) than secondary and congenital varicose veins.Conclusions: Varicose veins are highly common in the Indian population. The CEAP classification has been a major contributor to advances in the field of varicose veins since its inception, and it has now become universally accepted due to its simplicity and reliability.

Numerical modeling of the impact on the vascular wall during endovenous ultrasound treatment

The article describes the research of a new treatment method of lower limb varicose vein using low-frequency ultrasound. To study the effectiveness of this method we analyzed the interaction between the ultrasound instrument and the venous wall and defined the mechanisms of action during endovenous ultrasound treatment (EUT): thermal, mechanical, and chemical. We developed three models to study the impact of different combinations of mechanisms of action on varicose venous wall. The first model describes the endothelial cell layer delamination during mechanical mechanism. Other models investigate the two main modes of EUT. The EUT mode 1 models mechanical and thermal mechanisms of action, while the EUT mode 2 also studies the impregnation process of sclerosant. During the finite element analysis of both EUT modes, the instrument with an axisymmetric tip was inserted inside the vein with varying blood flow velocity. The amplitude of ultrasound oscillations required for the endothelial cell layer delamination was equal to 40 µm. The ultrasound exposure induced the impregnation enhancement of sclerosant up to 6 times. The temperature distribution and the necrotic tissue fraction of the venous wall were also evaluated. The results of the study demonstrate uniform irreversible damage to the venous wall for both EUT modes.

Comparative Study between Endovenous Laser Ablation and Conventional Surgery of Primary Varicose Veins of Lower Limbs

Comparative Study between Endovenous Laser Ablation and Conventional Surgery of Primary Varicose Veins of Lower Limbs

Effect of Lifestyle and Symptom Intensity Factors on the Severity of Lower Limbs Veins of Varicose Among Nurses in North Khorasan Hospitals, Iran

Introduction: Few data were reported the risk factors for lower limb varicose veins (VVs) among Iranian nurses. The current research aims to study the social, life style, and occupational factors associated with development of VVs in a sample of Iranian nurses. Materials and Methods: In this cross sectional study 235 volunteered nurses filled the consent forms and then examined by a vascular specialist. Varicose veins of the patient nurses were graded by CEAP criteria. The patients then filled out lifestyle questionnaire (LQ). Results: In this study, there were 163 (69.4%), 64 (27.2%) and 8 (3.4%) of cases with mild, moderate and severe VVs. Relation of age, laboring times, abortion times and BMI with VVs severity was statistically significant (P<0.005). found physical activity (OR=4.038), weight control and nutrition (OR=3.76) significantly effected on VVs intensity.Conclusion: This study highlighted lifestyle risk factors of varicose veins, which can considered in improving of lifestyle and quality of life of nurses in the long-time.Keyword: Varicose vein, Lifestyle, Quality of life, Physical activity, weight control

Clinical assessment of endovenous thermal ablation combined with concomitant phlebectomy for the treatment of lower limb varicose veins with or without poor glycemic control

BackgroundThis study aimed to investigate the clinical results of endovenous thermal ablation combined with stab phlebectomy for unilateral varicose veins based on diabetic management. MethodsThe study reviewed 501 patients who underwent endovenous thermal ablation combined with stab phlebectomy for unilateral varicose veins, including 337 nondiabetics (control group) and 164 diabetics. Diabetics with hemoglobin A1c ≥7% were classified as the poor glycemic control group, and hemoglobin A1c <7% as the good glycemic control group. Surgical outcomes were assessed by Venous Clinical Severity Score. The Chronic Venous disease quality of life Questionnaire was used to assess the quality of life. ResultsLower limb varicose veins can be treated successfully with endovenous thermal ablation combined with stab phlebectomy in patients with or without poor glycemic control, accompanied by a significant improvement in health status. For patients with initial varicose veins (preoperative Venous Clinical Severity Score <10), the results revealed satisfactory improvements in Venous Clinical Severity Score and quality of life among the control, poor glycemic control, and good glycemic control groups. Patients with advanced varicose veins (preoperative Venous Clinical Severity Score ≥10) also showed an obvious amelioration concerning venous symptoms and quality of life. However, the extent of improvement varied among the 3 groups. Patients subjected to advanced varicose veins with the condition of poor glycemic control exhibited a less desirable improvement in postoperative health conditions compared with the control and good glycemic control groups, especially in edema relief and ulcer healing. ConclusionEndovenous thermal ablation combined with stab phlebectomy is safe and effective in the treatment of varicose veins with or without poor glycemic control. Clinical attempts at hemoglobin A1c management may contribute to improved clinical outcomes in patients with advanced varicose veins.

Pure Mucinous Breast Carcinoma with Micropapillary Pattern in a 32-Year-Old Female

Background: Mucinous carcinoma (MC) is a rare breast malignancy with a large extracellular mucin secretion. It has a good prognosis in comparison to other breast malignancies. Case presentation: We report a 32 years old female with multiple hard palpable masses in the left breast with rapid growth in 6 months. She was mentally retarded with lower limb varicose veins associated with mucocutaneous lesions on the face. She underwent ultrasound examination of the breast, thyroid and lower extremity veins. Core needle biopsy and fine needle aspiration from left breast lesions and right thyroid nodules showed MC and follicular lesion with hurtle cell change, respectively. Suspected metastasis in the left rib and calvarium in the subsequent bone scan survey and brain magnetic resonance imaging was reported. She underwent radical mastectomy and right hemi-thyroidectomy. Conclusion: Pure mucinous carcinoma with micropapillary pattern (MUMPC) is a new histology variant of Pure Mucinous Carcinoma (PMC) that shows favorable prognosis with less aggression and occurs in older patients. However, PMC in our patient occurred at a young age with greater aggression.

Surgical management of varicose veins and its complications

Background: Varicose veins affects at least 1 out of 5 in world. Varicose veins and their associated symptoms and complications constitute chronic vascular disorders requiring surgical treatment. In developing countries like India, studies encompassing the clinical evaluation and management of varicose veins on the conventional lines seems a necessity to improve the quality of care with the available resources. Objectives: To study the clinical presentations, surgical management and its outcome and complications associated with varicose veins in lower limbs. Methods: A total of 30 patients with primary varicose veins were sourced from cases admitted to Kamineni Institute of Medical Sciences from October 2019 to August 2021. They were investigated, operated and followed up, and the final outcome evaluated. All the information was taken down in the proforma designed for the study. Results: In the study, it was noted that the varicose veins affect the young adult and middle age population (20-50yrs). Most of the patients were males (60%) and majority of patients sought medical help for one or the other complications (92%). Long saphenous vein involvement was seen in 93.3% of patients and both LSV & SSV involvement in 20%. A great number of patients had perforator incompetence (80%). Duplex Ultrasound of the venous system proved to be a crucial and clinching investigation. Sapheno-femoral flush ligation with stripping was the most commonly performed surgery (46.7%), with addition of Subfascial ligation in a few cases. Most patients had uneventful recovery, with a few cases suffering complications such as hematoma, seroma and wound infection. These resolved in follow-up, however, saphenous neuritis was a persistent complication in 3 patients. Conclusion: Majority of the patients with varicose veins were associated with complications and surgical management with stripping of path of incompetence (i.e. LSV trunk) with incompetent perforator ligation appear to be best option for lower limb varicose veins under our settings.

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.

Comparative Study between Conventional Stripping Surgery and Endovenous Laser Ablation in Management of Primary Lower Limb Varicose Veins

Comparative Study between Conventional Stripping Surgery and Endovenous Laser Ablation in Management of Primary Lower Limb Varicose Veins

Status of clinical profile and management of varicose veins in a tertiary care teaching hospital

Background: Varicose veins are a widespread medical condition found in at least 10 percent of the general population. Symptoms of varicose veins range from asymptomatic varicose veins to more extreme symptoms such as ulceration and bleeding.Methods: Fifty-six cases of varicose veins of lower limb were evaluated by taking detailed history and by carrying out thorough clinical examination. Patients with features of varicose veins and its complications were included in the study while patients with secondary varicose veins due to deep vein thrombosis, recurrent varicose veins, pregnancy, and venous flow obstruction were excluded from the study.Results: It was more common in left lower limb then compared to right one, 26 (46.4%) patients developed in left and 23 (41.1%) patients in right lower limb. In the present study, right limb involvement of 41.1% and left limb involvement of 46.4%. In the present study bilateral involvement is seen in four patients (12.5%).Conclusions: Distributions of varicose veins of lower limbs is greater common in center age organization of 30 to 50 years (58.9%) with male predominance, career and own family history are the opposite contributory factors.

Knowledge and Practices on Risk Factors and Prevention of Varicose Vein among Operation Room Nurses of the Selected Hospitals

Lower-limb varicose veins (VVs) are frequent, and they're known to be more common in persons who work in jobs that require a lot of standing. Because nursing demands physical labour and lengthy periods of standing, women in this profession are at a higher risk of getting varicose veins. The aim of this study is to assess the knowledge and practices on risk factors and prevention of varicose vein among operation room nurses of the selected hospitals. A cross-sectional research design was used among registered nursing staff working in operation rooms of the selected hospitals. The convenient sampling technique was used to select fifty nurses. A structured pre-tested, validated tool was developed by the investigators to collect data from the nurses which include demographic as well as knowledge and practice variables of varicose veins. The findings of the present study show that 26% of nurses had inadequate knowledge and 14% of operation room nurses had poor practices. Also, there was a positive correlation between the knowledge and practice of nurses (r = 0.71). There was significant association for practice skills score with education and years of experience at p=0.05. The study concludes that to prevent occupational hazards in nursing, periodic health education and health promotion initiatives must be implemented.

Перебіг та ефективність лікування варикозної хвороби вен нижніх кінцівок у хворих на цукровий діабет

Актуальність. Цукровий діабет 2-го типу (ЦД2) є чинником ризику артеріосклерозу нижніх кінцівок, а зв’язок зі станом венозного басейну судин ніг залишається вивченим недостатньо, не з’ясовано ефективність хірургічних методів лікування хворих із варикозом. Мета дослідження: проаналізувати характер перебігу варикозної хвороби вен ніг та ефективність лікувальних заходів на тлі ЦД2. Матеріали і методи. Під наглядом перебувало 302 хворі (75 чоловіків і 227 жінок віком 29–72 роки), 16 % з яких раніше перенесли флеботромбоз, а частота II–VI класів венозної недостатності становила відповідно 10, 14, 37, 16 і 23 %. Ендовенозну лазерну коагуляцію виконано 263 пацієнтам, а 39 — традиційну флебектомію або лігування перфорантів. Результати. Серед обстежених хворих на варикозну хворобу вен нижніх кінцівок ЦД2 виявлено в 9 % випадків, частіше у чоловіків і пацієнтів старших вікових груп на тлі атеросклерозу судин ніг (здухвинних, стегнових, гомілкових, підколінних артерій), що супроводжувалося частішим залученням до процесу великої підшкірної вени та приустєвим її розширенням, переважанням тяжких класів венозної недостатності, значно гіршими результатами хірургічного лікування варикозу та більшою частотою розвитку ускладнень, незважаючи на частіше фонове використання рівароксабану і низькомолекулярних гепаринів, а ефективність ендовенозної лазерної абляції за чотири тижні після її проведення поступається показнику в групі без ЦД2, при цьому рівень глікемії обернено корелює з показником поверхневого натягу венозної крові, що має прогностичну значущість у контексті подальших лікувальних заходів. Висновок. Наявність ЦД2 є чинником ризику тяжкого перебігу варикозу вен ніг, негативним фактором щодо прогнозу ефективності хірургічного лікування цього захворювання й числа ускладнень.

HISTORICAL AND MODERN ASPECTS OF TREATMENT OF LOWER LIMB VARICOSE VEIN DISEASE (THE LITERATURE REVIEW)

In developed countries, lower limb varicose vein (LLVV) is determined in 25% of the adult population. The high prevalence of varicose vein disease and the likelihood of severe complications developments determine the socio- economic importance of fi nding the eff ective methods of treatment this pathology. Age, height, female gender, overweight and heredity are well known traditional risk factors. The pathogenesis of LLVV is a complex and multifactorial process.The aff ected of endothelial cells is the main pathogenetic link in the LLVV development, that leads to a violation of their antithrombogenic properties. In the future, other membranes of the vein wall are involved in the pathological process. The development of LLVV is associated with a violation of the venous valves and their damage as well. The main method for diagnostic LLVV is ultrasound CT angiogram, that allows you to simultaneously visualize the researched vessel, determine the direction of blood fl ow and its parameters, its individual anatomical features. There are conservative and surgical methods of LLVV treatment. The fi rst attempts of the conservative management for this disease were wrapping the aff ected leg, as evidenced by the rock paintings that had been found in the Sahara Desert. The current analogue is the compression therapy, which plays a major role in the conservative management of venous diseases. Before the conservative method of treatment of LLVV the drug therapy is used as well. The use of various herbs for the management of blood vessels was common in ancient India. Currently, there is the wide range of modern pleotropic drugs. Aulus Cornelius Celsus removed varicose veins with a tiny hook, which is an extremely early version of a varicose vein treatment performed today. In the following centuries, the methods of surgical treatment of this disease were constantly have been improved. Nowadays, the most frequently used methods of varicose vein obliteration are based on endovasal thermal damage of the venous wall, that leads to the occlusive fi brosis and transformation of the vein into a connective tissue cord. The main advantages of these interventions are minimal trauma, speedy rehabilitation, and good cosmetic result.

Study of clinical profile and management of varicose veins in the department of surgery

Background: Varicose veins are common problem and are present in at least 10% of the general population. So far as the aetiology is concerned varicose veins mostly occur due to incompetence of their valves. Risk factors for varicose veins include obesity, female sex, inactivity, and family history. Varicose veins do not threaten life and are seldom disabling, but it causes a considerable demand on medical care.Methods: The study was prospective observational single center study. 30 patients were selected for the study which fit in the selection criteria laid down at the beginning of the study. Informed consent was obtained from each patient before any investigations and treatment.Results: The study revealed that the varicose veins of lower limbs are a disease of younger age group, occurring more commonly during third and fifth decades of life. The involvement of long saphenous system was more common.Conclusions: Results of our study are comparable with various other studies in literature.

Epidemiological, life style, and occupational factors associated with lower limb varicose veins: a case control study

BackgroundFew data were documented about risk factors for lower limb varicose veins (LLVV) among Egyptian population. Identifying modifiable risk factors is crucial to plan for prevention. The current research aims to study the epidemiological, life style, and occupational factors associated with LLVV in a sample of Egyptian population.MethodsA case control study was adopted. Cases with LLVV (n = 150) were compared with controls (n = 150). Data was collected using an interview questionnaire and clinical assessment. Data was analyzed using the univariate and multivariate logistic regression analyses.ResultsAccording to multivariate analysis among all participants (n = 300), the odds of LLVV was 59.8 times greater for those who frequently lift heavy objects (95% CI = 6.01, 584.36) and 6.95 times higher for those who drink < 5 cups of water/day (95% CI = 2.78, 17.33). Moreover, it was 4.27 times greater for those who infrequently/never consume fiber-rich foods (95% CI = 1.95, 9.37) and 3.65 times greater for those who stand > 4 h/day (95% CI = 1.63, 8.17). Additionally, odds of LLVV was 3.34 times greater for those who report irregular defecation habit (95% CI = 1.68, 6.60), and 2.86 times higher for those who sleep < 8 h/day (95% CI = 1.14, 7.16), and 2.53 times higher for smokers compared with ex-smokers/non-smokers (95% CI = 1.15, 5.58). In addition, a standing posture at work was an independent predictor of LLVV among ever employed participants (n = 234) in the current study (OR = 3.10; 95% CI = 1.02, 9.38).ConclusionsThis study highlighted seven modifiable independent predictors of LLVV mostly related to the life style, namely, frequent lifting of heavy objects, drinking < 5 cups of water/day, infrequent/no consumption of fiber-rich food, standing more than 4 h/day, irregular defecation habit, sleeping less than 8 h/day, and smoking. These findings provide a basis to design an evidence-based low-cost strategy for prevention of LLVV among Egyptian population.

EPIDEMIOLOGY OF PRIMARY VARICOSE VEINS OF LOWER LIMB IN A TERTIARY CARE HOSPITAL.

Introduction: Epidemiological studies plays an important role in providing information on the spectrum and frequency of venous disease distribution in a population. In India, study encompassing the clinical evaluation and surgical management of varicose veins on the conventional lines seems a necessity to improve the quality care with the available resources. We have undertaken an epidemiological study on inuence of age, sex, body mass index, posture on clinical manifestations and complications of varicose veins of lower limbs in patients attending the Department of Vascular Surgery . Materials and Methods: A prospective observational study was conducted in Department of vascular surgery on patients with primary varicose veins of lower limb. Patients with secondary varicose veins, recurrent varicose veins, patients less than 18 years, deep vein thrombosis&amp; peripheral arterial disease were excluded from the study. Results: In the present study 88.89% of ulcer patients had combined saphenofemoral(SFJ) and perforator incompetence, while 11.11% of ulcer patients had combined saphenofemoral, saphenopopliteal (SPJ)and perforator incompetence.14% patients present with combined SFJ, SPJ and perforator incompetence. The patients with higher CEAP classication had combined SFJ and SPJ valvular incompetence. Most commonly, the disease affected the males in the age group of 40-50 years. Conclusion: The present study shows that prolonged standing , obesity ,increasing age are the common risk factors for development of varicose veins.

Ultrasound-guided foam sclerotherapy of lower limb varicose veins: outcome and patient satisfaction

Background: Varicose veins are defined as dilated, tortuous, and elongated superficial veins of the lower limbs with incompetent valves. Sclerotherapy could be a minimally invasive technique that uses an injection of a special chemical (sclerosant) into a varicosity to wreck and scar the inside lining of the vein. Resulting in blockage of the treated vein. Objective: To explain the efficacy and safety of foam sclerotherapy within the treatment of varicose veins and to see patient’s satisfaction after ultrasound-guided foam sclerotherapy. Patients and Methods: This study was conducted at Sohag University hospitals to evaluate the efficacy, safety, and patient satisfaction following foam sclerotherapy for varicose veins. There was 60 cases with lower limb varicosities whose mean age was 33.72 years (range 20 – 52). Females represented 62% of cases, while the remaining cases were males. Results: The cosmetic appearance showed a major improvement (p < 0.001) after our intervention. Pain sensation was significantly decreased after the intervention. Only 25% of cases reported that sensation after 1 week, of which percent decreased all the way down to 3, 3, and seven during the following visits respectively. Saphenofemoral reflux was present in 48% of cases before the intervention, and it decreased all the way down to 7, 3, 3, and seven of cases at the scheduled follow up visits respectively. Complications were reported by 28% of cases. Skin hyperpigmentation was the most common complication (22%), followed by visual disturbances (8%), and thrombophlebitis (7%). Conclusion: Ultrasound-guided foam sclerotherapy seemed to be a safe and effective procedure for the treatment of chronic venous insufficiency within the selected group of patients.