Polidocanol Foam Sclerotherapy Research Articles

Efficacy of polidocanol foam sclerotherapy in treatment of patients with advanced hemorrhoids

Efficacy of polidocanol foam sclerotherapy in treatment of patients with advanced hemorrhoids

Early Results of the Sandwich Technique Using Cyanoacrylate Glue and Polidocanol Foam Sclerotherapy for the Treatment of Varicose Veins

Background: This is a retrospective analysis of the results of treatment for varicose veins using the sandwich technique with cyanoacrylate glue and foam sclerotherapy. This novel method allows for a substantial reduction in the amount of glue needed for vein closure, and minimizes the risk of granuloma formation and allergic reaction related to the epifascial administration of cyanoacrylate. Methods: This technique was used in 60 patients, 77 intrafascial veins were managed. Vein closures were performed with Venex cyanoacrylate glue and 1–3% polidocanol foam. All procedures were performed under ultrasonographic control, through direct percutaneous punctures of target veins. Follow-ups were scheduled 1–3 weeks after the procedure. If revealed, unclosed segments of the target veins were obliterated at these follow-up visits, with glue and/or sclerotherapy. Results: There were no serious adverse events intra- or postprocedurally. The technical success rate was 100%. The primary success rate at 1–3 weeks follow-up was 84.4%. The primary assisted success rate, after additional closures, was 100%. Conclusions: We demonstrated that the treatment for varicose veins, using a sandwich technique, which combines cyanoacrylate glue and foam sclerotherapy, can be safe and efficient.

Deep Vein Thrombosis of Saphenous-Femoral Junction After Leg Lauromacrogol Foam Ultrasound Guided Percutaneous Sclerotherapy

Background: Lauromacrogol foam sclerotherapy is characterized by a high success rate in obliterating varicose veins and a low frequency of adverse effects. Most of these parts consist of minor effects, and few data are available about significant effects (e.g., vein thrombosis), pointing out the technical safety of ultrasound-guided foam sclerotherapy.Case Presentation: a 78-year-old woman was evaluated for chronic vein disease; at ultrasonographic and Doppler scan (USDS), severe GSV dilatation and GSV reflux were documented in both legs below the knee. After meticulous anamnesis and physical examination, informed consent was obtained, and ultrasound-guided percutaneous polidocanol foam (one part of 2% lauromacrogol solution + one part of the air, mixed with Double Syringe System) sclerotherapy was performed in the right leg; best medical therapy was given after the procedure. After five days, USDS pointed out thrombosis extending to the thigh upper region to saphenous-femoral junctions, consisting of deep vein thrombosis. Appropriate anticoagulant therapy was promptly dispensed, and the patient had no aftermaths.Conclusion:The prevalence of vein thrombosis after lauromacrogol sclerotherapy is unknown, and their correlation is uncertain, but, in our experience, it should be suspected in patients who referred lower limb pain after this procedure despite the best medical therapy dispensation.

Clinical outcomes and predictors of bleomycin polidocanol foam sclerotherapy treatment response in venous malformations.

To evaluate the safety and efficacy of bleomycin polidocanol foam (BPF) sclerotherapy for venous malformations (VMs) and analyze the associated clinical outcomes and predictors. We retrospectively assessed BPF sclerotherapy outcomes in 138 patients with VMs. We analyzed pain levels, lesion volume reduction, and subjective perception of response. Logistic regression analysis was performed to identify potential predictors of treatment outcome. Additionally, we carefully monitored and recorded complications. There was a notable average reduction in lesion volume by 78.50% ± 15.71%. The pain numerical rating scale (NRS) score decreased from 4.17 ± 2.63 prior to treatment to 1.05 ± 1.54 afterward, and 70.3% of the patients experienced effective relief after a single BPF treatment. Multivariate analysis revealed that a high baseline NRS (odds ratio [OR]: 4.026) and elevated activated partial thromboplastin time (APTT, OR: 1.200) were positive predictors of pain reduction. Additionally, a high baseline NRS score (OR: 1.992) and elevated thrombocytocrit (PCT, OR: 2.543) were positive predictors of incomplete postoperative pain relief. Minor complications occurred in 31 (22.46%) patients. BPF sclerotherapy is safe and effective for VMs, resulting in significant reduction in lesion volume, improved symptoms, and minimal complications. APTT and PCT levels are important predictors of pain outcomes following BPF treatment.

Sclerobanding in the treatment of second and third degree hemorrhoidal disease in high risk patients on antiplatelet/anticoagulant therapy without suspension: a pilot study.

Around 20% of population in western countries is under anticoagulant treatment. However, there is paucity of evidence about the treatment of HD in patients under anticoagulant/antiplatelet therapy, although both suspension and continuation in the perioperative period may increase the risk of severe complications. The aim of this pilot study was to confirm the feasibility and safety of sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy), an office-based procedure, for the treatment of second-and third-degree HD in patients under anticoagulant/antiplatelet therapy without suspension. Patients affected by second-third-degree haemorrhoids unresponsive to conservative treatment and under anticoagulant/antiplatelet were enrolled between November 2019 and October 2021. Postoperative complications, readmission, mortality and reintervention during the follow-up were evaluated. Fifty-one patients were recruited, 23 female (45.1%) and 28 male (54.9%), with an average age of 65 years ± 11.4 SD (range 42-90). Twenty-seven patients (52.9%) had II-degree haemorrhoidal disease, and 24 (47.1%) had grade III-degree. The most frequently taken medications were dual antiplatelet therapy (51%) and new oral anticoagulants (NOACs) (21.6%). The mean follow-up was 23 months. No intraoperative complications were recorded. The rate of complications in the first postoperative month was 13.7%, represented by mild complications: 6 cases of moderate to severe pain and 1 case (2%) of thrombosis of a residual haemorrhoidal nodule, all regressing after conservative therapy. No severe complications were reported. Postoperative complications were not statistically significantly associated with the number of nodules treated (1, 2, or 3), the disease grade (2nd vs. 3rd) or the specific anticoagulant/antiplatelet regimen. During follow-up, 2 patients (4%) required a new procedure for recurrent bleeding: one an infrared photocoagulation as outpatient, and another a haemorrhoidectomy after 3 months. No cases of intraoperative or postoperative mortality occurred. Sclerobanding is a safe and effective technique in treating intermediate-grade haemorrhoidal disease in patients at high risk on anticoagulant/antiplatelet therapy. Sclerobanding is repeatable, usually does not require anaesthesia, and is cost-effective. Observational multicentre studies with a larger number of patients and controlled clinical trials will be needed to confirm these results.

Clinical results of polidocanol sclerotherapy in venous malformation treatment: Patient-perceived improvement and satisfaction.

This study evaluated the results of polidocanol sclerotherapy in the treatment of venous malformations (VM) including patient satisfaction, perceived improvement, and predictors of satisfaction. Patients with VM that underwent polidocanol foam sclerotherapy between June 2013 and July 2021 in a single center were retrospectively evaluated. Patient demographics, VM, and treatment characteristics were analyzed. Patient-reported outcomes and satisfaction were analyzed with a questionnaire. This study included 232 (136, 58.6%, female) patients. The mean age was 24.49 ± 12.45years (range 3-72). The clinical response rate was 82.3%. The rate of satisfaction was 82.3%, and 116 (50%) patients were significantly satisfied. There were no major complications. Clinical response and VM margin were related to satisfaction (p < 0.01, p = 0.012, respectively). Clinical response to pretreatment swelling was related to significant satisfaction (p = 0.02). Polidocanol sclerotherapy was safe and effective in VM treatment with high satisfaction and low complication rates.

Sclerotherapy Improves Symptoms in Patients with Small and Moderate Diameter Low-Flow Vascular Malformations: A Prospective Cohort Study

Vascular malformations are rare diseases and treatment remains controversial. Sclerotherapy is accepted as a minimally invasive treatment with good results; however, some patients do not report good response to sclerotherapy, and it is not clear which variables influence treatment outcome, preventing optimal patient selection. We hypothesized that large diameter lesions have reduced efficacy and satisfaction with sclerotherapy. Therefore, we prospectively evaluated the clinical response of low-flow vascular malformations treated with 1% polidocanol foam sclerotherapy and determined the correlation of symptom improvement with clinical variables. Prospective cohort study of patients with symptomatic low flow vascular malformations treated at the Hospital das Clínicas between December 2016 and November 2018. Lesions were classified according to location, extension, diameter, type of vessels, margins, and symptoms. Sclerotherapy was performed by direct injection of 1% polidocanol foam, with a maximum volume of 10ml per session. Symptom improvement was evaluated using the visual analog scale and patient-reported quality of life was assessed by the Short-form 6 dimensions (SF-6D) questionnaire. Follow-up was performed every 3months after treatment. Forty lesions were treated in 38 patients, with 19 women and 19 men; median age was 20.5years (range 4months to 63years). Most lesions (80%) were venous, and most commonly in the lower limbs (47.5%); 27.5% were superficial, 35% were deep, and 37.5% affected both compartments. The most common clinical presentations were deformity (95%), pain (78%), and functional limitation (58%); deep compartment lesions were more associated with functional limitation (69% vs. 27%; P=0.030). Fifty-three per cent of lesions were >10cm and were associated with increased numbers of psychosocial symptoms (P=0.038). Two-hundred and forty-two sessions of sclerotherapy were performed, with 6 mean treatments per lesion (range 1-15). The mean follow-up time was 23months (range 2-23months). The most common complications were pain and local edema, without any major complications; some patients reported symptom recurrence (15% pain, 10% deformity, and 12% functional limitation). Sclerotherapy was associated with significant improvement of all symptoms (P<0.001). However, lesions >10cm were associated with poor improvement in deformity (P=0.003). Quality of life improved for most patients (60%) and treatment satisfaction was high (82%). Treatment of low-flow vascular malformations with 1% polidocanol foam is safe and effective; sclerotherapy improves symptoms and quality of life. Large diameter lesions (>10cm) are associated with increased treatment failure. A small percentage of patients reported recurrent symptoms and require other modalities for successful treatment.

Sclerobanding Is a Novel Technique for the Treatment of Second- and Third-Degree Hemorrhoidal Disease. Reply to Jongen et al. Comment on "Pata et al. Sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy) for the Treatment of Second- and Third-Degree Hemorrhoidal Disease: Feasibility and Short-Term Outcomes. J. Clin. Med. 2022, 11, 218".

We thank Johannes Jongen and colleagues for their correspondence [...].

Comment on Pata et al. Sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy) for the Treatment of Second- and Third-Degree Hemorrhoidal Disease: Feasibility and Short-Term Outcomes. J. Clin. Med. 2022, 11, 218.

Dr. Pata kindly tweeted the publication of the above-mentioned paper [...].

Ultrasound-guided polidocanol foam sclerotherapy for symptomatic giant hepatic cyst: A single-center experience.

Simple hepatic cysts are typically benign; however, when they are large and symptomatic, therapeutic intervention is required. We previously reported our initial experience with ultrasound (US)-guided polidocanol foam sclerotherapy in three patients with symptomatic giant hepatic cysts. In the present study, we examined the efficacy and safety of polidocanol foam sclerotherapy in a larger number of patients with long-term follow-up. Between May 2016 and April 2021, 15 patients with symptomatic giant hepatic cysts were referred to our hospital. All patients were prospectively included in the study and underwent US-guided polidocanol foam sclerotherapy. The mean maximum diameter and estimated cyst volume were 128.4mm (77-223mm) and 922.3ml (123.2-2797ml), respectively. Polidocanol foam was successfully administered through an 8.5-Fr pigtail catheter in all patients. The percentages of cyst diameter/volume after 1-3months, 3-6months, 6months-1 year, 1-2years, and 2-4years of sclerotherapy were 66.8%/36.5%, 48.1%/14.8%, 34.1%/6.9%, 28.2%/3.7%, and 26.2%/3.1%, respectively. During the follow-up period, there were no cases of symptom recurrence or need for additional treatment due to cyst re-growth. Six patients (40%) had fever, one had nausea, and one had right-sided chest pain, but none of these adverse events required prolonged hospitalization or readmission. US-guided polidocanol foam sclerotherapy may be an effective and safe method for the treatment of symptomatic giant hepatic cysts.

Polidocanol foam sclerotherapy in the treatment of hemorrhoidal disease in patients with bleeding disorders: a multicenter, prospective, cohort study.

BackgroundThe management of hemorrhoidal disease (HD) in patients with bleeding disorders (BD) is challenging. Polidocanol foam sclerotherapy (PFS) is associated with a low rate of bleeding complications. The aim of this study was to compare the efficacy and safety of PFS in the treatment of HD in patients with and without BD.MethodsThis prospective, multicenter, cohort study enrolled patients with (group B) and without (group A) BD, with symptomatic internal HD grades I–III over an 18-month period. All patients were treated with PFS. Patients with congenital BD did not undergo prior replacement therapy and those with acquired BD due to antithrombotic drugs, did not discontinue therapy. Efficacy outcomes included therapeutic success and HD recurrence during a 1-year follow-up period. To evaluate safety the complications related to PFS were recorded.ResultsWe included 228 patients (group A: 155, group B: 73; male/female: 114/114; mean age: 59.4 ± 15.9 years). The baseline hemorrhoidal disease bleeding grade (p < 0.001) and Sodergren hemorrhoidal symptom severity score (p = 0.019) were higher for group B. The overall therapeutic success rate was 93.4% with an average number of sessions of 1.51 ± 0.74, significantly higher for group B (1.68 ± 0.86 vs 1.43 ± 0.65, p = 0.013). Complications occurred in 11.4% of the patients, with bleeding reported in 4.8%. The majority of complications were mild (96.2%). No significant differences between the two groups were observed for therapeutic success, recurrence, or complication rate.ConclusionsPatients with BD may have more symptomatic HD at baseline. Even so, PSF showed similar effectiveness and safety in patients with BD compared to patients without BD.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10151-022-02600-5.

Sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy) for the Treatment of Second- and Third-Degree Hemorrhoidal Disease: Feasibility and Short-Term Outcomes.

Background: Sclerobanding is a novel technique combining rubber band ligation with 3% polidocanol foam sclerotherapy for the treatment of hemorrhoidal disease (HD). The aim of this study is to evaluate the feasibility, safety and short-term outcomes of sclerobanding in the treatment of second- and third-degree HD. Methods: A retrospective analysis of second- and third-degree HD cases from November 2017 to August 2021 was performed. Patients on anticoagulants or with other HD degrees were excluded. Follow-up was conducted at 1 month, 3 months, 6 months, 1 year and then every 12 months. Results: 97 patients with second- (20 pts; 20.6%) and third-degree (77 pts; 79.4%) HD with a mean age of 52 years (20–84; SD ± 15.5) were included. Fifty-six patients were men (57.7%) and forty-one women (42.3%). Median follow-up was 13 months (1–26 months). No intraoperative adverse events or drug-related side effects occurred. Minor complications occurred in four patients (4.1%) in the first 30 postoperative days and all resolved after conservative treatment at the 3-month follow-up visit. No mortality or readmissions were observed. Conclusions: Sclerobanding is a safe technique with a low rate of minor postoperative complications. Further studies on larger samples are necessary to establish the effectiveness and long-term outcomes of the technique.

Association of great saphenous vein diameter and clinical severity score after treatment of severe chronic venous insufficiency with foam sclerotherapy

Objectives: to evaluate the association of the greater saphenous vein (GSV) diameter in the treatment of patients with severe chronic venous insufficiency (C6 CEAP classification) with ultrasound-guided polidocanol foam sclerotherapy (UGFS). Methods: A prospective, descriptive and analytical study of 28 patients (30 limbs) that underwent UGFS. Patients were divided into 2 subgroups by GSV diameter (&lt; 8 mm and ≥ 8 mm). Variables analyzed were ulcer healing, clinical intercurrences, clinical CEAP classification, Venous Clinical Severity Score (VCSS), diameter of the treated vein and presence of occlusion or recanalization by Doppler ultrasound. Patients were analyzed at the 1st, 3rd, and 6th months post-treatment. Results: The average age was 68.7 ± 10.5 years, 23 (82,1%) were women, and the average body mass index was 29.2 kg/m2. Although an improvement in VCSS score was observed during follow-up, no significant intergroup difference was noted. Seventeen (56%) limbs presented occlusion of the treated vein at the 1st month, 11 (36%) at the 3rd month, and 9 (30%) at the 6th month of follow-up. The ulcer healing rate was 56,6%. The average ulcer healing time was 90 days. Three (10%) patients presented with ulcer recurrence at the 6th month. Survival analysis showed no significant difference in ulcer healing rate between subgroups after one year of follow-up (log-rank, p = 0,178). Conclusion: There was no difference between the subgroups of large and small VSM diameter in terms of symptom severity. However, significant reduction of VCSS and pain relief was observed after foam sclerotherapy.

The experimental rationale for new bleomycin-polidocanol mini-foam administration in the treatment of children with head and neck venous malformations

Relevance. Venous malformation (VM) is an abnormal development of the collecting blood vessels based on the vascular wall formation disorder, which occurs during the peripheral vascular network differentiation. According to various sources, VM prevalence ranges from 1 to 2 in 10 000 newborns. Head and neck VMs significantly reduce patients’ quality of life, causing severe functional and aesthetic impairments. Sclerotherapy is an effective treatment method for children with venous malformations. In recent years, bleomycin has been the most commonly used sclerosant. It is a glycopeptide antibiotic synthesized by Streptomyces verticillus and belongs to cytostatic medications. They successfully use it for venous malformations sclerotherapy, also in children. Purpose – the study aimed to improve the sclerotherapy method by combining the advantages of foam sclerotherapy and bleomycin.Materials and methods. 48 samples of rats’ external femoral veins were morphologically examined. We divided the rats into 2 groups depending on the administrated agent: the first group – 3% polidocanol (lauromacrogol 400), the second group – bleomycin-polidocanol mini-foam composition. The histological assessment identified the changes in the vein endothelium, necrosis of tissue structures, cell dystrophy characteristics.Results. The first group, which used the bleomycin-polidocanol mini-foam composition, demonstrated more pronounced irreversible changes in the venous vessel endothelium compared to the second group.Conclusions. The experimental study revealed that the proposed method of VM sclerotherapy using new bleomycin-polidocanol mini-foam composition is more effective than the polidocanol foam sclerotherapy. The new method is highly effective, minimally invasive, safe and can be considered an independent treatment method in children with head and neck VM.

Pulmonary embolic episode after hybrid treatment with endovascular laser ablation combined with polidocanol foam sclerotherapy

Pulmonary embolic episode after hybrid treatment with endovascular laser ablation combined with polidocanol foam sclerotherapy

Combined rubber band ligation with 3% polidocanol foam sclerotherapy (ScleroBanding) for the treatment of second‐degree haemorrhoidal disease: a video vignette

Sclerotherapy (SCL) and rubber banding ligation (RBL) are recognised options in the treatment of second degree haemorrhoidal disease (HD) [1]. They are low-risk, inexpensive, repeatable and can be performed as office-based procedures [2][3]. The simultaneous combined use of both techniques may improve symptom control and long-term results [4][5]. However, no studies in the literature describe the use of 3% polidocanol foam as a sclerotizing agent in combination.

Efficacy and safety of polidocanol in the treatment of varicose veins of lower extremities: A protocol for systematic review and meta-analysis.

Background:The varicose veins of the lower extremities showed earthworm-like dilatation and venous protrusion of the lower extremities. Polidocanol foam sclerotherapy, as a minimally invasive treatment with rapid recovery, less trauma and not easy to relapse, has achieved good results in clinical, but it is lack of evidence-based medicine. The purpose of this study is to evaluate the efficacy and safety of polidocanol in the treatment of varicose veins of the lower extremities by meta-analysis.Method:Chinese National Knowledge Infrastructure, Wanfang Database, Chinese Scientifific Journals Database, China Biology Medicine disc, PubMed, EMBASE database, Web of Science, and Cochrane Library will be used as search sources to conduct for randomized controlled trials of polidocanol in the treatment of varicose veins of lower extremities. The search time is set from the establishment of the database in December 2020 in this study. Two researchers independently extract, delete files, extract data and evaluate the quality. Revman software version 5.3 will be used for statistical analysis of data.Result:In this study, the efficacy and safety of polidocanol in the treatment of varicose veins of the lower extremities will be evaluated in terms of total effective rate, incidence of complications and recurrence rate.Conclusion:This study will provide reliable evidence-based evidence for the clinical application of polidocanol in the treatment of varicose veins of lower extremities.Ethics and dissemination:Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences.OSF Registration number:DOI 10.17605/OSF.IO/AUR4X.

Biphasic anaphylaxis after use of foam polidocanol sclerotherapy

Polidocanol is a sclerogenic agent commonly used for the treatment of varicose veins. Common complications such as hyperpigmentation, telangiectasia matting on skin may be observed in relation with foam sclerotherapy. Complications such as deep vein thrombosis, stroke and tissue necrosis are rarely seen. Fatal complications such as anaphylaxis are seen very uncommonly. A 50-year-old female patient underwent polidocanol foam sclerotherapy for left leg reticular varicosity (CEAP 2-3). Our patient has experienced biphasic anaphylaxis, which was observed as two attacks following the foam sclerotherapy. Biphasic anaphylaxis complication after the foam sclerotherapy is not known, this presentation may even be the first condition experienced ever.

Foam sclerotherapy for lower-limb varicose veins: impact on saphenous vein diameter.

ObjectiveTo assess changes in the great saphenous vein (GSV) after foam sclerotherapy for varicose veins.Materials and MethodsThis was a prospective study of 33 patients who were treated with polidocanol foam sclerotherapy after having had varicose veins with a clinical severity-etiology-anatomy-pathophysiology classification of C4-C6 for three months. The patients were evaluated by ultrasound before, during, and after the procedure (on post-procedure days 7, 15, 30, 60, and 90). The GSV diameter, the rate of venous occlusion, and the rate of reflux elimination were determined. Two patients were excluded for having a history of deep vein thrombosis history, and one was excluded for having bronchial asthma.ResultsThirty patients (26 females and 4 males, with mean age of 62 years) completed the protocol. The mean pre-procedure GSV diameter was 6.0 ± 0.32 mm (range, 3.6-11.2 mm). During the sclerotherapy, the mean GSV diameter was reduced to 1.9 ± 0.15 mm (range, 0.6-3.8 mm). On post-procedure day 7, the mean GSV diameter increased to 6.3 ± 0.28 mm (range, 3.9-9.7 mm). On post-procedure day 90, the mean GSV diameter was 4.0 ± 0.22 mm (range, 1.9-8.2 mm). The rate of GSV reflux was significantly lower in the assessment performed on post-procedure day 90 than in the pre-procedure assessment (p < 0.0028).ConclusionOn the basis of our ultrasound analysis, we can conclude that foam sclerotherapy for varicose veins results in a significant reduction in GSV diameter, as well as in the elimination of GSV reflux.

Escleroterapia de safena associada a enxerto de pele no tratamento de úlceras venosas

ResumoContextoÚlceras são a resultante final de varizes associadas a refluxo de veias safenas.ObjetivoDemonstrar a possibilidade de associar dois procedimentos, a escleroterapia com espuma de veias safenas e o enxerto de pele parcial, para o tratamento de pacientes com úlceras venosas relacionadas a refluxo de veias safenas.MétodosForam tratados 20 membros em 20 pacientes, todos com ulcerações relacionadas a refluxo de veias safenas. Realizamos o enxerto de pele expandida, seguido da escleroterapia ecoguiada com espuma de polidocanol nas veias associadas às úlceras, através de punção ou dissecção da veia.ResultadosEm todos os casos, houve melhora dos sintomas relacionados à úlcera e cicatrização da lesão. Em 11 casos, obtivemos a viabilidade do enxerto de pele por completo; em quatro casos, houve cicatrização de cerca de 50% da lesão; e nos cinco casos restantes, houve cicatrização de aproximadamente 75% da lesão. A primeira ultrassonografia de controle revelou esclerose completa dos vasos tratados em 19 dos 20 casos e esclerose parcial sem refluxo detectável em um caso. Na segunda ultrassonografia, realizada após 45 dias, observamos esclerose completa de 15 casos; em cinco casos, houve esclerose parcial, dos quais três sem refluxo detectável e dois com refluxo em segmentos isolados associados a varizes. A complicação mais frequente foi a pigmentação nos trajetos venosos, observada em 13 pacientes. Um caso apresentou trombose assintomática de veias musculares da perna.ConclusãoEssa associação de procedimentos consiste em uma opção válida com potencial para promover um tratamento mais breve e de menor custo.