Introduction. Chronic venous disease of the lower extremities, particularly recurrent varicose vein disease (RVVD), is frequently complicated by venous leg ulcers. These lesions significantly impair quality of life and remain challenging to manage. Although minimally invasive endovenous techniques are increasingly applied in clinical practice, evidence regarding their role in C6 recurrent disease remains limited. Aim. To evaluate the efficacy and safety of a combined minimally invasive approach for the treatment of active trophic ulcers in patients with recurrent varicose vein disease. Materials and methods. A retrospective cohort analysis included 41 patients with active venous ulcers undergoing secondary interventions for recurrent disease. Treatment consisted of individualized combinations of endovenous laser ablation or radiofrequency ablation, ultrasound-guided foam sclerotherapy, and miniphlebectomy. All patients received standardized compression therapy and local ulcer care using calcium alginate dressings. Clinical outcomes were assessed using VCSS (Venous Clinical Severity Score), VDS (Venous Disability Score), VDSS (Venous Disease Severity Score), and CIVIQ-14 (Chronic Venous Insufficiency Quality of Life Questionnaire-14) before and after treatment. Results. Significant improvements were observed across all evaluated parameters. VCSS decreased by 58.8%, VDS by 49.2%, and VDSS by 68.3%. Quality-of-life scores (CIVIQ-14) improved by 42.4%. All changes were statistically significant (p < 0.001), with large standardized effect sizes (Cohen’s dz from −1.31 to −1.75). The combined approach was associated with effective elimination of reflux sources and ulcer healing in the majority of cases. Conclusions. An anatomically personalized combined minimally invasive strategy appears to be a safe and effective option for managing venous leg ulcers in patients with recurrent varicose vein disease. Further prospective studies are warranted to confirm these findings and to support the development of standardized treatment protocols.

BACKGROUND: Recurrent varices after treatment (REVAT) is an important finding in phlebology practice. REVAT can occur regardless of the treatment method used. The current study primarily aimed to examine the efficacy of foam sclerotherapy for REVAT at the sapheno-femoral junction (SFJ) in the treatment of varicose vein disease. Further, it secondarily aimed to evaluate the complication rate and pain intensity of REVAT. The predefined hypothesis was that repeated REVAT increases the occlusion rate, and that the type and size of REVAT affects therapeutic success.METHODS: This study included 104 patients with 123 REVATs at the SFJ over a period of 12 months. REVAT was classified as either neoangiogenesis (NEO) or saphenous stump recurrence (SSR). Ultrasound-guided foam sclerotherapy with 2% or 3% Aethoxysklerol® (with polidocanol as the active ingredient) was performed on all REVATs. The patients were allowed to undergo 1-3 treatment sessions.RESULTS: Three months after the initial treatment, 78% of the patients exhibited complete occlusion. REVATs that were completely occluded after 3 months were re-examined 12 months after the initial treatment. Approximately 85% of the cases achieved complete occlusion. The occlusion rates between NEO and SSR differed. After 3 months, 64% of the SSR and 90.7% of the NEO were occluded. Patients with REVATs of smaller diameters at the SFJ had high occlusion rates. None of the patients experienced major side effects during the study period, and the patients rated the mean treatment-related pain intensity as extremely low.CONCLUSIONS: Foam sclerotherapy is a very effective and safe method for treating REVATs with small diameters at the SFJ. Thus, this treatment can be repeated as often as required and is considered a minimally painful and well-tolerated treatment.

Ultrasound-guided foam sclerotherapy with polidocanol: a novel strategy to stabilize and definitively resolve superficial venous thrombosis

Retroperitoneal lymphatic malformations (LMs) are rare, and their deep location adjacent to critical structures renders treatment particularly challenging. This retrospective study aims to investigate the safety and efficacy of laparoscopic polidocanol foam sclerotherapy (LPFS) in the treatment of retroperitoneal LMs in children. We conducted a retrospective analysis of 12 pediatric patients with retroperitoneal LMs who underwent LPFS at our institution between July 2020 and July 2025. The procedure involved laparoscopic-guided cyst puncture, aspiration, and injection of polidocanol foam prepared using the Tessari technique. Key outcomes included operative details, number of treatment sessions, complications, and treatment response defined by imaging. All 12 patients were successfully completed laparoscopically without conversion to open surgery. The cohort comprised 2 macrocystic and 10 mixed LMs, with a median maximum diameter of 8.6 cm (range: 5.3–19.3 cm). Intracystic hemorrhage was noted intraoperatively in 9 cases and adhesions in 5 cases. Complete radiologic resolution was ultimately achieved in all patients. 10 patients required only a single treatment session, while the remaining 2 achieved complete resolution after a second LPFS session. All ten patients who presented with preoperative symptoms reported complete and sustained resolution. No major complications, such as vascular injury, visceral organ damage, or clinical evidence of adhesion-related obstruction, were observed. During a median follow-up of 36 months (range: 7–60 months), there were no cases of recurrence. LPFS is a safe and effective minimally invasive treatment for pediatric retroperitoneal lymphatic malformations. It may represent a feasible option, particularly for lesions in anatomically complex locations.

Polidocanol is a widely recognised drug for its effectiveness as a sclerosant in the treatment of lymphovenous disease. The versatility and minimal invasiveness of polidocanol make it a favoured treatment modality for chronic venous disease (CVD) and other venous and vascular disorders. Especially, polidocanol foam sclerotherapy achieves high closure rates and efficiency compared to thermal ablation, in cases of venous hypertension affecting small tributary veins of the peripheral venous system. The underlying pathophysiology of these venous disorders is multifactorial. Elevated venous hypertension and related microcirculatory barriers lead to cellular damage. Additionally, CVD manifestations are typically limited to the lower legs because venous return is hindered by anatomical and gravitational forces, especially around the ankle. In addition, clinical severity tends to increase with procedures that occlude venous exit sites, further distorting circulatory dynamics. Genetic influences on the integrity of collagen and elastin contribute importantly to venous wall strength. It also became apparent that the actual primary pathological cause is not valve malfunction but venous wall weakness. Polidocanol addresses this by targeting venous wall instability, highlighting that varicose (dilated) veins are a symptom, not the disease itself. It has asuperior safety profile compared to agents like sodium tetradecyl sulphate and hypertonic salineand hence is a preferred choice for treating haemorrhoidal disease, oesophageal varices, telangiectasias, lymphovenous malformations, and CVD. Polidocanol useis associated with a very low incidence of complications, and the development of foam formulations has further enhanced its efficacy by improving retrograde flow dynamics. During sclerotherapy, forceful injection of polidocanol cancause intervention with plasma proteins, increasing itsfoam stability and therapeutic effectiveness.

BackgroundIt is mostly challenging to ablate great saphenous vein (GSV) completely including the below-knee level.ObjectiveThe aim of this study was to evaluate the effectiveness of cyanoacrylate ablation (CAA) and catheter directed foam sclerotherapy (CDFS) combination in full length ablation of GSV with mid-term results.Materials and MethodsPatients undergoing CAA and CDFS of the GSV between January 2015 and December 2021 were reviewed. Preoperative and postoperative CEAP class, symptoms, recurrence, and Doppler findings were compared.ResultsPostoperative overall closure rate at the first year was 99.5% ± 0.01 and at 5 years was found to be 93.8 ± 0.02%. Symptom free survival rate at the first year was 98.8% ± 0.01 and the cumulative 5-years symptom free survival rate was 73.0 ± 0.10%. Venous Clinical Severity Scores decreased from 5.9 ± 1.3 to 0.8 ± 0.4. Aberdeen Varicose Vein Questionnaire scores decreased from 19.7 ± 6.1 to 4.7 ± 1.8.ConclusionWhen techniques are evaluated, CAA and CDFS combination (Glue + Foam) may be preferable as a simple and shorter application with full-length complete occlusion of GSV and less early postoperative discomfort. Long-term outcomes and cost analyses of larger series still need to be documented.

ObjectiveEndovenous thermal ablation (EVTA) is the preferred treatment for symptomatic incompetent truncal varicose veins. Radiofrequency ablation (RFA) and laser ablation are commonly used. RFA devices can be either monopolar (F-Care) or bipolar/segmental (ClosureFast). Limited data is available on the comparison between these two modalities of treatment, which suggest that the Great saphenous vein (GSV) ablation is incomplete with the monopolar system. This study compares the results of RFA with the two systems (monopolar and bipolar) with regard to early outcomes of treatment and vein closure rates at 1year and describes a method that could improve results with monopolar system.MethodsA prospective audit of 66 limbs (52 patients) undergoing RFA, either monopolar (33limbs) or bipolar (33 limbs) was carried out.ResultsCEAP C4 was the most common clinical stage (41.5% in ClosureFast group and 60.6% in F-Care group). Preoperative VCSS ranged from 3 to 21 (mean 7.48 ± 3.53) in both groups. All patients underwent adjuvant treatment with either foam sclerotherapy (FS) or a combination of FS with concomitant phlebectomy. Procedural complications were infrequent in both treatment groups. Primary outcome at 1year showed one subject (3.0%) in each group had complete failure. Three subjects (9.1%) in the F-Care group and one subject (3.0%) in the ClosureFast group were found to have partial failure. GSV occlusion rate at 1year was 97%. Overall, VCSS had significantly improved in both the groups from preoperative values.ConclusionMonopolar and bipolar RFA had similar primary closure rates for truncal veins at 1 year. Both are safe and had the same effect with minimal complications. However, F-Care system requires catheter removal, cleaning and reintroduction to achieve similar ablation.

To evaluate the effectiveness and safety of 3% polidocanol foam sclerotherapy (PFS) injection under anoscopy in the treatment of hemorrhoidal disease (HD) compared with rubber band ligation (RBL). This was a multicenter, open-label, prospective, observational study that enrolled 222 patients with Goligher grade I, II, or III HD (internal or mixed), who were treated with 3% PFS or RBL, which depended on the physician's assessment and the patient's willingness. The primary endpoint was the clinical cure rate under anoscopy and clinical symptoms assessment at 4weeks post-treatment. A total of 222 patients from 14 centers participated in the study, with 127 patients receiving PFS and 95 patients receiving RBL. Among the effectiveness analysis set (EAS), the clinical cure rate was 74.19% (69/93) in the PFS group and 83.13% (69/83) in the RBL group (P > 0.05). The PFS group showed quicker and better improvement in hemorrhage score post-treatment than the RBL group, with the mean (SD) changes from baseline in hemorrhage score of the two groups (P < 0.001) at 1, 4, and 12weeks being -3.44 (1.99) vs. -1.70 (2.19), -3.85 (1.80) vs. -2.75 (2.02), and -3.81 (1.84) vs. -2.89 (2.10), respectively. The incidences of adverse events (AEs) were 2.36% (3/127) in the PFS group and 3.16% (3/95) in the RBL group, respectively, and no serious adverse events (SAEs) occurred in both groups. Patients treated with PFS showed similar effectiveness and safety as those treated with RBL under anoscopy, and a quick improvement trend in hemorrhage score post-treatment was observed in patients treated with PFS, but it needs further verification. This study has been registered on the website of Chinese Clinical Trial Registry ( https://www.chictr.org.cn/ ), registration number: ChiCTR2200060325.

Time-Driven Activity-Based Costing of Sclerotherapy for the Treatment of Venous Malformations at a National Referral Hospital in Tanzania.

Background: Anterior saphenous vein (ASV) incompetence represents the third most common form of truncal varicose veins, and evidence for endovenous laser ablation (EVLA) in this setting remains limited. Methods: We evaluated outcomes of EVLA in cases with dominant ASV insufficiency. All EVLA procedures performed by a single surgeon between April 2019 and December 2023 for primary ASV reflux (ASV-R) were compared with a cohort containing all EVLA treatments for great saphenous vein (GSV) insufficiency without ASV reflux from April to December 2019 (GSV-R). We used a 1470-nm diode laser with radially emitting fibers for the interventions. Results: We included 378 patients (mean age 49.5 years): 208 and 256 treated limbs in the ASV-R and GSV-R cohorts, respectively. Female patients were more frequent in the ASV-R cohort than in the GSV-R cohort (80.5% vs. 62.9%, p < 0.001). ASV-R cases exhibited concomitant GSV insufficiency in 54.3% of cases. Redo procedures due to initial treatment failure were more frequent in ASV-R (1.9% vs. 0%, p = 0.04). Over a mean follow-up period of 332 days, 16 recurrences occurred in the ASV-R cohort compared with 4 in the GSV-R cohort, corresponding to a significantly increased hazard of recurrence in ASV-R (HR 8.41, 95% CI 2.78-25.4). Rates of subsequent foam sclerotherapy (16.8% vs. 10.5%) and minor complications (5.3% vs. 4.3%) did not differ significantly between ASV-R and GSV-R, respectively. ASV-R cases without concomitant GSV reflux demonstrated a higher need for secondary sclerotherapy, compared to ASV-R cases with additional GSV insufficiency. Conclusions: Our findings suggest that EVLA for ASV insufficiency is technically more challenging and yields inferior outcomes than EVLA for GSV incompetence. These considerations should be taken into account during preoperative planning and patient counseling. Further prospective and comparative analyses are needed to better define the effectiveness of thermal ablation strategies in ASV insufficiency and to support patient-centered, individualized treatment decisions.

Impact of Endovenous Radiofrequency Ablation Combined with Foam Sclerotherapy on Hemorrheological Profiles and Inflammatory Responses in Patients with Great Saphenous Varicose Veins

Varicose veins of the great saphenous vein (GSV) significantly affect patient quality of life. Recent advancements in minimally invasive treatments such as endovenous laser therapy (EVLT), radiofrequency ablation (RFA), and ultrasound-guided foam sclerotherapy (UGFS) have revolutionized therapeutic approaches. This bibliometric study evaluates the scientific landscape to identify trends and key contributions in this field. We conducted a bibliometric analysis using data from the Web of Science Core Collection (WoSCC), spanning publications from 1987 to 2024, focusing exclusively on English-language articles. Bibliometric tools including VOSviewer and CiteSpace, and R 4.3.3 were used to analyze publications, citations, authorship, institutional affiliations, and keyword trends. The study included 1,005 publications, accumulating 24,820 citations. Leading contributions came from the United States led with 264 articles, followed by the United Kingdom with 117 and China with 72. Key productive authors included Gough M. J. and Gloviczki Peter. Prominent institutions involved were Erasmus MC and Imperial College London. The Journal of Vascular Surgery and the European Journal of Vascular and Endovascular Surgery were primary publication venues. Central keywords were “reflux”, “surgery” and “radiofrequency ablation” with rising interest in “clinical practice guidelines” and societal impacts. This study presents a bibliometric analysis on minimally invasive therapy for varicose veins of GSV, highlighting research trends, influential studies, and collaborative networks. The analysis identifies key contributions to the field and provides insights for future research directions.

Varicose veins of the lower limbs, particularly involving the great saphenous vein (GSV), are a common vascular condition often requiring intervention. Conventional surgeries entail higher morbidity and prolonged recovery. To minimize complications while ensuring efficacy, a novel hybrid technique -Endovenous Chemical Ablation and Trendelenburg's operation (eCAT) -was developed. This study aimed to evaluate the efficacy and safety of the eCAT operation for treating GSV varicosities. A single-arm open-label interventional study was conducted on 500 patients with primary lower limb varicose veins (2014-2021). The eCAT procedure, developed by Walied Khereba at Al-Azhar University (New Damietta), combined Trendelenburg's operation with polidocanol foam sclerotherapy under local anaesthesia. The primary outcome was GSV ablation efficacy at 1 week, 3 months, and 1 year. Secondary outcomes included postoperative complications, pain reduction, and factors influencing success. GSV ablation succeeded in all cases (100%). At 1 week, 88% of veins were fully occluded and 12% partially; at 3 months, full occlusion decreased to 76%, then improved to 88% at 1 year. Postoperative complications included oedema (30%), hyperpigmentation (20%), and residual varicosities (40%), all resolved by 1 year. Median pain scores decreased from 4 (IQR: 1) preoperatively to 2 (IQR: 1) at 1 week and 1 (IQR: 0) at both 3 months and 1 year (P = 0.001). Age, gender, and standing occupation significantly impacted early surgical success. The eCAT is a safe, effective, and minimally invasive procedure for GSV varicosities treatment, achieving durable clinical outcomes with minimal complications and significant pain reduction.

To compare high ligation and stripping (HLS), endovenous laser ablation (EVLA), and ultrasound guided foam sclerotherapy (UGFS) for symptomatic great saphenous vein (GSV) reflux in the long term, given the limited comparative data beyond ten years. Patients with symptomatic GSV reflux were randomised (1:1:1) to undergo HLS, EVLA, or UGFS. One hundred and ninety-six patients treated at Helsinki University Hospital were invited to 14 year follow up. Primary outcomes were above knee GSV reflux and GSV re-intervention rates. Secondary outcomes included quality of life. Of 233 randomised patients, 214 were included. UGFS increased the risk of GSV reflux recurrence compared with both HLS (risk ratio [RR] 11.7, 95% confidence interval [CI] 1.6 - 85.6) and EVLA (RR 5.0, 95% CI 1.5 - 16.6; 30.8% [12 of 39] after UGFS vs. 2.6% [one of 38] and 6.1% [three of 49] after HLS and EVLA, respectively; overall p < .001). UGFS was associated with a higher risk of GSV re-interventions compared with HLS (RR 4.3, 95% CI 1.8 - 10.2) and EVLA (RR 6.9, 95% CI 2.6 - 18.4; 56.4% for UGFS vs. 13.2% for HLS and 8.2% for EVLA; overall p < .001). Neovascularisation rates did not differ between the treatments (29.0%, 22.5%, and 23.1% for HLS, EVLA, and UGFS, respectively; overall p = .76). Aberdeen Varicose Vein Questionnaire scores were comparable across the groups (median [interquartile range] 8.9 [3.7, 13.3] in HLS, 6.1 [0.8, 12.2] in EVLA, and 8.8 [4.1, 13.4] in UGFS, with median differences of +2.8 [HLS vs. EVLA], +0.1 [HLS vs. UGFS], and -2.7 [EVLA vs. UGFS]; overall p = .21). UGFS demonstrated inferior outcomes in terms of GSV recurrent reflux and re-intervention rates compared with both HLS and EVLA, whereas HLS and EVLA showed comparable performance across these outcomes. Long term quality of life was comparable across all groups.

Flexible endoscopic therapies are effective for grade II-III internal hemorrhoids; however, the impact of intravenous anesthesia on clinical outcomes remains uncertain. This study compared the efficacy, safety, and cost-effectiveness of endoscopic treatment performed with versus without anesthesia. We retrospectively analyzed 559 patients who underwent endoscopic rubber band ligation (ERBL) or polidocanol foam sclerotherapy (EPFS) from May 2023 to November 2024. Patients were stratified by anesthesia modality (intravenous propofol vs. no anesthesia). Primary outcomes included procedure time, retreatment rate, symptom improvement, postoperative discomfort, patient satisfaction, total cost, and cost acceptance. Subgroup analysis was performed for EPFS cases. Baseline characteristics were similar between groups. The anesthesia group had shorter procedure times (median 10.5 vs. 11.3min, P = 0.036) and a lower retreatment rate (1.3% vs. 6.2%, P = 0.003). Rates of symptom improvement (83.1% vs. 82.7%, P = 0.940), postoperative discomfort, and patient satisfaction were comparable. Although the total treatment cost was higher in the anesthesia group (CNY 2,140.6 vs. 1,732.7, P < 0.001), cost acceptance remained high in both groups (85.8% vs. 91.4%, P = 0.173).Subgroup analysis of EPFS cases yielded consistent findings. Flexible endoscopic treatment for internal hemorrhoids is safe and effective regardless of anesthesia use. Intravenous anesthesia improves procedural efficiency and reduces retreatment rates without compromising symptom relief or satisfaction. These findings support individualized anesthesia strategies tailored to patient preferences and institutional resources.

Clinical study on transparent cap-assisted endoscopic foam sclerotherapy for internal hemorrhoids in the Tibetan Plateau region

The Milligan-Morgan Hemorrhoidectomy remains the gold standard for IV-degree hemorrhoidal disease. However, postoperative pain, bleeding, and prolonged recovery persist as challenges. Sclerotherapy shows promise but lacks evidence in IV-degree hemorrhoidal disease management. This study evaluated the efficacy and safety of open excisional hemorrhoidectomy (Milligan-Morgan hemorrhoidectomy) combined with 3% polidocanol foam sclerotherapy in patients with IV-degree hemorrhoidal disease. Randomized, open-label, single-center clinical trial. Department of Anorectal Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China. Thirty-six patients aged 18-75 years with IV-degree hemorrhoidal disease were enrolled and randomized equally to two groups. The experimental group received Milligan-Morgan hemorrhoidectomy combined with 3% polidocanol foam sclerotherapy; the control group received Milligan-Morgan hemorrhoidectomy. The primary outcome is the time to return to daily activities. Secondary outcomes: Hemorrhoidal Disease Symptom Score, Vaizey Incontinence scores, Visual Analogue Scale, Short Health Scale for Hemorrhoidal Disease scores, postoperative bleeding grade, usage of analgesics, and satisfaction. The experimental group demonstrated a mean 5.78-day earlier return to normal activities and work than the control group (mean ± SD: 19.28 ± 8.35 vs. 25.06 ± 7.85 days, 95% CI: -11.27 to -0.29 days, p = 0.04), reduced postoperative bleeding (0-3 scale, Estimate: -0.45, 95% CI: -0.72 to -0.16, p = 0.002), lower analgesic use (0-3 scale, Estimate: -0.38, 95% CI: -0.66 to -0.09, p = 0.009), and improved symptom scores at 1-2 months (Z -2.52 and -2.11, p < 0.05). Median satisfaction scores were 10 vs. 9.5 (p = 0.12). No adverse events occurred. Small sample size, non-blinded, single-center design, and short follow-up period. Milligan-Morgan hemorrhoidectomy combined with 3% polidocanol foam sclerotherapy significantly enhances postoperative recovery, reduces complications, and demonstrates comparable patient satisfaction. Long-term follow-up is warranted to validate sustained efficacy. Clinical trial registration number: Chinese Clinical Trial Registry: ChiCTR2400087552. See Video Abstract.

BackgroundRecurrence of superficial venous incompetence is common following interventional treatment and a classification system (Recurrent Varices After Surgery, REVAS) has been developed. However, it is not known whether specific, predictable patterns of reflux occur following treatment nor how these may vary by treatment modality. This study aimed to explore varicose vein recurrence patterns according to procedural technique.MethodsFollowing PRISMA guidelines and a registered protocol (CRD42023455512), MEDLINE, Embase, and ClinTrials.gov were searched for randomized control trials (RCTs) on surgical or endovenous treatment of primary saphenous vein insufficiency with at least 1-year follow-up, and assessment of recurrence patterns. The primary outcome was reflux recurrence as per the REVAS classification. A random-effects network meta-analysis was conducted in R, calculating risk ratios and 95% confidence intervals (CIs).ResultsThe 3467 records identified yielded 23 unique RCTs, investigating 8 different modalities. Recurrence rates varied by anatomical section: saphenofemoral junction (SFJ) showed 23.6% cumulative recurrence, thigh perforators 7.6%, and lower leg perforators 4.7% recurrence. Endovenous laser ablation (EVLA) and foam sclerotherapy (FS) had higher risk of SFJ recurrence compared to HLS with a risk ratio of 2.29 (1.40-3.76) and 2.09 (1.20-3.62) (I2 = 47.7%). EVLA was associated with a reduced risk of thigh perforator recurrence compared to HLS (0.45, (0.21-0.93)) (I2 = 0%). FS was associated with higher risk of recanalization compared to HLS (4.05 (2.23-7.35)), and EVLA (3.14 (1.82-5.41)), Both EVLA and FS were associated with lower risk of neovascularization, compared to HLS; 0.28 (0.18-0.43) and 0.18 (0.08-0.40), respectively (I2 = 0%).ConclusionRecurrence patterns varied by treatment modality, with HLS showing lower SFJ and ASV recurrence, while endovenous methods had less neovascularization and thigh perforator recurrence. Concerningly, only 13% of RCTs reported recurrence using REVAS. Improved reporting of varicose vein recurrence to delineate reflux sources will allow better technical outcome assessment and enhanced patient care.

PurposeThis study aimed to evaluate the efficacy and safety of Controlled Venospasm-Assisted Foam Sclerotherapy (CVAFS) combined with high ligation (HL) for treating primary great saphenous vein (GSV) varicosities.Materials and methodsA retrospective cohort of 127 patients with primary GSV varicosities underwent CVAFS with high ligation between 1 Jan 2023 and 1 October 2023. Venospasm was induced by rotational mechanical stimulation of the catheter combined with external compression, resulting in a transient reduction of vessel diameter by 50%–70%, followed by DSA (Digital subtraction angiography)-guided foam injection (1:4 liquid-to-gas ratio). Technical success was defined as complete procedural execution under imaging guidance. Primary endpoints included 1-year GSV occlusion rate (assessed by duplex ultrasound) and reduction in Venous Clinical Severity Score (VCSS). Complications were recorded and managed conservatively.ResultsTechnical success was achieved in 100% of limbs (145/145). Among 127 enrolled patients, 109 patients (125 limbs) completed the 12-month follow-up, yielding a follow-up rate of 85.8% (109/127). At 12 months, 93.6% of great saphenous veins (117/125 limbs) maintained complete occlusion. The Venous Clinical Severity Score (VCSS) significantly decreased from 6.18 ± 3.90 preoperatively to 0.86 ± 0.90 postoperatively (V = 7,875, p < 0.001). Thrombophlebitis observed in 9.6% of limbs (12/125), all cases resolved spontaneously within 2 weeks with conservative management (warm compression and NSAIDs). Saphenous Junction Pain occurred in 32.8% of limbs (41/125), with complete resolution within 2 weeks without intervention. No deep venous thrombosis (DVT), pulmonary embolism, skin necrosis, or neurological injuries were documented.ConclusionCVAFS leverages controlled venospasm to enhance foam-endothelium contact, significantly improving occlusion rates and symptom relief with acceptable safety. This approach offers a promising minimally invasive alternative for GSV varicosities.

BackgroundThis investigation aimed to assess the long-term effectiveness and symptomatic manifestations of the combined therapy of sclerosing foam and endovenous laser ablation (ELA) for treating lower-extremity varicose veins.Materials and methodsIn this study, we examined 2,118 patients (2,324 limbs) diagnosed with varicose veins in one or both lower extremities. These patients were treated at our center between January 2019 and December 2021. All individuals underwent the combined treatment of sclerosing foam and ELA. We closely monitored the occlusion status of the great saphenous vein (GSV) trunk and its tributaries, along with the postoperative therapeutic outcomes and symptomatic presentations. The average follow-up duration was 41.3 months, and data were collected via outpatient appointments and telephone follow-up inquiries.ResultsThe success rate of the treatment procedure was 100%. Based on the outcomes of continuous follow-up spanning from 1 to 3 years after the surgery, among the 2,324 legs, 16 legs still required repeated foam sclerotherapy for varicose veins, 2 legs exhibited venous edema, and 11 legs showed skin pigmentation. At one week and one year after the procedure, incomplete closure of the GSV trunk (characterized by patency, blood flow, and reflux) was observed in 1.8% (38 limbs) and 1.1% (23 limbs), respectively. Nineteen patients with local recurrence of varicose veins decided not to undergo further treatment.ConclusionThe long-term follow-up data demonstrated that the combination of sclerosing foam and endovenous laser was highly efficacious in treating varicose veins. The main postoperative symptoms included the requirement for additional sclerosing foam injections, skin pigmentation, pain and tissue induration.