Ultrasound-guided Foam Sclerotherapy Research Articles

Treatment of superficial venous insufficiency class C 6 with ultrasound-guided foam sclerotherapy

Treatment of superficial venous insufficiency class C 6 with ultrasound-guided foam sclerotherapy

Combination of Minimally Invasive Methods for the Treatment of Varicose Veins.

The aim of the study was to evaluate the efficacy and safety of the combination of minimally invasive methods for the treatment of incompetent great saphenous vein and perforating veins. Between December 2019 and October 2020, F-care radiofrequency ablation combined with ultrasound-guided foam sclerotherapy and residual perforator ligation and concomitant microphlebectomy were adopted for all eligible patients. The clinical symptoms scores, complications, and quality of life were recorded. 49 patients (64 limbs) with a mean age of 63.29 ± 10.14years, and 60.9%4 were male. The 1-year truncal closure rate was 63/64 (98.4%).1 A significant improvement in the Venous Disability Score, the Venous Segmental Disease Score, the Venous Clinical Severity Score and Chronic Venous Disease Quality of Life Questionnaire Score, at 12months after the combination of minimally invasive treatment, were observed in the study. One patient developed intermuscular vein thrombosis that was successfully managed with rivaroxaban. The combination of minimally invasive methods is a safe and effective method for the treatment of lower extremity varicose veins. Further large-scale, prospective, multi-center studies are needed to further verify the findings of this study.

Evaluation of Endovenous Laser Ablation in the Management of Varicose Veins.

Background The treatment of varicose veins has undergone tremendous changes over the years. High ligation of the saphenofemoral junction (SFJ) and stripping of the great saphenous vein (GSV) have been considered standard treatments for GSV insufficiency for over a century and are still adopted as the preferred method in the majority of surgical centers in North Africa. However, the increase in minimally invasive treatments such as endovenous thermal ablation (EVTA), radiofrequency ablation (RFA), ultrasound-guided foam sclerotherapy, and cryo-stripping has produced excellent results. Most patients who underwent these minimally invasive treatments were satisfied with their outcomes. Methodology and results In this clinical and prospective study, 30 cases (19 male and 11 female) of primary varicose veins underwent endovenous laser ablation (EVLA), and their outcomes were reviewed, and their results were satisfying to the patients. After EVLA with or without sclerotherapy, no major complications occurred (recurrence or recanalization) at the time of the study, although minor complications were quite common and included bruising or ecchymosis, postoperative pain that required analgesics, superficial thrombophlebitis, and skin burns that were very responsive to medical treatment. Conclusion Endovenous laser ablation continues to be a valid minimally invasive method for treating varicose veins with minimal complications and a very short recovery period, which appeals to patients.

Proposed public policies to improve outcomes in vascular surgery: an experts' forum.

To evaluate outcomes of vascular surgeries and identify strategies to improve public vascular care. This was a descriptive, qualitative, and cross-sectional survey involving 30 specialists of the Hospital Israelita Albert Einstein via Zoom. The outcomes of vascular procedures performed in the Public Health System extracted through Big Data analysis were discussed, and 53 potential strategies to improve public vascular care to improve public vascular care. There was a consensus on mandatory reporting of some key complications after complex arterial surgeries, such as stroke after carotid revascularization and amputations after lower limb revascularization. Participants agreed on the recommendation of screening for diabetic feet and infrarenal abdominal aortic aneurysms. The use of Telemedicine as a tool for patient follow-up, auditing of centers for major arterial surgeries, and the concentration of complex arterial surgeries in reference centers were also points of consensus, as well as the need to reduce the values of endovascular materials. Regarding venous surgery, it was suggested that there should be incentives for simultaneous treatment of both limbs in cases of varicose veins of the lower limbs, in addition to the promotion of ultrasound-guided foam sclerotherapy in the public system. After discussing the data from the Brazilian Public System, proposals were defined for standardizing measures in population health care in the area of vascular surgery. Notification of complications of arterial surgeries is essential in identifying strategies to improve surgical outcomes. Screening of prevalent and/or morbid diseases allows early intervention and prevention of complications. Use of telemedicine in vascular follow-up allows optimizing the use of resources and reducing the burden on health services. Concentrating complex cases in reference hospitals leads to improved surgical outcomes.

Safety and Efficacy of Combining Saphenous Endovenous Laser Ablation and Varicose Veins Foam Sclerotherapy: An Analysis on 5500 Procedures in Patients With Advance Chronic Venous Disease (C3-C6).

endovenous laser ablation (EVLA) represents the gold standard in treating both great and small saphenous veins (GSV and SSV) incompetence. To achieve a "no-scalpel" procedure in patients with chronic venous insufficiency (CVI, CEAP C3-C6), concomitant phlebectomies could be replaced by ultrasound-guided foam sclerotherapy (UGFS) into varicose tributaries. The aim of this study is to present a single-centre experience on EVLA + UGFS for patients with CVI secondary to varicose veins and saphenous trunk incompetence, analysing ling-term outcomes. all consecutive patients with CVI and treated by EVLA + UGFS from 2010 to 2022 were included in the analysis. EVLA was performed using a 1470-nm diode laser (LASEmaR® 1500, Eufoton, Trieste, Italy), adapting the linear endovenous energy density (LEED) depending on saphenous trunk diameter. Tessari method was used for UGFS. Patients were evaluated clinically and by duplex scanning at 1, 3 and 6months, and annually up to 4years, to assess treatment efficacy and adverse reactions. 5500 procedures in 4895 patients (3818 women, 1077 men) with a mean age of 51.4years were analysed during the study period. A total of 3950 GSVs and 1550 SSVs were treated with EVLA + UGFS (C3 59%, C4 23%, C5 17% and C6 1%). Neither deep vein thrombosis nor pulmonary embolism were detected during follow-up, as well as superficial burns. Ecchymoses (7%), transitory paraesthesia (2%), palpable vein induration/superficial vein thrombosis (15%) and transient dyschromia (1%) were registered. Saphenous and tributaries closure rate at 30days, 1 and 4years were 99.1%, 98.3% and 97.9%, respectively. EVLA + UGFS for an extremely minimally invasive procedure appears to be a safe technique, with only minor effects and acceptable long-term outcomes, in patients with CVI. Further prospective randomized studies are needed to confirm the role of this combined therapy in such patients.

Foam Sclerotherapy in the Treatment of Hemangiomas and Venous Malformations.

Sclerotherapy has achieved great success in treating most venous malformation (VM) lesions. To compare the effects of foam sclerotherapy on infantile hemangioma and pyogenic granuloma (PG). In addition, we analyzed the data and outcomes of foam sclerotherapy for the VM. Thirty-nine patients with hemangiomas and 83 patients with VMs were treated, and clinical outcomes, resolution, and complication rates were compared. Sclerotherapy data from the VM group were also analyzed. The average age of the patients and the distribution and tissue involvement of lesions among the 3 groups were significantly different ( p < .001). The average amount of sclerosing foam administered per session in VMs was significantly higher than that in the other 2 groups ( p < .0001) (whereas that in the PG group was lower than that in the infantile hemangioma group [ p < .0001]). However, the overall therapeutic efficacy and side effects in the 3 groups were not significantly different. For VMs, the frequency of ultrasound guided foam sclerotherapy and use of 3% polidocanol increased from superficial to deep lesions, whereas the use of 1% POL decreased ( p < .0001). Infantile hemangioma and PG treatments presented good results and minor adverse reactions comparable with those of VMs.

A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Cohort Studies to Study the Efficacy of Ultrasound-Guided Foam Sclerotherapy for Varicose Vein Treatment

A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Cohort Studies to Study the Efficacy of Ultrasound-Guided Foam Sclerotherapy for Varicose Vein Treatment

Outcomes of thermal ablation combined with u/s guided foam sclerotherapy in treatment of superficial venous reflux in patients with postphlebitic venous leg ulcer

Background Venous leg ulcers are a considerable health problem because of their high incidence, slow healing, high recurrence rate, and high cost of treatment. Minimally invasive treatments such as endovenous thermal ablation and foam sclerotherapy proved to be safe and effective. However, there is a paucity in studies focusing on the management of postphlebitic venous ulcers using endovenous thermal ablation of the superficial system in combination with foam sclerotherapy. Objectives The aim of our study was to assess the healing time, procedure-related complications and recurrence rate in patients having a postphlebitic venous leg ulcer after being treated with EVLA associated with ultrasound-guided foam sclerotherapy to incompetent perforators with compression therapy. Subjects and methods This is a prospective observational study, conducted at Ain Shams University Hospitals and Nasser institute hospital in Cairo on 30 patients presented with postphlebitic venous leg ulcers. Results After one year, 90% of cases had a totally healed ulcers, 10% with ulcer decrease in size of more than 50%, and recurrence rate 6.7%. The adverse events of this procedure were DVT (6%), hematoma (6%), ecchymosis (43%), thrombophlebitis (6%), and pain (70%). There was significant improvement of the VCSS as regard pain, edema, inflammation, ulcer size, and number. There was highly significant (P &lt; 0.0001) improvement in the mean (SD) VCSS (preoperative 18 [2.808] vs. postoperative 6.367 [2.3449]). Conclusion Patients with totally recanalized deep venous system post deep venous thrombosis, presenting with nonhealing venous leg ulcers, may benefit from thermal ablation of superficial varicose veins combined with ultrasound-guided foam sclerotherapy. This combined approach is a feasible, safe, and effective modality in terms of improved healing rate, low recurrence rate, low complications, and significant improvement in quality of life.

3D and Smart Foam, new avenues to explore, to improve the safety and effectiveness of ultrasound guided foam sclerotherapy

3D and Smart Foam, new avenues to explore, to improve the safety and effectiveness of ultrasound guided foam sclerotherapy

Efficacy and safety of ultrasound-guided foam sclerotherapy combined with endoluminal radiofrequency closure in patients with varicose veins of lower extremities.

We aimed to explore the efficacy and safety of ultrasound-guided foam sclerotherapy combined with endoluminal radiofrequency closure in patients with varicose veins of lower extremities (VVLEs); furthermore, we aimed to provide a theoretical basis for the effective management of VVLE patients in clinical work. From January 1, 2020, to March 1, 2021, 88 patients with VVLE admitted to Third Hospital of Shandong Province were included in this retrospective study. Depending on the type of treatment, the patients were divided into study groups and control groups. The study group consisted of 44 patients who were given ultrasound-guided foam sclerotherapy combined with endoluminal radiofrequency closure. The control group consisted of 44 patients who were given high ligation and stripping of the great saphenous vein. Efficacy indicators included postoperative venous clinical severity score (VCSS) of affected limb and postoperative visual analogue scale (VAS) score. Safety indicators included length of operation, intraoperative blood loss, length of postoperative rest in bed, length of hospital stay, postoperative heart rate, preoperative blood saturation (SpO2 ), preoperative mean arterial pressure (MAP), and complications. The VCSS score 6months after operation in the study group was significantly lower than that in the control group (P < .05). The pain VAS score in the study group was significantly lower than that in the control group at 1 and 3 days after operation (both P < .05). Compared with the control group, the study group was significantly lower in length of operation, intraoperative blood loss, postoperative in-bed time, and hospital stays (all P < .05). Heart rate and SpO2 were significantly higher, and MAP was significantly lower in the study group compared with that in the control group 12 hours after surgery (all P < .05). The overall postoperative complication rate in the study group was significantly lower than that in the control group (P < .05). In conclusion, compared with surgical treatment of high ligation and stripping of the great saphenous vein, ultrasound-guided foam sclerotherapy combined with endoluminal radiofrequency ablation for the treatment of VVLE disease has better efficacy and safety, which is worthy of clinical promotion.

An observational study to evaluate efficacy and safety of ultrasound guided foam sclerotherapy for treatment varicose veins

Background: There are various minimally invasive techniques for varicose veins. Tessari has invented simple method to create sclerosant foam that has become popular nowadays as treatment for varicose veins. Aim was to describe the efficacy and safety of ultrasound guided foam sclerotherapy for treating varicose veins. Methods: The observational study was carried out in 50 patients between July 2020 to June 2021. Sclerosant foam was made by Tessari method using polidocanol was introduced under ultrasound guidance in to affected veins. After 3 days looked for any residual varicosities and complications. All patients were followed up at 3 days, 1 month, 3 month and 6 months after treatment. Results: 37 patients were treated with 3.0% of polidocanol. Rest 13 patients (26.0%) were treated with 1.0% of polidocanol. Six (12.0%) and eight patients (16.0%) received three and four sessions of sclerotherapy respectively. After 1 month, 41 patients (82.0%) achieved complete occlusion, in 5 patients (10%) partial occlusion was seen. After 3 months, 47 patients (94%) achieved complete occlusion without any symptom and three patients (6.0%) had partial occlusion. At the end of 6 months 48 patients (96.0%) achieved complete occlusion without any symptoms. Four patients (8.0%) developed SVT blurred vision in 3 patients (6.0%) and pain with redness at injection site was observed in one patient (2.0%). Conclusions: Ultrasound guided foam sclerotherapy is safe and effective in obliterating varicosities of lower limb including perforators using polidocanol sclerosant agent with less complication, low recurrences and good cosmetic outcome.

Effect of Endovenous Laser Ablation Along With Compression Therapy on Chronic Venous Ulcer Healing.

Introduction Chronic venous insufficiency is a major cause of morbidity, and there is a paucity of data regarding its epidemiology due to the lack of a central wound registry. In this study, we aimed to study the time for healing of the ulcer and compliance with compression therapy (CT) following endovenous laser ablation (EVLA) ± ultrasound-guided foam sclerotherapy (UGFS) along with CT in patients with chronic venous ulcers. Methods This prospective observational study was conducted from January 2020 to June 2021 after obtaining institutional ethical committee clearance. Patients with chronic venous ulcers (>six weeks to <six months duration) were included in this study. Demographic details, venous duplex findings, and duration of ulceration were noted. All patients underwent EVLA (Biolitec® 1470 nm) ± UGFS and CT. The patients were followed up weekly till the healing of the ulcer, followed up at one month, three months, and then at six monthly intervals to look for recurrence. Venous clinical severity score (VCSS) at presentation and follow-up, compliance with CT, rate of ulcer healing at six months, and recurrence rates at two years of follow-up were observed prospectively. Results The mean age of the study participants was 45.7±14.2 years, of which 42 (84%) were males. Ulcer size of <2 cm was present in 38%, 2-4 cmin 52%, and >4 cmin 10% of patients. A total of 38% of patients underwent only EVLA, and EVLA+UGFS were done in 62% of participants. The healing rate at six months follow-up was 92%, with the average time taken being 2.55±1.38 months. Those who remained with an unhealed ulcer at six months follow-up had anulcer size of >5 cmand an age of >50 years. Ninety-six percent of the patients were compliant with CT after an endovenous intervention. The recurrence rate at two years post-ablation was 6%. VCSS was 19.66±3.23 at presentation and 5.5±2.82 at six months of follow-up. Conclusion Endovenous ablation of superficial venous reflux along with CT is associated with a shorter healing time of venous ulcerations and reduced chances of recurrence.There is an improvement in VCSS score over the period of six months follow-up.

Lateral Subdermic Venous Plexus Insufficiency: The Association of Varicose Veins with Restless Legs Syndrome and Nocturnal Leg Cramps

PurposeTo determine whether nocturnal symptoms of restless legs syndrome (RLS) and muscle cramps in the legs are associated specifically with lateral subdermic venous plexus (LSVP) insufficiency and whether treatment can provide symptomatic relief. Materials and MethodsA retrospective cross-sectional observational study of 506 patients at a single site analyzed whether RLS or nighttime leg cramping symptoms were associated with venous reflux in the LSVP using comprehensive venous ultrasound. The treatment outcomes of ultrasound-guided foam sclerotherapy (USGFS) were followed up for 1 year. ResultsOf 209 patients who reported restless legs symptoms, 179 (85%) demonstrated an abnormal LSVP. A total of 214 patients reported nighttime muscle cramping, of whom 197 (92%) demonstrated an abnormal LSVP. Among 124 patients presenting with both the symptoms, 113 (91%) demonstrated an abnormal LSVP. Conversely, of 83 patients who presented with neither RLS nor nocturnal cramping, 2 (2%) had an abnormal LSVP. Among 242 symptomatic patients with an abnormal LSVP who underwent treatment, the technical success rate was 100%. At 90-day follow-up, 224 patients (93%) reported continued relief, which was maintained at 93% (224/242) at follow-up at 1 year. When substratified, 90 patients presented primarily with RLS or cramping and showed only LSVP reflux, and when treated, all 90 (100%) had significant or complete relief of the symptoms. ConclusionsLSVP insufficiency demonstrates an association with symptoms of RLS and nocturnal leg cramps. LSVP treatment using USGFS demonstrated high technical and clinical success rates, with symptomatic relief up to 1 year, most pronounced when the LSVP was the only treated vein.

FOVELASS: A Randomised Trial of Endovenous Laser Ablation Versus Polidocanol Foam for Small Saphenous Vein Incompetence

To compare the outcomes of ultrasound guided foam sclerotherapy (UGFS) and endovenous laser ablation (EVLA) to treat isolated small saphenous vein (SSV) incompetence in a multicentre randomised controlled study (RCT; ClinicalTrials.gov identifier: NCT05468450). Patients aged ≥ 18 years undergoing isolated SSV treatment (reflux > 0.5 seconds) were randomised to UGFS or EVLA. Patients treated with UGFS were allowed one additional truncal treatment at six weeks. Tributary treatments (phlebectomy or sclerotherapy) were permitted after six months. Participants were assessed at eight days, six months, and one, two, and three years. The primary endpoint was the absence of SSV reflux (> 0.5 seconds). Secondary outcomes included clinical scores and quality of life (QoL) scores. All analyses were done by intention to treat. Of 1 522 screened patients, 161were randomised to UGFS (n= 82) and EVLA (n= 79). Only 3% of patients who received UGFS had the second (allowed) treatment and 86% of patients completed the three year study. Forty-one and 19 tributary treatments (by sclerotherapy) were performed in 27 UGFS patients (33%) and 15 EVLA patients (19%), respectively. The complete absence of reflux at three years was significantly better after EVLA (86%) than after UGFS (56%) (odds ratio [OR] 5.36, 95% confidence interval [CI] 2.31 - 12.44; risk ratio 1.59, 95% CI 1.26 - 2.01). Two deep vein thromboses (DVTs; one femoropopliteal and one gastrocnemius) and one endovenous heat induced thrombosis occurred in the EVLA group. Seven DVTs were seen in the UGFS group, including two partial popliteal DVTs and five gastrocnemius veins thromboses (four asymptomatic and incidental on day 8 screening). At three years, there was no difference between groups for the following: rate of visible varices (p= .87), revised Venous Clinical Severity Score (p= .28), and QoL (p= .59). Patient satisfaction scores were high in both groups (median score: EVLA 97/100 and UGFS 93/100; p= .080). Symptoms were significantly improved in both groups. (p < .001) CONCLUSION: Technical success was better for EVLA than for UGFS three years after SSV treatment. This agrees with studies that have reported on these treatments in the great saphenous vein. However, improvements in clinical outcome were similar for both groups.

Impact of Ultrasound-Guided Foam Sclerotherapy for Pain Control in Patients with Chronic Venous Disease and Great Saphenous Vein Reflux.

Chronic venous disease (CVD) associated with great saphenous vein (GSV) reflux has a higher prevalence of pain in the lower limbs. This study evaluates the impact of ultrasound-guided foam sclerotherapy (UGFS) for GSV and symptom control, accessed by the visual analogue scale (VAS). Patients with CVD who underwent GSV-UGFS were included in this retrospective cohort (417 limbs). The pain was measured before and after the treatment. The scale alteration was assessed as a function of age, sex, Clinical Etiologic Anatomic Pathophysiologic (CEAP) classes, total of sclerotherapy sessions, GSV occlusion patterns, and ulcer healing. Majority of patients were female (59.2%), and the mean age was 56 ± 11.5 years. In the total sample, 78.2% of the GSVs were fully occluded, 19.7% had partial occlusion, 2.2% remained open, and 3.2 ± 1.9 (median = 3.0) sessions were performed. The reduction of symptoms occurred in 88.3% of participants (VAS drop median = 4.8). Patients younger than 50 years and females had the greatest VAS decreases. When comparing the outcomes of complete occlusion versus partial occlusion, there was no significant difference in VAS pain reduction ( p  = 0.14). The comparison between CEAP clinical classes also did not show statistically significant differences in delta VAS ( p  = 0.71). GSV-UGFS was effective for pain control. However, this improvement does not appear to be related to the pattern of occlusion, indicating that in the short term, the outcomes of total and partial occlusion suggest successful management of symptoms. Other aspects such as gender, age, pretreatment pain intensity, and CEAP classes seem to play a role in the clinical outcome.

Preliminary experience with a 1470 nm diode ring laser with echosclerotherapy in lower limb varicose veins

Objective：To study the effect of endovenous laser ablation (EVLA) of lower limb varicose veins using a 1470 nm diode ring laser with ultrasound-guided foam sclerotherapy (UGFS), also known as echosclerotherapy. Methods：From January 2020 to December 2022, 236 patients with primary lower limb varicose veins were enrolled in the study. All patients were treated with 1470 nm diode ring laser with echosclerotherapy in our center. Under tumescent anesthesia, venipuncture of the great saphenous vein (GSV) trunk was performed, followed by 1470 nm laser therapy (80-100J/10W). Before the procedure, 1% polidocanol foam was injected into the insufficient collateral veins extending from the main trunk of the GSV. During the 3days after surgery, self-adhesive elastic bandage was used for compression therapy. After 3 days of surgery, grade II compression stockings was used for 1 month. All patients underwent a follow-up duplex Doppler ultrasound 1, 30 days after the procedure. Hospital stay time, postoperative pain, GSV occlusion rate, recurrence rateand complications, such as ecchymosis, edema, paresthesia and endovenous heat-induced thrombosis (EHIT). Results: Four patients were lost to follow up. The average hospitalization time was 2.8 days, the average admission time after operation was 1-2 days. The average operating time was 45.79 ± 8.57min. At the one month follow up all treated GSV remained occluded. There were 2 patients were treated with echosclerotherapy in outpatient because of new reflux in the treated collateral veins. Seventy-five percent of patients did not have any pain after the treatment and ninety-one point eight percent of ones did not take any analgesic tablets at any time after the procedure. No severe complications such as deep venous thrombosis could be detected. And there was no patient developed EHIT after treatment. Minor complications were ecchymosis at 15.1%, edema at 44.8%, and paresthesia around ankle at 0, respectively. All patients expressed satisfaction with the operative curative effects and cosmetic effects. Conclusion: EVLA with 1470-nm diode ring laser with echosclerotherapy in lower limb varicose veins is comfortable with less incision, hospitalization procedure and is a safe and efficient treatment option.

Thermal Ablation, Nonthermal Ablation And Surgical Striping Applications: 1-Year Single Center Early Results

ABSTRACT: Objectives : Starting from the 1900's minimally invasive methods such as endovenous laser ablation (EVLA), radiofrequency ablation (RFA), and ultrasound-guided foam sclerotherapy (UGFS) developed. Methods: This study includes a total of 136 patients (81 women/55 men), of whom 22 (10 women/12 men) were treated with classic surgical stripping, 54 (32 women/22 men) with thermal ablation and 60 (39 women/55 men) with non-thermal ablation. Results: Twenty-two patients (10 women/12 men) were treated with surgical stripping. In one female patient a hematoma arose in the medial crural region postoperatively. A radiofrequency catheter (ThermoBLOCK TM) was used in the thermal ablation procedures in 54 patients (32 female/22 male). It is believed that permanent paresthesia occured in one female patient after the procedure. In 3 male patients temporary paresthesia occured postoperatively. Non- thermal ablation was performed in 60 patients(39 female/55 male). Even through a severe burning sensation was present in 6 patients (5 female/1 male) during the procedure, this symptom was only transient. In one of the patients, deep venous thrombosis (DVT) occured at the level of the popliteal vein postoperatively at the sixth day. Conclusion: Even if thermal and non-thermal ablation and surgical procedures have the same pain decreasing rates, hematomas and a longer hospital stay are more frequent in surgical procedures.

Foam ultrasound guided sclerotherapy faced with literature

To discuss the role of ultrasound guided foam sclerotherapy (UGFS) to treat saphenous insufficiency by analysis of the current literature.

Aneurysm of the lateral marginal vein of the foot

Superficial venous aneurysms are a very rare pathology. This case report describes a 21-years-old male patient, who developed a soft, slow-growing mass, in the lateral part of the dorsal foot. Based on clinical examination and EcocolorDoppler ultrasound exam, the diagnosis of venous aneurysm of the lateral marginal vein was confirmed. The treatment proposed was ultrasound-guided foam sclerotherapy. The purpose of this work is to describe for the first time a venous superficial aneurysm localized in the lateral marginal vein of the foot. It is the first case reported in English literature.

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.