泡沫硬化剂注射术与大隐静脉剥脱术的近期疗效对照研究

目的 评价泡沫硬化剂注射术联合高位结扎术治疗下肢大隐静脉曲张的近期临床效果.方法 55例(55条肢体)下肢大隐静脉曲张患者随机分为两组:传统大隐静脉剥脱术组(A组,23例);大隐静脉高位结扎联合泡沫硬化剂注射术组(B组,32例),比较两组手术前后CEAP分级及静脉临床严重程度评分(VCSS)的变化.结果 A、B两组手术...     

Ultrasound-guided foam sclerotherapy as a therapeutic modality in venous ulceration

ObjectivesThe objective of this systematic review and meta-analysis was to evaluate rates of ulcer healing following ultrasound-guided foam sclerotherapy (UGFS).MethodsThe MEDLINE, CENTRAL and Embase databases were used to search for relevant studies using the terms ' (sclerotherapy AND ulcer) OR (vein AND ulcer) OR (sclerotherapy AND vein)'. Heterogeneity between studies was quantified using the I² statistic. A random effects model was used to calculate risk ratios where substantial heterogeneity was found.ResultsThe initial search yielded 8266 articles. 8 studies were included in the qualitative synthesis and 3 in the meta-analysis. Superior complete ulcer healing rates were noted in patients treated with foam sclerotherapy versus compression therapy alone (pooled OR 6.41, 95% CI = 0.3–148.2, p = 0.246, random effects method). A marked degree of heterogeneity was observed between studies (I² = 81%).ConclusionA prospective, trial is warranted in order to determine the true merits of UGFS in the setting of venous ulceration.     

DSA引导泡沫硬化治疗下肢静脉曲张中长期效果

目的 观察DSA引导泡沫硬化治疗下肢静脉曲张的效果及对患者生活质量的影响。方法 对573例（744肢）下肢静脉曲张患者行泡沫硬化治疗;随访4年,统计治疗前和治疗后1、2、3、4年健康调查12条简表（SF-12）评分及静脉疾病临床严重程度评分（VCSS）,4年后填写下肢症状改善情况问卷,记录期望值达到情况及治疗满意度。结果 所有患肢治疗均成功,平均泡沫硬化剂用量为每肢（21.62±10.83）ml;治疗中及治疗后均未见深静脉血栓、肺栓塞等严重并发症。治疗后1、2、3、4年SF-12中躯体健康成分（PCS）总分和精神健康成分（MCS）总分均较术前增加（P均<0.05）,VCSS均较术前降低（P均<0.01）。治疗后4年患者对患肢外观、疼痛、瘙痒、肿胀及沉重感改善超过预期+达到预期者分别占100%（91/91）、100%（36/36）、93.55%（29/31）、88.46%（23/26）及91.38%（53/58）;患者满意度100%（72/72）。结论 DSA引导泡沫硬化治疗下肢静脉曲张中长期疗效较好,并可改善患者生活质量。     

Ultrasound-guided foam sclerotherapy for the treatment of varicose veins

BACKGROUND: The aim was to assess the early efficacy and complications of ultrasound-guided foam sclerotherapy (UGFS) in a cohort of patients with varicose veins. METHODS: Of 192 consecutive patients referred with varicose veins over 15 months, only 11 chose surgery; the rest underwent UGFS treatment. Polidocanol was foamed 1 : 3 with air. Under ultrasound control via butterfly or Seldinger cannulation, 1 per cent foam was injected into superficial veins and 3 per cent foam into saphenous trunks, up to a total volume of 14 ml. Outcome was defined as complete when occlusion of the saphenous trunk and/or over 85 per cent of the varicosities was achieved, and partial closure when less. RESULTS: In 163 legs, complete occlusion occurred after one intervention, a further 32 after a second, and one after a third (overall 91 per cent). Of the remainder, all other legs achieved partial occlusion after up to three interventions, apart from two legs with great saphenous vein (GSV) incompetence, which failed. All 23 legs with small saphenous veins had complete occlusion after one intervention compared with 64 of 97 legs with GSV incompetence (P < 0.010). Occlusion rates were also higher when the GSV was cannulated directly: 56 of 70 versus 8 of 27 (P < 0.001). CONCLUSIONS: UGFS achieved early complete occlusion safely in over 90 per cent of legs with varicose veins.     

大隐静脉腔内激光消融联合泡沫硬化治疗静脉曲张性溃疡

目的观察腔内激光消融(EVLA)大隐静脉联合泡沫硬化治疗下肢静脉曲张性溃疡(VULE)的临床疗效。方法回顾性分析接受EVLA联合泡沫硬化治疗的19例VULE患者(20条患肢)的资料,并观察治疗效果。结果EVLA联合泡沫硬化治疗19例20条患肢均获成功,溃疡长径术前[(2.30±1.61)cm],术后2周明显缩小到(0.90±0.32)cm(t=10.53,P0.01),溃疡愈合时间为7天~3个月,无复发病例。结论大隐静脉EVLA联合泡沫硬化治疗VULE临床疗效好。     

Validation of a new duplex derived haemodynamic effectiveness score, the saphenous treatment score, in quantifying varicose vein treatments

ObjectivesTo evaluate a duplex-derived score for varicose vein treatments using numerical values of haemodynamic effectiveness.DesignThe saphenous treatment score (STS) was developed prospectively to compare the effect of endovenous treatments on reflux within saphenous segments.PatientsSixty-six patients were randomised to endovenous laser ablation (EVLA) or ultrasound-guided foam sclerotherapy (UGFS) to the great saphenous vein (GSV).MethodsAssessments included the Aberdeen varicose vein severity score (AVVSS), the venous clinical severity score (VCSS), the venous filling index (VFI) and the STS.ResultsA mean STS of 5.70 decreased to 3.30, P < .0005, post-treatment. The median (IQR) AVVSS, VCSS and VFI (ml/sec) decreased from 21.52(15.48) to 18.86(11.27), P = .14, from 6(4) to 3(4), P < .0005 and from 7.1(6.9) to 1.9(.9) P < .0005, respectively. In 15 patients requiring additional UGFS the mean STS values decreased from 5.8 to 4.13 and then to 2.6 P < .0005, respectively. The individual above and below knee mean treatment differences in STS on 38 EVLA and 28 UGFS patients were 1.92 and .87 (EVLA) compared to 1.57and .29 (UGFS) P = .001, respectively.ConclusionsThe STS has been shown to grade the haemodynamic effects of different treatments as well as ongoing treatments on the GSV.     

Prospective randomized efficacy of ultrasound-guided foam sclerotherapy compared with ultrasound-guided liquid sclerotherapy in the treatment of symptomatic venous malformations

OBJECTIVE: To compare the clinical outcome between ultrasound-guided foam sclerotherapy (UGFS) and ultrasound-guided liquid form sclerotherapy (UGLS) in patients with venous malformations (VM). METHODS: Eighty-nine patients with symptomatic VM were treated with ultrasound-guided sclerotherapy. There were 22 males and 67 females with mean age of 14.5 years. The sclerosing agents used were 1% polidocanol (POL) or 10% ethanolamine oleate (EO). POL was injected predominantly into smaller, superficial lesions, whereas EO was used for large, deeper lesions. Foam sclerosing solution was provided using Tessari's method. Patients were randomized to receive either UGFS or UGLS. Post-sclerotherapy surveillance was done at 6 months after last session using duplex ultrasound. Findings obtained by duplex scanning were divided into four groups: (1) disappeared group: the venous space was occluded and was totally shrunk; (2) partially recanalized group: the venous space was partially recanalized and was partially shrunk; (3) totally recanalized group: the venous space was totally recanalized and returned at the same size; and (4) worsened group: the venous space was totally recanalized and became worse. RESULTS: Forty-nine patients were treated with UGFS and the remaining 40 were treated with UGLS. There were no significant differences in age and men:women ratio. There was no significant difference in the anatomic distribution of VMs between the two groups. The amount of POL was significantly smaller in patients who were treated with UGFS (P = .022). Similarly, there was a significant reduction in the use of EO in patients treated with UGFS (P = .005). The proportion of VM with total disappearance and partial recanalization was significantly higher in patients treated with UGFS (P = .002). No major complications related to sclerotherapy were encountered in both groups. CONCLUSIONS: These findings suggest that UGFS could have greater promise compared with UGLS in the treatment of VMs.     

导管引导下泡沫硬化剂疗法治疗大隐静脉曲张

目的 探讨导管引导下的泡沫硬化剂疗法治疗下肢静脉曲张的临床效果.方法 选择2008年4月至8月间有微创治疗意愿的30例(条)中重度下肢静脉曲张患者.其中男性11例,女性19例;年龄34-85岁,平均年龄52岁.病史2～30年,平均20年.对其进行导管引导下患肢大隐静脉主干内注射1%聚桂醇泡沫硬化剂,观察大隐静脉主干的闭合情况.结果 30条患肢均在导管引导下成功注射硬化剂,平均每条患肢应用6.2 ml泡沫硬化剂,27条(90%)大隐静脉主干治疗后即刻可见反流消失.术后早期大隐静脉走行轻微浅静脉炎5例(条),2周内自行缓解,无严重的并发症发生.平均随访3个月,27例患者下肢活动后酸胀、乏力感消失,下肢明显的曲张畸形静脉消失;27条患肢(90%)于治疗后2周、3个月后复诊血管超声时大隐静脉主干闭塞.4例(条)患者(15%)仅有小腿局限的轻度曲张.结论 导管引导的泡沫硬化剂疗法治疗下肢静脉曲张的大隐静脉主干闭合率较高,是微创治疗下肢静脉曲张有效的新方法.     

Duplex Ultrasound Outcomes Following Ultrasound-Guided Foam Sclerotherapy of Symptomatic Primary Great Saphenous Varicose Veins

ObjectivesTo describe duplex ultrasound (DUS) outcomes 12 months following ultrasound-guided foam sclerotherapy (UGFS) of primary great saphenous varicose veins (GSVV).MethodsA consecutive series of UK National Health Service patients underwent serial DUS examinations following UGFS with 3% sodium tetradecyl sulphate for symptomatic primary GSVV.Results344 treated legs (CEAP C_2/3 237, C₄ 72, C₅ 14, C₆ 21) belonging to 278 patients (103 male) of median age 57 (range 21–89) years were enrolled between November 2004 and May 2007. The median volume of foam used was 10 (range 2–16) ml. Above-knee (AK) and below-knee (BK) GSV reflux was present in 333 (96.8%) and 308 (89.5%) legs respectively prior to treatment. AK and BK-GSV reflux was completely eradicated by a single session of UGFS in 323 (97.0%) and 294 (95.5%) legs respectively; and by two sessions of UGFS in 329 (98.8%) and 304 (98.7%) legs respectively. In those legs where GSV reflux had been eradicated, recanalisation occurred in 18/286 (6.3%) AK and 23/259 (8.9%) BK-GSV segments after 12 months follow-up.ConclusionsA single session of UGFS can eradicate reflux in the AK and BK-GSV in over 95% of patients with symptomatic primary GSVV. Recanalisation at 12 months is superior to that reported after surgery and similar to that observed following other minimally invasive techniques.     

Ultrasound-guided foam sclerotherapy combined with sapheno-femoral ligation compared to surgical treatment of varicose veins: early results of a randomised controlled trial.

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

Healing and Recurrence Rates Following Ultrasound-guided Foam Sclerotherapy of Superficial Venous Reflux in Patients with Chronic Venous Ulceration

ObjectivesTo determine healing and recurrence rates following ultrasound-guided foam sclerotherapy (UGFS) of superficial venous reflux (SVR) in patients with healed (clinical, etiologic, anatomic and pathophysiologic (CEAP) classification, C5) and open (C6) chronic venous ulceration (CVU).MethodsBetween 1 March 2005 and 31 December 2009, 130 consecutive patients (132 limbs, 49 CEAP C5, 83 C6) of median age 70 (interquartile range (IQR) 56–76) years underwent UGFS as part of their treatment for CVU.ResultsThe median (IQR) follow-up time was 16 (12–32) months. One C6 patient moved abroad 1 week after UGFS and was lost to follow-up. Healing was observed in 67/82 (82%) remaining C6 patients at a median (IQR) of 1 (1–2) month following their first UGFS treatment. In 49 limbs originally treated for C5 disease, and in 67 limbs treated for C6 that healed following UGFS, there were five recurrent ulcers during the follow-up period, giving a 4.9% Kaplan–Meier estimate of recurrence at 2 years. In legs treated for C6 and C5 disease, the median (IQR) ulcer-free periods were 22 (IQR 9–32) and 14 (IQR 8–36) months, respectively.DiscussionHealing rates following UGFS for CVU are comparable to those reported after surgery but recurrence may be lower. UGFS is a safe, clinically effective and, thus, highly attractive minimally invasive alternative to surgery in patients with C5 and C6 disease.     

Comparative Study of Outcome of Duplex Ultrasound-Guided,Catheter-Directed Foam Sclerotherapy and Radio-frequency Ablation in the Management of Great Saphenous Varicose Veins

Chronic venous insufficiency of lower limbs is a common problem in adults. We compared the two modalities, namely duplex ultrasound-guided, catheter-directed foam sclerotherapy (UGFS) and radio-frequency ablation (RFA), in the management of great saphenous varicose veins using clinical assessment (Venous Clinical Severity Score, Venous Disability Score) and duplex imaging. Patients presenting with great saphenous vein (GSV) varicosity due to incompetent saphenofemoral junction (SFJ) were selected and randomly assigned in each arm, i.e., duplex UGFS group and RFA group. Patients were assessed on days 7, 30, and 90 both clinically and sonologically. Clinical assessment was based on the Venous Clinical Severity Score (VCSS) and Venous Disability Score (VDS). Obliteration of the treated GSV segment was noted in all the limbs of the RFA group (31/31) on duplex sonography on days 7, 30, and 90, while in the UGFS group, out of 30 limbs, obliteration was successful in 28 (28/30) and 2 had treatment failure. However, outcome of both the groups were statistically comparable (P value?>?0.05). After the procedure, improvement in the VCSS was noted in both the study arms in every follow-up and both the modalities were found to be equally effective. Improvement in the Venous Disability Score was there on every follow-up, but maximum improvement was seen on the second visit, i.e., post-treatment day 30. Improvement was statistically significant and equal in both arms after the initial 1 week. Foam sclerotherapy, especially catheter-directed, is as effective as radio-frequency ablation in achieving anatomical obliteration and yielding relief in clinical signs and symptoms in patients with GSV varicosity with SFJ incompetence.     

泡沫硬化剂注射治疗下肢慢性静脉功能不全

目的 探讨泡沫硬化剂注射治疗下肢慢性静脉功能不全(CVI)的临床疗效.方法 2011年3月至2012年1月,对我院行泡沫硬化剂注射治疗的95例CVI患者(131条患肢,CEAP分级为C2～5级)的临床资料进行回顾性分析.结果 131条患肢均成功治疗,平均每条肢体应用泡沫硬化剂15.5 ml.31条(23.7％)肢体于治疗后2周复诊时实施了第2次注射治疗,其中3条(2.3％)肢体于治疗后1个月复诊时实施了第3次注射治疗.无严重并发症发生.结论 泡沫硬化疗法对各种类型的下肢CVI都有效,且简单易行,应扩大其临床适应证.     

无水乙醇联合泡沫硬化治疗儿童体表静脉畸形

目的观察无水乙醇联合泡沫硬化治疗体表静脉畸形(VM)患儿的有效性及安全性。方法回顾性分析接受DSA引导下无水乙醇联合聚桂醇泡沫硬化治疗的42例体表VM患儿,术后随访观察治疗效果及不良反应。结果共行79次硬化治疗,平均每例(1.1±0.2)次;总有效率97.62%(41/42)。79例次硬化治疗中,24例次术后疼痛明显,65例次术后病灶明显肿胀;12例次术后低热,对症治疗缓解或自行缓解;1例次术后局部坏死,经对症治疗3个月后瘢痕愈合;未发生过敏、异位栓塞及肺动脉高压等严重并发症。结论无水乙醇联合泡沫硬化治疗儿童体表VM安全有效。     

Efficacy and safety of great saphenous vein sclerotherapy using standardised polidocanol foam (ESAF): a randomised controlled multicentre clinical trial.

AIM: To assess the safety and efficacy of sclerotherapy of the great saphenous vein (GSV) comparing standardised polidocanol foam to liquid polidocanol in a randomised controlled trial (RCT). METHODS: A multicentre randomised controlled clinical trial was carried out in which saphenous trunks were treated by sclerotherapy. 106 patients with primary varicose veins due to an incompetent GSV were treated with either standardised 3% polidocanol foam or 3% liquid polidocanol. The primary efficacy criterion was elimination of reflux (<0.5 sec) measured 3 cm below the sapheno-femoral junction (SFJ) by duplex ultrasonography 3 months after the last injection. RESULTS: A significantly greater number of patients were successfully treated by foam sclerotherapy resulting in 69% elimination of reflux compared to 27% patients treated with liquid sclerosant. The secondary endpoints of vein occlusion, reflux time, refilling time and patient satisfaction also improved significantly more in the foam group. The mean number of treatment sessions was 1.3 in the foam group compared to 1.6 in the liquid group. Differences between study centres occurred with a mean of 96% reflux elimination in 6 centres versus 39% in 4 other centres. Centres with a high response rate injected a higher mean volume (4.3 vs. 3.6 ml) in the first session in a vein with a smaller diameter (7.5 mm vs. 8.4 mm). No difference in adverse drug reactions was observed between treatment groups. CONCLUSIONS: Standardised 3% polidocanol foam is more efficient and equally safe compared to 3% liquid polidocanol for treatment of GSV. In comparison to other studies a relatively small volume was injected into relatively large veins.     

Ultrasound Guided Foam Sclerotherapy: Factors Associated with Outcomes and Complications

ObjectivesIn recent years ultrasound guided foam sclerotherapy (UGFS) has become an increasingly popular treatment for varicose veins. Although many published series detail the results of UGFS, little is known about the factors which are associated with outcomes and complications. The aim of this study was to identify these factors.DesignA review of a prospectively collected database of UGFS which commenced in July 2007.MethodsA successful outcome was defined as complete occlusion of the target vein on duplex scanning at follow-up. Eight factors were assessed to determine whether they were associated with outcomes and complications. These factors were age, gender, compliance with post-procedure compression hosiery, previous varicose vein surgery, single or multiple sites of injection, concentration of sclerosant, volume of sclerosant and pre-procedure severity score.ResultsBetween July 2007 and July 2009, a total of 126 patients (60 men, 66 women) attended follow-up visits and had a post-procedure duplex scan. Targets for UGFS included the great saphenous vein (n = 75), small saphenous vein (n = 13) and anterior accessory great saphenous vein (n = 8). The remainder of procedures involved other veins or more than a single target vein. The median timing of follow-up was 3 months (range 1.5–14 months) with duplex scans revealing complete occlusion of the target vein in 79% of patients. The only factor associated with a successful outcome was compliance with post-procedure compression hosiery (p < 0.05). The most frequently encountered complications following UGFS were skin staining (28%), superficial thrombophlebitis (18%) and pain (14%). The only factor associated with post-UGFS complications was female gender (p < 0.05). When complications were analysed in isolation female gender was also significantly associated with skin staining (p < 0.05), but no other complication.ConclusionsThese data suggest that compliance with post-procedure compression hosiery and gender are important factors associated with a successful outcome and reported complications following UGFS, respectively.     

Recovery after ultrasound‐guided foam sclerotherapy compared with conventional surgery for varicose veins

Background:

The advantages of minimally invasive alternatives such as ultrasound‐guided foam sclerotherapy (UGFS) over conventional surgery for the treatment of varicose veins include lower morbidity and faster recovery times. The aim was to compare morbidity, analgesia use, and time to return to driving and work following UGFS with those reported after conventional surgery for varicose veins.

Methods:

Patients who had UGFS or surgery for varicose veins were sent a questionnaire 4 weeks after treatment.

Results:

A total of 332 (84·9 per cent) of 391 patients who had UGFS and 53 (56 per cent) of 94 who had surgery returned a questionnaire. The groups were similar in terms of age, sex, and the proportion who had treatment of bilateral or recurrent veins. Patients who had surgery were more likely to have significant bruising (44 versus 7·2 per cent; P < 0·001) and pain (17 versus 5·5 per cent; P = 0·001). After UGFS, 43·2 per cent of patients returned to work within 24 h compared with none who had surgery (P < 0·001). Patients who had UGFS were more likely to return to driving within 4 days (P = 0·014).

Conclusion:

UGFS was associated with less pain and analgesia requirement, time off work and quicker return to driving. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.     

超声引导下泡沫硬化治疗四肢血管瘤

目的探讨超声引导下注射泡沫硬化剂治疗四肢血管瘤的疗效。方法收集经超声确诊的四肢血管瘤患者30例,于超声引导下向血管瘤腔内注射聚桂醇泡沫硬化剂,随访8个月,观察治疗后血管瘤体积变化和临床症状改善情况,评价疗效,观察治疗相关并发症。结果对13例进行1次治疗、12例进行2次治疗、3例进行3次治疗、2例进行4次治疗;血管瘤体积缩小≥60%19例、缩小30%~59%7例、缩小1%~29%2例、无明显变化2例,临床症状消失14例、明显好转11例,症状无明显变化5例;25例治疗有效,有效率为83.33%(25/30)。所有患者均未发生严重并发症。结论超声引导下聚桂醇泡沫硬化剂治疗四肢血管瘤费用低廉、安全、有效,值得临床推广与应用。     

Treatment of venous leg ulcers with ultrasound‐guided foam sclerotherapy: Healing,long‐term recurrence and quality of life evaluation

Venous leg ulcers (VLU) generally have slow healing rates (HR) and frequent recurrence rates (RR). The underlying etiology is venous hypertension. The present observational cohort study was to determine healing and RR in VLU treated with ultrasound‐guided foam sclerotherapy (UGFS). One hundred and eighty VLU were treated with polidocanol microfoam monthly under ultrasound control. Median follow‐up was 30 months (range: 17–40). One hundred seventy‐two (95.6%) ulcers healed during the study. The overall twenty‐four week HR was 79.4% and was significantly higher (95.1%) in patients with isolated great saphenous vein incompetence than in those with great saphenous vein plus perforator (91.7%) or exclusive perforator incompetence (78.9%) (p < 0.01). Patients without deep vein incompetence had a significantly higher 6‐month HR (89.8%) than those with (67.4%) (p < 0.01). Multivariate analysis identified the following independent risk factors: chronicity > 12 months (OR 7.69), area > 6 cm² (OR 4.24), lipodermatoesclerosis (OR 12.22), history of > 3 previous ulcers (OR 5.57) and history of deep vein thrombosis (OR 6.18). One, two and three year ulcer RR were 8.1%, 14.9%, and 20.8%, respectively. Isolated perforator incompetence and previous history of venous surgery were significantly (p = 0.03) associated with a higher RR. VLU treated with microfoam sclerotherapy are associated with high HR and low mid‐term RR.     

Chronic venous disease treated by ultrasound guided foam sclerotherapy.

AIM: To report the outcome of a series of patients with chronic venous disease due to incompetence of saphenous trunks managed by ultrasound guided foam sclerotherapy (UFS). PATIENTS AND METHODS: A group of 808 patients comprise this series. CEAP clinical class for limbs was C1: 15%, C2: 81%, C3: 0.5%, C4: 2%, C5: 0.2%, C6: 0.4%. UFS using 1% polidocanol (107 limbs), 1% sodium tetradecyl (102 limbs), 3% sodium tetradecyl (900 limbs) was employed to treat incompetent saphenous trunks. In patients with unilateral varices 1 treatment was required in 43% of patients and 2 treatments in 48% of patients to obliterate incompetent saphenous trunks and varices. For bilateral varices 2 treatments were required in 40% of patients and 3 treatments in 46% of cases. The clinical outcome and patency of treated veins on duplex ultrasonography was assessed at a mean follow-up interval of 11 months. RESULTS: A total of 459 limbs were available for assessment at a follow-up interval of 6 months or greater. The CEAP clinical stage was C0:182 limbs, C1: 241, C2: 22, C3: 0, C4: 11, C5: 2, C6:1. The GSV had remained obliterated in 88% of limbs and the SSV in 82% of limbs. Recurrent venous incompetence following previous surgery was as effectively treated by UFS as primary incompetence. CONCLUSIONS: This technique is useful in the management of chronic venous disease as an alternative to surgery.