Ultrasound-guided Foam Sclerotherapy Combined with Sapheno-femoral Ligation Compared to Surgical Treatment of Varicose Veins: Early Results of a Randomised Controlled Trial

Abstract

Ligation of the saphenofemoral junction (SFJ), stripping of the great saphenous vein (GSV) and multiple phlebectomies is considered the standard treatment for varicose veins. This achieves rapid relief of symptoms and has an acceptable long-term recurrence rate.¹ x 1 Mac Kenzie, R.K., Allan, P.L., Rukley, C.V., and Bradbury, A.W. The effect of long saphenous vein stripping on deep venous reflux. Eur J Vasc Endovasc Surg. 2004; 28: 104–107 Google Scholar See all References ^{, 2} x 2 Neglen, P. Long saphenous vein stripping is favored in treating varicose veins. Dermatol Surg. 2001; 27: 901–902 Google Scholar See all References Any alternative technique must have the same or better outcome with fewer complications or reduced cost. Stripping of the GSV is not used at present in some centres on the basis that selective ligation of incompetent veins is as effective as stripping and results in less morbidity by decreasing the incidence of thigh haematomas and post-operative pain. However, it has been reported that the residual incompetent GSV results in a higher recurrence rate for varices.³ x 3 Rudgers, P.H. and Kirslaar, P.J. Randomised trial of stripping versus high ligation combined with sclerotherapy in the treatment of the incompetent greater saphenous vein. Am J Surg. 1994; 168: 311–315 Google Scholar See all References Others have proposed ligation of major sites of venous incompetence such as the SFJ followed by sclerotherapy of the GSV.³ x 3 Rudgers, P.H. and Kirslaar, P.J. Randomised trial of stripping versus high ligation combined with sclerotherapy in the treatment of the incompetent greater saphenous vein. Am J Surg. 1994; 168: 311–315 Google Scholar See all References Foam sclerotherapy under ultrasound control is a relatively new technique that appears to be safer and more effective than liquid sclerotherapy.⁴ x 4 Orbach, E.J. Contribution to the therapy of the varicose complex. J Int Coll Surg. 1950; 13: 765–771 Google Scholar See all References ^{, 5} x 5 Frullini, A. and Cavezzi, A. Sclerosing foam in the treatment of varicose veins and telangiectases: history and analysis of safety and complications. Dermatol Surg. 2002; 28: 11–15 Google Scholar See all References ^{, 6} x 6 Hsu, T.S. and Weiss, R.A. Foam sclerotherapy: a new era. Arch Dermatol. 2003; 139: 494–496 Google Scholar See all References ^{, 7} x 7 Wollmann, J.C. The history of sclerosing foams. Dermatol Surg. 2004; 30: 694–703 Google Scholar See all References