Treatment of Varicose Veins by Foam Sclerotherapy: Two Clinical Series

Abstract

Objective: To assess the efficacy and safety of sclerotherapy of varicose veins (VV) with sclerosing foam (SF) made using Tessari's method (three-way tap and two plastic syringes). Design: Two multi-centre prospective clinical series were documented (CS1 and CS2). In CS1, which ran from March to December 2000, 177 patients (39 men, 138 women), mean age 56 years, were treated in three centres for W related to incompetence of saphenous veins, recurrence, perforators or collaterals. Conventional or duplex-guided sclerotherapy was performed using SF made of purified sodium tetradecyl sulphate (PSTS) 0.2−3% (Fibro-vein, STD Pharmaceuticals, UK) and air. An average of 1.6 (SD 0.8) sessions per patient were performed and 2.9 (SD 1.0) ml of SF (i.e. 0.6 ml of PSTS) per session was employed. An elastic stocking providing 20 −30 or 30−40 mmHg compression was worn by patients following treatment. All the patients were reviewed (clinical examination and colour duplex ultrasonography) at 1 month. Sixty-six patients had a further follow-up 45−370 days after treatment. The 17 patients in CS2, a multi-centre study, were treated in March and April 2001. An independent observer assessed patients with major W (CEAP and W type distribution similar to CS1) before and after the treatment, and also observed the treatment, which was carried out using the technique employed in CS1. Results: In CS1 at 1 month follow-up there was: (A) obliteration of the vessel or antegrade flow in 161 (91%) patients, (B) minimal retrograde flow in the treated vein, without visible W, in 15 (8.4%) cases and (C) persistence of vessel patency with retrograde flow and visible W (failure) in 1 (0.6%) case. At 45−370 days (mean 138 days) follow-up results were: type A in 44 (67%) cases, type B in 17 (26%) cases and type C in 5 (8%) cases. The main complications were extension of sclerothrombus from superficial to deep veins (n = 2), allergy (n = 1), malaise (n = 1) and scotoma (n = 1). In CS2 at 30 days follow-up 100% of the treated venous segments had a type A outcome after an average of 1.4 sessions. No relevant complication occurred in this series. Conclusions: Sclerotherapy of major VV by means of SF prepared by Tessari's method is a safe and effective form of treatment. Low doses and a low concentration of drug may be successfully employed. Further studies are needed to establish the long- term results and overall safety of this form of foam sclerotherapy.