1
|
Bossart S, Kos S, Keo HH, Staub D, Uthoff H. Combining Proximal Foam Sclerotherapy and Distal Endovenous Laser Ablation for Recurrent Varicose Vein Treatment. Dermatol Surg 2023; 49:575-580. [PMID: 36989122 DOI: 10.1097/dss.0000000000003765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Recurrent varicose veins with neovascularization are a common clinical problem. Although endovenous laser ablation (EVLA) has become the standard treatment modality to treat truncal veins, additional sclerotherapy is required to treat newly formed tortuous veins. A novel laser fiber with an injection channel (nLF) allows for such simultaneous proximal sclerotherapy and offers a potentially more effective treatment option. OBJECTIVE The aim of this study was to present our experience using the nLF for combined EVLA and sclerotherapy treatment of symptomatic recurrent varicose veins. MATERIALS AND METHODS A retrospective single-center cohort study analyzed the outcomes of all patients with symptomatic recurrent varicose veins, treated with an nLF between September 2020 and August 2022. RESULTS In total, 28 combined EVLA/sclerotherapy procedures performed with the nLF in 26 patients were analyzed. In all cases, neovascularizations were treated by sclerotherapy through the nLF catheter, followed by laser ablation of the remaining truncal veins. All follow-up ultrasound examinations showed persistent complete occlusion of the treated truncal veins and neovascularizations. No clinically relevant complications were observed. CONCLUSION Combining proximal foam sclerotherapy and distal EVLA using an nLF for the treatment of symptomatic recurrent varicose veins is safe and effective.
Collapse
Affiliation(s)
- Simon Bossart
- Gefässpraxis am See - Lakeside Vascular Center Lucerne, Lucerne, Switzerland
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Sebastian Kos
- Institute for Radiology and Nuclear Medicine Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Hak Hong Keo
- Department of Angiology, University Hospital, University of Basel, Basel, Switzerland
- Vascular Institute Central Switzerland, Aarau, Switzerland
| | - Daniel Staub
- Department of Angiology, University Hospital, University of Basel, Basel, Switzerland
| | - Heiko Uthoff
- Gefässpraxis am See - Lakeside Vascular Center Lucerne, Lucerne, Switzerland
- Department of Angiology, University Hospital, University of Basel, Basel, Switzerland
| |
Collapse
|
2
|
Pannier F, Noppeney T, Alm J, Breu FX, Bruning G, Flessenkämper I, Gerlach H, Hartmann K, Kahle B, Kluess H, Mendoza E, Mühlberger D, Mumme A, Nüllen H, Rass K, Reich-Schupke S, Stenger D, Stücker M, Schmedt CG, Schwarz T, Tesmann J, Teßarek J, Werth S, Valesky E. S2k guidelines: diagnosis and treatment of varicose veins. DER HAUTARZT; ZEITSCHRIFT FUR DERMATOLOGIE, VENEROLOGIE, UND VERWANDTE GEBIETE 2022; 73:1-44. [PMID: 35438355 PMCID: PMC9358954 DOI: 10.1007/s00105-022-04977-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/29/2022]
Affiliation(s)
- F Pannier
- Praxis für Dermatologie und Phlebologie, Helmholtzstr. 4-6, 53123, Bonn, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Rabe E, Breu FX, Flessenkämper I, Gerlach H, Guggenbichler S, Kahle B, Murena R, Reich-Schupke S, Schwarz T, Stücker M, Valesky E, Werth S, Pannier F. Sclerotherapy in the treatment of varicose veins : S2k guideline of the Deutsche Gesellschaft für Phlebologie (DGP) in cooperation with the following societies: DDG, DGA, DGG, BVP. DER HAUTARZT 2021; 72:23-36. [PMID: 33252705 PMCID: PMC8692296 DOI: 10.1007/s00105-020-04705-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E Rabe
- Emeritus Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn (AöR), Venusberg-Campus 1, 53127, Bonn, Germany.
| | | | | | | | | | - B Kahle
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - R Murena
- Phlebologische Praxis, Köln, Germany
| | - S Reich-Schupke
- Privatpraxis für Haut- und Gefäßmedizin, Wundtherapie, Recklinghausen, Germany
| | - T Schwarz
- Praxis für Gefäßmedizin, Freiburg, Germany
| | - M Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, St. Josef Hospital, Bochum, Germany
| | - E Valesky
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinik Frankfurt, Frankfurt, Germany
| | - S Werth
- Universitäts-Gefäßzentrum, Innere Medizin III, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - F Pannier
- Praxis Dermatologie & Phlebologie Bonn und Dermatologische Universitätsklinik Köln, Bonn, Germany
| |
Collapse
|
4
|
Gawas M, Bains A, Janghu S, Kamat P, Chawla P. A Comprehensive Review on Varicose Veins: Preventive Measures and Different Treatments. J Am Coll Nutr 2021; 41:499-510. [PMID: 34242131 DOI: 10.1080/07315724.2021.1909510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this article was to review the different preventive measures and treatments for varicose veins disease. Varicose veins are tortuous, enlarged veins that are usually found in the lower extremities damages blood vessels leading to its painful swelling cause's blood clots, affecting people over increasing prevalence with age and affects the proficiency, productivity, and life quality of a person. Prolonged standing and obesity are the major reason for varicose vein disease. The mechanisms, prevention, risk factors, complications, and treatment of varicose veins are explained in this review. Various types of treatments such as endovascular, surgical, and herbal treatments improve quality of life and reduce the secondary complications of varicose veins. Besides these methods of treatments, varicose vein disease can be prevented by doing regular yoga/exercise and consumption of several fruits and vegetables such as Grapes, blackberries, avocados, ginger, and rosemary. Typically, varicose veins can be a benign process with several problems that can influence the life quality of an individual that can lead to potentially life-threatening complications. However, there are numerous surgical, endovascular, and chemical treatments that improve quality of life and decrease secondary complications of varicose veins. Patients with varicose veins should take an antioxidant medicament from the flavonoid groups to reduce the arterial blood pressure value, risk of atherosclerosis development, prevent thrombotic incidents.Key teaching pointsChronic venous disease is a pathological state of vein circulatory systems of the lower limbsProlonged standing and obesity are the major reason for varicose vein diseaseEndovascular, surgical, and herbal treatments improve quality of life and reduce the secondary complications of varicose veinsVenoactive drugs such as flavonoids, saponins, and others have a therapeutic effect on chronic venous disordersPhlebotropic drugs are semi-synthetic substances widely used in different states of chronic venous insufficiencyFood rich in phytoconstituents are more effective in varicose veins.
Collapse
Affiliation(s)
- Mandar Gawas
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Aarti Bains
- Department of Biotechnology, Chandigarh group of Colleges Landran, Mohali, Punjab, India
| | - Sandeep Janghu
- Indian Institute of Food Processing Technology, Thanjavur, Tamilnadu, India
| | - Pranali Kamat
- Department of Pharmacy, Goa College of Pharmacy, Panaji, Goa, India
| | - Prince Chawla
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| |
Collapse
|
5
|
Bai T, Jiang W, Liang L, Li Y, Fan Y. An Optical Method for Immediate Evaluation of Microfoam Stability in Foam Sclerotherapy. Skin Pharmacol Physiol 2021; 34:128-134. [PMID: 33794544 DOI: 10.1159/000514322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 01/10/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The objective of our study was to develop an optical method that instantly evaluates the stability of sclerosing foam, which would enable early predictions of the clinical performance of the foam and reduce the occurrence of clinical side effects. METHODS Based on the principle of light scattering, we developed a method to optically test foam stability and verified it experimentally using sodium morrhuate (2 mL; 0.05 g/mL) and carbon dioxide. A self-made foam preparation instrument was used to achieve a preparation speed of 275 mm/s. The liquid-gas ratios were considered as 1:3, 1:4, and 1:5. Curves of illuminance with respect to the drainage rate and decay time were obtained. By fitting the curve, the relationship between foam half-life time (FHT) and foam decay was obtained. Thus, foam stability was evaluated using the initial illuminance value; the foam transfer time was approximately 3 s. RESULTS The experimental FHT varies between 205 and 232 s. Illuminance is exponentially related to drainage rate and linearly related with time. FHT can be expressed by the initial illuminance and illuminance curve fitting coefficients. The half-life of the foam decreases as the initial illuminance value increases, for the same sclerosing drug. The suitability of foam stability is determined by the position of the initial value in the chart. CONCLUSION Optical methods are feasible for evaluating foam stability over a short period of time. Clinically predicting the stability of freshly prepared foam can reduce number of incidences of further complications. This will promote the development of foam sclerotherapy and provide a basic understanding of the internal mechanical properties of foam.
Collapse
Affiliation(s)
- Taoping Bai
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Wentao Jiang
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Lin Liang
- School of Civil Engineering, Southwest Jiaotong University, Chengdu, China
| | - Yalan Li
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Yubo Fan
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| |
Collapse
|
6
|
[Guidelines for sclerotherapy of varicose veins : S2k guideline of the German Society of Phlebology (DGP) in cooperation with the following professional associations: DDG, DGA, DDG, BVP. German Version]. DER HAUTARZT 2021; 72:50-64. [PMID: 33151348 DOI: 10.1007/s00105-020-04707-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
7
|
Seyam OA, Elshimy AS, Niazi GEM, ElGhareeb M. Ultrasound-guided percutaneous injection of foam sclerotherapy in management of lower limb varicose veins (pilot study). THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00264-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Minimally invasive procedures; like ultrasound-guided percutaneous injection of foam sclerotherapy (USGFS) are being the keystone methods in managing lower limb varicose veins and its complications, being advantageable over the surgery as being minimally invasive with better postoperative comfort and immediate cosmetic effect and faster return to full socioeconomic activity. Varicose veins are common problem that affects the quality of life and have a significant cost burden on the health care system. Sclerotherapy (endovenous chemical ablation) destructs the endothelium to induce inflammation and fibrosis and then occlusion of the blood vessel lumen.
Results
The study included 33 diseased limbs of females (64.7%) and 18 (35.3 %) limbs of males. Of the diseased limbs, 16 (31.3%) presented with disfigurement, 14 (27.4%) with pain, 11 (19.6%) with heaviness, 6 (11.7%) with edema, and 4 (7.8%) with non-healed venous ulcer. Twenty-six (50.9%) diseased limbs show competent sapheno-femoral junction (SFJ) while 25 (49.1%) limbs showed SFJ reflux of variant degrees. All patients underwent direct ultrasound-guided foam sclerotherapy either as the primary therapy in 29 (56.9%) limbs or as a complementary therapy for residual perforators and varicosities after treatment with other methods of treatment like laser ablation and phlebograph in 22 (43.1%) limbs. Nine (17.6%) limbs treated with 2% polidocanol (Pol.) and 42 (82.3%) limbs with 3% Pol. In the 2nd session Doppler follow-up, 35 (68.6%) limbs showed complete occlusion while 13 (25.5%) limbs showed partial occlusion, while in the 3rd session Doppler follow-up, 3 (5.9%) limbs still show partial occlusion while 45 (88.2%) limbs showed complete occlusion and no recanalization. Forty (78.4%) limbs addressed marked symptomatic relief while 5 (9.8%) limbs moderate relief and 3 (5.9%) cases with mild relief and the other 3 (5.9%) cases missed follow-up. Twenty-five (49%) limbs had no complications while 23 (45%) limbs had different local complications ranging from pain, hyperpigmentation, and superficial thrombophlebitis. Also, we find a statistically significant correlation between the Pol. concentration injected and the symptomatic relief and Doppler US follow-up while there is a borderline correlation between the Pol. concentration injected and the detected complications.
Conclusions
The preliminary results revealed ultrasound-guide foam sclerotherapy is an effective and safe treatment for lower limb varicose veins. The concentration of polidocanol injected could be correlated significantly with the symptoms improvement and borderline correlation to the complication rate.
Collapse
|
8
|
Nicolaides A, Kakkos S, Baekgaard N, Comerota A, de Maeseneer M, Eklof B, Giannoukas A, Lugli M, Maleti O, Mansilha A, Myers KA, Nelzén O, Partsch H, Perrin M. Management of chronic venous disorders of the lower limbs. Guidelines According to Scientific Evidence. Part II. INT ANGIOL 2020; 39:175-240. [PMID: 32214074 DOI: 10.23736/s0392-9590.20.04388-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | | | | | | | | | - Bo Eklof
- American Venous Forum, Hoffman Eastates, IL, USA
| | | | | | | | - Armando Mansilha
- Faculty of Medicine of the University of Porto, Department of Angiology and Vascular Surgery, S. João Hospital, Porto, Portugal
| | | | - Olle Nelzén
- Vascular Surgery Unit, Skaraborg Hospital, Kärnsjukhuset, Skövde, Sweden
| | | | | |
Collapse
|
9
|
Hansen K, Morrison N, Neuhardt DL, Salles-Cunha SX. Transthoracic Echocardiogram and Transcranial Doppler Detection of Emboli after foam Sclerotherapy of Leg Veins. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/154431670703100405] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Patients with chronic venous insufficiency have been successfully treated with foam sclerotherapy. Reports of cerebral and respiratory symptoms after the foam procedure have been related to an open foramen ovale (PFO) between the right and left sides of the heart. This work evaluated the value of ultrasonography to demonstrate that bubbles may traverse a PFO and may be detected at the middle cerebral artery. Methods Patients describing cerebral or respiratory symptoms or suspected of having a PFO entered this study. Cerebral symptoms included visual disturbance, lightheadedness, dizziness and migraine. Respiratory problems included cough. A total of 20 patients had transthoracic echocardiography (TTE), and 12 had transcranial Doppler (TCD) of the middle cerebral artery. Results TTE detected bubbles in the left heart in 13 (65%) of 20 patients. The 12 TCDs were performed in nine patients with positive and three with negative TTE evaluation; five TCDs were positive for emboli at the middle cerebral artery. All five patients had positive transthoracic echocardiography. Conclusions This single-institution evaluation for quality control demonstrated that 1) patients with cerebral or respiratory symptoms after foam sclerotherapy may have PFO; and 2) patients with patent PFO may embolize the gas particles to the brain. Therefore, patients with known PFO must be evaluated before foam injection, and patients that are candidates for this treatment may have to be screened for PFO.
Collapse
Affiliation(s)
- Kristin Hansen
- CompuDiagnostics, Inc., and Morrison Vein Institute, Scottsdale, Arizona
| | - Nick Morrison
- CompuDiagnostics, Inc., and Morrison Vein Institute, Scottsdale, Arizona
| | - Diana L. Neuhardt
- CompuDiagnostics, Inc., and Morrison Vein Institute, Scottsdale, Arizona
| | | |
Collapse
|
10
|
Silva MADM, Araujo ÁZP, do Amaral JF, de Jesus-Silva SG, Cardoso RS, Miranda F. Impacto da escleroterapia com espuma de polidocanol guiada por ultrassom em pacientes com úlcera venosa. J Vasc Bras 2017; 16:239-243. [PMID: 29930653 PMCID: PMC5868941 DOI: 10.1590/1677-5449.002717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Contexto
A escleroterapia com espuma de polidocanol guiada por ultrassom tem sido utilizada no tratamento de pacientes com úlceras venosas. É um procedimento minimamente invasivo e de fácil execução, porém apresenta taxas de recidiva elevadas.
Objetivos
Relatar a evolução a curto e médio prazo de pacientes com úlcera venosa tratados com escleroterapia com espuma de polidocanol guiada por ultrassom.
Métodos
Foram reavaliados 19 pacientes submetidos ao tratamento de escleroterapia com espuma de polidocanol guiada por ultrassom no período de janeiro de 2013 a dezembro de 2014. Foram analisados tempo de cicatrização da úlcera, melhora de sintomas clínicos, recanalização das veias tratadas, recidiva dos sintomas e da úlcera venosa.
Resultados
Foram analisados 15 pacientes do sexo feminino (78,9%) e quatro do sexo masculino (21,1%). A média geral de idade foi de 53 anos. O tempo de seguimento dos pacientes variou de 448 dias a 1.276 dias (média de 791 dias). O tempo médio de presença das úlceras foi de 53 meses. Na avaliação pós-procedimento, foram observadas recanalização total em 15,7%, recanalização parcial em 21% e oclusão em 47,3% das veias tratadas. Apenas em um caso foi observada recidiva da úlcera. Pela avaliação das médias do Venous Clinical Severity Score (VCSS), houve diferença significativa antes e após o procedimento, com variação entre os grupos de 11,2 (p < 0,01).
Conclusões
A escleroterapia por espuma guiada por ultrassom apresenta altas taxas de sucesso terapêutico, com índices de cicatrização de úlceras venosas elevados.
Collapse
Affiliation(s)
| | | | | | | | | | - Fausto Miranda
- Universidade Federal de São Paulo - UNIFESP, Escola Paulista de Medicina, Cirurgia Vascular, São Paulo, SP, Brasil
| |
Collapse
|
11
|
Abstract
BACKGROUND Foam sclerotherapy is well established in the treatment of varicose veins of different sizes. METHODS A literature review was performed to determine which specific indications for foam sclerotherapy exist. RESULTS Treatment of venous leg ulcers, varices that might rupture, varicose veins in geriatric patients, pudendal veins and seroma could be determined as specific indications for foam sclerotherapy. CONCLUSION In some indications, foam sclerotherapy is the treatment option of first choice. It is an effective and safe treatment option.
Collapse
Affiliation(s)
- B Kahle
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| |
Collapse
|
12
|
Abstract
Venous malformations are the most common vascular anomalies. When they are superficial and large, they are easily recognized. However, when the malformation is deep or involves normally occurring veins, the diagnosis can be challenging. Extremity varicosities may be the only visible signs of the problem. Unfortunately, varicosities are often presumed to be the result of superficial venous insufficiency and the underlying venous malformation is overlooked. The phlebologist must be cognizant of the possibility that a venous malformation may be the cause of the patient's symptoms and varicosities. Ultrasound and magnetic resonance imaging can help to confirm the correct diagnosis. Treatment involves image-guided endovenous occlusion of the malformation, most commonly with potent liquid sclerosing agents. Some of these agents can cause severe complications. A thorough knowledge of the sclerosing solutions and the endovascular techniques to properly deliver them to the malformation is essential. This article will review the basic principle surrounding endovascular management of venous malformations.
Collapse
Affiliation(s)
- M Rosenblatt
- Connecticut Image Guided Surgery, Fairfield, CT, USA
| |
Collapse
|
13
|
Eduardo Jiménez C, Quiroga F. Radiofrecuencia en el tratamiento de las varices de los miembros inferiores. Estudio prospectivo en 176 pacientes en Bogotá. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2016.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
14
|
Abstract
Recent trends toward less invasive technologies for treating varicose veins have led to expanding interest in transilluminated powered phlebectomy. Although initial experience with transilluminated powered phlebectomy was variable, with the newer-generation system and modification of technique that allow for slower oscillation speed, higher suction, and extensive tumescence irrigation and drainage, these previous problems have been mostly eliminated. The following report reviews current instrumentation, operative technique, and reported outcomes for transilluminated powered phlebectomy.
Collapse
Affiliation(s)
- Marc Passman
- *Section of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
15
|
Lawson JA, Toonder IM. A review of a new Dutch guideline for management of recurrent varicose veins. Phlebology 2016; 31:114-24. [PMID: 26916778 DOI: 10.1177/0268355516631683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 2013, the new Dutch guideline for "Venous Pathology" was published. The guideline was a revision and update from the guideline "Diagnostics and Treatment of Varicose Veins" from 2009 and the guideline "Venous Ulcer" from 2005. A guideline for "Deep Venous Pathology" and one for "Compression Therapy" was added to the overall guideline "Venous Pathology." The chapter about treatment of recurrent varicose veins after initial intervention was recently updated in 2015 and is reviewed here. The Dutch term "recidief varices" or the French "récidive de varices" should be used analogous to the English term "recurrent varicose veins." The DCOP Guideline Development Group Neovarices concluded that "recidief" in Dutch actually suggests recurrence after apparent successful treatment and ignores the natural progression of venous disease in its own right. So the group opted to use the term "neovarices." In the Dutch guideline, neovarices is meant to be an all embracing term for recurrent varicose veins caused by technical or tactical failure, evolvement from residual refluxing veins or natural progression of varicose vein disease at different locations of the treated leg after intervention. This report reviews the most important issues in the treatment of varicose vein recurrence, and discusses conclusions and recommendations of the Dutch Neovarices Guideline Committee.
Collapse
Affiliation(s)
- James A Lawson
- Section of Phlebology and Vascular Surgery, Centrum Oosterwal, The Netherlands
| | - Irwin M Toonder
- Section of Phlebology and Vascular Surgery, Centrum Oosterwal, The Netherlands Department of Vascular Surgery, Maastricht University Medical Centre, The Netherlands
| |
Collapse
|
16
|
Zhan HT, Bush RL. A review of the current management and treatment options for superficial venous insufficiency. World J Surg 2015; 38:2580-8. [PMID: 24803347 DOI: 10.1007/s00268-014-2621-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The recognition of lower extremity venous disease as a significant cause of morbidity and lower quality of life, afflicting up to 25 % of Western populations, has led to rapid and drastic improvements in treatment options as well as an increasing awareness of the disease. Superficial venous disease, a frequent medical problem encountered in clinical practices, is now a common reason for referral to providers offering a spectrum of interventions. Venous guidelines have been set forth by the American Venous Forum and Society for Vascular Surgery covering simple spider veins to chronic venous ulcerations. (Gloviczki et al. J Vas Surg 53:2S-48S, 2011) This review provides an overview of the modern management of varicose veins and venous insufficiency.
Collapse
Affiliation(s)
- Henry T Zhan
- Texas A&M Health Science Center, MS 1359, 8447 State Highway 47, HPEB 3064, Bryan, TX, 77807-3260, USA
| | | |
Collapse
|
17
|
Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, de Wolf M, Eggen C, Giannoukas A, Gohel M, Kakkos S, Lawson J, Noppeney T, Onida S, Pittaluga P, Thomis S, Toonder I, Vuylsteke M, Kolh P, de Borst GJ, Chakfé N, Debus S, Hinchliffe R, Koncar I, Lindholt J, de Ceniga MV, Vermassen F, Verzini F, De Maeseneer MG, Blomgren L, Hartung O, Kalodiki E, Korten E, Lugli M, Naylor R, Nicolini P, Rosales A. Editor's Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2015; 49:678-737. [PMID: 25920631 DOI: 10.1016/j.ejvs.2015.02.007] [Citation(s) in RCA: 493] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
18
|
Rabe E, Pannier F. Indications, contraindications and performance: European Guidelines for Sclerotherapy in Chronic Venous Disorders. Phlebology 2014; 29:26-33. [DOI: 10.1177/0268355514528127] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim Sclerotherapy is the targeted chemical ablation of varicose veins by intravenous injection of a liquid or foamed sclerosing drug. The treated veins may be intradermal, subcutaneous, and/or transfascial as well as superficial and deep in venous malformations. The aim of this guideline is to give evidence-based recommendations for liquid and foam sclerotherapy. Methods This guideline was drafted on behalf of 23 European Phlebological Societies during a Guideline Conference on 7th – 10th May 2012 in Mainz. The conference was organized by the German Society of Phlebology. Results This guideline focuses on the two sclerosing drugs which are licensed in the majority of the European countries, Polidocanol (POL) and Sodium tetradecyl sulphate (STS). Other sclerosants are not discussed in detail. In this paper the recommendations concerning indications, contraindications, concentrations, volumes and technique of liquid and foam sclerotherapy of varicose veins and venous malformations are reviewed.
Collapse
Affiliation(s)
- E Rabe
- Department of Dermatology, University of Bonn, Bonn, Germany
| | - F Pannier
- Department of Dermatology, University of Cologne, Cologne & Private Practice Dermatology and Phlebology Bonn, Germany
| | | |
Collapse
|
19
|
Pannier F, Rabe E. Results from RCTs in Sclerotherapy: European Guidelines for Sclerotherapy in Chronic Venous Disorders*. Phlebology 2014; 29:39-44. [DOI: 10.1177/0268355514528133] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim Sclerotherapy is the targeted chemical ablation of varicose veins by intravenous injection of a liquid or foamed sclerosing drug. The treated veins may be intradermal, subcutaneous, and/or transfascial as well as superficial and deep in venous malformations. The aim of this guideline is to give evidence-based recommendations for liquid and foam sclerotherapy. Methods This guideline was drafted on behalf of 23 European Phlebological Societies during a Guideline Conference on 7th–10th May 2012 in Mainz. The conference was organized by the German Society of Phlebology. Results This guideline focuses on the two sclerosing drugs which are licensed in the majority of the European countries, Polidocanol (POL) and Sodium tetradecyl sulphate (STS). Other sclerosants are not discussed in detail. In this paper the results from recent RCTs in sclerotherapy are reviewed.
Collapse
Affiliation(s)
- F Pannier
- Department of Dermatology, University of Cologne, Cologne & Private Practice Dermatology and Phlebology Bonn, Germany
| | - E Rabe
- Department of Dermatology, University of Bonn, Bonn, Germany
| | | |
Collapse
|
20
|
Abstract
Tumescent anesthesia refers to the percutaneous administration of large volume anesthetic to cause the target tissue to become swollen or firm. The use of tumescent anesthesia is essential for the treatment of refluxing truncal veins using endothermal technologies. In order to obviate the use of tumescent anesthesia as an adjunct to treatment, one has to evaluate the technologies that do not employ thermal energy as the modality for treatment. These technologies include foam sclerotherapy, mechanicochemical ablation (MOCA), and the use of glue (Sapheon™ closure system). The following review juxtaposes the literature supporting the use of tumescent-based techniques to the literature supporting the use of tumescent-less techniques
Collapse
|
21
|
Willenberg T, Smith PC, Shepherd A, Davies AH. Visual disturbance following sclerotherapy for varicose veins, reticular veins and telangiectasias: a systematic literature review. Phlebology 2014; 28:123-31. [PMID: 23761921 DOI: 10.1258/phleb.2012.012051] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of the study was to review the literature reporting visual disturbance (VD)following sclerotherapy for varicose veins. Underlying mechanisms will be discussed. A literature search of the databases Medline and Google Scholar was performed. Original articles including randomized trials, case series and case reports reporting VD in humans following sclerotherapy for varicose veins were included. Additional references were also obtained if they had been referenced in related publications. The search yielded 4948 results of which 25 reports were found to meet the inclusion criteria. In larger series with at least 500 included patients the prevalence of VD following sclerotherapy ranges from 0.09% to 2%. In most reports foam sclerotherapy was associated with VD (19); exclusive use of liquid sclerosant was reported in two cases, some reports included foam and liquid sclerosant (4). There were no persistent visual disorders reported. VD occurred with polidocanol and sodium tetradecyl sulphate in different concentrations (0.25–3%). Various forms of foam preparation including various ways of foam production and the liquid –air ratio (1 or 2 parts of liquid mixed with 3, 4 or 5 parts of air) were reported in association with the occurrence of VD. VDs following sclerotherapy for varicose veins are rare and all reported events were transient. Bubble embolism or any kind of embolism seems unlikely to be the only underlying mechanism. A systemic inflammatory response following sclerotherapy has been suggested. Further research to clarify the mechanism of action of sclerosants is required.
Collapse
Affiliation(s)
- T Willenberg
- Academic Section of Vascular Surgery Imperial College School of Medicine Charing Cross Hospital, London, UK
| | | | | | | |
Collapse
|
22
|
Rabe E, Breu FX, Cavezzi A, Smith PC, Frullini A, Gillet JL, Guex JJ, Hamel-Desnos C, Kern P, Partsch B, Ramelet AA, Tessari L, Pannier F. European guidelines for sclerotherapy in chronic venous disorders. Phlebology 2013; 29:338-54. [DOI: 10.1177/0268355513483280] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim Sclerotherapy is the targeted chemical ablation of varicose veins by intravenous injection of a liquid or foamed sclerosing drug. The treated veins may be intradermal, subcutaneous, and/or transfascial as well as superficial and deep in venous malformations. The aim of this guideline is to give evidence-based recommendations for liquid and foam sclerotherapy. Methods This guideline was drafted on behalf of 23 European Phlebological Societies during a Guideline Conference on 7–10 May 2012 in Mainz. The conference was organized by the German Society of Phlebology. These guidelines review the present state of knowledge as reflected in published medical literature. The regulatory situation of sclerosant drugs differs from country to country but this has not been considered in this document. The recommendations of this guideline are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines. Results This guideline focuses on the two sclerosing drugs which are licensed in the majority of the European countries, polidocanol and sodium tetradecyl sulphate. Other sclerosants are not discussed in detail. The guideline gives recommendations concerning indications, contraindications, side-effects, concentrations, volumes, technique and efficacy of liquid and foam sclerotherapy of varicose veins and venous malformations.
Collapse
Affiliation(s)
- E Rabe
- Department of Dermatology, University of Bonn, Bonn, Germany
| | - FX Breu
- Practice for Vascular Medicine, Tegernsee, Germany
| | - A Cavezzi
- Vascular Unit, Poliambulatorio Hippocrates and Clinic Stella Maris, San Benedetto del Tronto (AP), Italy
| | | | - A Frullini
- Studio Medico Flebologico – Figline Valdarno, Florence, Italy
| | - JL Gillet
- Vascular Medicine and Phlebology, Bourgoin-Jallieu, France
| | - JJ Guex
- Cabinet de Phlébologie, Nice, France
| | - C Hamel-Desnos
- Department of Vascular Medicine, Saint Martin Private Hospital, Caen, France
| | - P Kern
- Private office Vevey, Service of Angiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - AA Ramelet
- Department of Dermatology, University of Bern, Switzerland
| | | | - F Pannier
- Department of Dermatology, University of Cologne, Cologne, Germany
| | | |
Collapse
|
23
|
Silva MADM, Burihan MC, Barros ODC, Nasser F, Ingrund JC, Neser A. Resultados do tratamento da Insuficiência Venosa Crônica grave com espuma de polidocanol guiada por ultrassom. J Vasc Bras 2012. [DOI: 10.1590/s1677-54492012000300007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXTO: A insuficiência venosa crônica (IVC) em suas formas mais graves, com ulceração e lesões inflamatórias, associa-se a um tratamento cirúrgico convencional de difícil execução. A escleroterapia de veias tronculares com espuma de polidocanol é considerada uma alternativa terapêutica com resultados satisfatórios. OBJETIVO: Relatar os resultados da escleroterapia com espuma de polidocanol no tratamento de pacientes com IVC de membros inferiores com úlcera ativa. MÉTODOS: Em um período de 48 meses, 71 pacientes (76 membros) foram submetidos à escleroterapia de veias tronculares com espuma de polidocanol a 3% guiada por ultrassom. O seguimento pós-procedimento foi feito por meio de questionário clínico, exame físico e ultrassom Doppler, realizados em sete dias, um e seis meses e, a partir de então, semestralmente. Analisou-se tempo de cicatrização da úlcera, melhora de sintomas clínicos, recanalização, recidiva dos sintomas e complicações. RESULTADOS: O sexo feminino correspondeu a 61% dos casos, e a idade variou de 25 a 85 anos (média de 59 anos). O tempo médio de acompanhamento foi de 460 dias. O refluxo do sistema venoso profundo foi observado em 53,4% dos membros. A cicatrização das úlceras ocorreu em 84,2% dos casos, com um tempo médio de cicatrização de 37 dias. A recanalização ocorreu em 31,5%, porém a recidiva de sintomas, com ressurgimento de úlcera, foi de 11,8%. CONCLUSÃO: A esclerose com espuma é efetiva e apresenta altas taxas de cicatrização de úlceras, com baixos índices de complicações, em pacientes com IVC grave.
Collapse
|
24
|
Rathbun S, Norris A, Stoner J. Efficacy and safety of endovenous foam sclerotherapy: meta-analysis for treatment of venous disorders. Phlebology 2012; 27:105-17. [DOI: 10.1258/phleb.2011.011111] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Aim Endovenous foam sclerotherapy (EFS) is used widely throughout the USA for the treatment of venous disorders. The purpose of the quantitative meta-analysis was to systematically and comprehensively evaluate the literature to provide accurate estimates of safety and efficacy outcomes for this procedure. Methods A comprehensive electronic search of published literature in several databases was performed using a wide variety of MESH headings. In addition, meeting abstracts and bibliographies of selected references were reviewed for eligible papers. Two reviewers abstracted selected treatment-related data. Results Of 684 identified manuscripts and abstracts reviewed, 104 papers were abstracted and analysed. More than 50% were published between 2004 and 2008. EFS was found to be effective with similar vein occlusion rates to laser therapy, but less effective than surgery. In addition, major adverse effects were rare. Conclusions EFS is a safe and effective therapy for the treatment of venous disorders.
Collapse
Affiliation(s)
- S Rathbun
- Cardiovascular Section, College of Medicine
| | - A Norris
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - J Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
25
|
Long-term results of a randomized controlled trial on ultrasound-guided foam sclerotherapy combined with saphenofemoral ligation vs standard surgery for varicose veins. J Vasc Surg 2012; 55:451-7. [DOI: 10.1016/j.jvs.2011.08.040] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 08/18/2011] [Accepted: 08/22/2011] [Indexed: 11/20/2022]
|
26
|
Darvall K, Bate G, Adam D, Silverman S, Bradbury A. Duplex Ultrasound Outcomes following Ultrasound-guided Foam Sclerotherapy of Symptomatic Recurrent Great Saphenous Varicose Veins. Eur J Vasc Endovasc Surg 2011; 42:107-14. [DOI: 10.1016/j.ejvs.2011.03.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 03/13/2011] [Indexed: 11/25/2022]
|
27
|
Changing to endovenous treatment for varicose veins: How much more evidence is needed? Surgeon 2011; 9:150-9. [DOI: 10.1016/j.surge.2010.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 10/30/2010] [Accepted: 11/02/2010] [Indexed: 11/18/2022]
|
28
|
Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML, Lohr JM, McLafferty RB, Meissner MH, Murad MH, Padberg FT, Pappas PJ, Passman MA, Raffetto JD, Vasquez MA, Wakefield TW. The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011; 53:2S-48S. [PMID: 21536172 DOI: 10.1016/j.jvs.2011.01.079] [Citation(s) in RCA: 802] [Impact Index Per Article: 61.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 01/12/2011] [Accepted: 01/15/2011] [Indexed: 12/20/2022]
Affiliation(s)
- Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Morrison N, Neuhardt D, Rogers C, McEown J, Morrison T, Johnson E, Salles-Cunha S. Incidence of Side Effects Using Carbon Dioxide–Oxygen Foam for Chemical Ablation of Superficial Veins of the Lower Extremity. Eur J Vasc Endovasc Surg 2010; 40:407-13. [DOI: 10.1016/j.ejvs.2010.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 04/18/2010] [Indexed: 11/16/2022]
|
30
|
Stücker M, Kobus S, Altmeyer P, Reich-Schupke S. Review of published information on foam sclerotherapy. Dermatol Surg 2010; 36 Suppl 2:983-92. [PMID: 20590705 DOI: 10.1111/j.1524-4725.2009.01406.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND New data on foam sclerotherapy of varicose veins has been recently published. OBJECTIVE To identify the current treatment modalities and their effectiveness in use of foam sclerotherapy. MATERIALS AND METHODS Review of the recent literature regarding clinical treatment of varicose veins using foam sclerotherapy, with emphasis on safety and efficacy. RESULTS Foam sclerotherapy of the great saphenous vein is more effective than liquid. Higher sclerosant concentrations tend to induce higher occlusion. Catheter-assisted sclerotherapy may further improve occlusion rates. To achieve adequate occlusion, vein diameter and volume of foam must be matched. If a critical foam volume is exceeded, the risk of deep venous thrombosis increases. Foam sclerotherapy offers the possibility of using lower sclerosant concentrations than with liquids. Foam sclerotherapy can also be used in venous malformations and periulcerous tributaries. Side effects are hyperpigmentation, skin necrosis, scotoma, and thromboembolic events. Thromboembolism prophylaxis is necessary only in patients with special risk factors. CONCLUSION Foam sclerotherapy has significantly better efficacy than liquid. It is essential to select the correct concentration and the correct foam volume. In the hands of an experienced physician, foam sclerotherapy is a safe and effective option for treating varicose veins.
Collapse
Affiliation(s)
- Markus Stücker
- Department of Dermatology and Vascular Surgery, Vein Centre-Ruhr-University Bochum, St Maria-Hilf-Hospital, Bochum, Germany.
| | | | | | | |
Collapse
|
31
|
Bradbury AW, Bate G, Pang K, Darvall KA, Adam DJ. Ultrasound-guided foam sclerotherapy is a safe and clinically effective treatment for superficial venous reflux. J Vasc Surg 2010; 52:939-45. [PMID: 20638224 DOI: 10.1016/j.jvs.2010.04.077] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Revised: 04/23/2010] [Accepted: 04/29/2010] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To test the hypothesis that ultrasound-guided foam sclerotherapy (UGFS) is a safe and durable treatment for superficial venous reflux (SVR) associated with CEAP clinical grade 2-6 disease. METHODS This was an interrogation of a prospectively gathered computerized database. RESULTS Between March 23, 2004 and December 31, 2009, 977 patients (1252 legs) underwent UGFS for unilateral (702 legs) or bilateral (550 legs) SVR in association with CEAP clinical grade 2-3 (n = 868), 4 (n = 232), or 5/6 (n = 152) disease. The following reflux in 1417 venous segments was treated: primary great saphenous vein (GSV) (n = 745); recurrent GSV (n = 286), primary small saphenous vein (SSV) (n = 189), recurrent SSV (n = 50); primary anterior accessory saphenous vein (AASV) (n = 93); recurrent AASV (n = 46); vein of the popliteal fossa (VOPF) (n = 5), and Giacomini vein (GV) (n = 3). Three hundred forty-eight legs (27.8%) had undergone previous surgery. Three patients suffered post-UGFS deep vein thrombosis (DVT) and one a pulmonary embolus (PE), all within the first month (0.4% venous thrombo-embolic complication rate). Five patients (0.5%) had transient visual disturbance at the time of, or shortly after, treatment. No other neurologic or serious complications were reported. During a mean (range) follow-up of 28 (<1 to 68) months, 161 (12.9%) legs underwent a further session of UGFS for truncal VV at a mean (range) of 17 (<1 to 63) months following the first treatment. In 52 legs, retreatment was due to the development of new SVR and in 109 legs was for true recurrence (8.7% complete or partial recanalization rate leading to treatment). There was no significant difference in retreatment rates between UGFS for GSV and SSV reflux or between UGFS for primary or recurrent disease. CONCLUSION UGFS for CEAP 2-6 SVR is associated with a low complication and retreatment rate. However, as patients are at risk of developing recurrent and new SVR they should be kept under review. Further UGFS for new or recurrent disease is simple, safe, and effective.
Collapse
Affiliation(s)
- Andrew W Bradbury
- Department of Vascular Surgery, Birmingham University, Birmingham, UK.
| | | | | | | | | |
Collapse
|
32
|
Pittaluga P, Chastanet S, Locret T, Rousset O. Retrospective evaluation of the need of a redo surgery at the groin for the surgical treatment of varicose vein. J Vasc Surg 2010; 51:1442-50. [DOI: 10.1016/j.jvs.2009.12.065] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 12/16/2009] [Accepted: 12/23/2009] [Indexed: 11/16/2022]
|
33
|
Brunken A, Rabe E, Pannier F. Changes in venous function after foam sclerotherapy of varicose veins. Phlebology 2009; 24:145-50. [DOI: 10.1258/phleb.2009.008068] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Foam sclerotherapy of varicose veins has recently proven to be an effective, economic and safe treatment modality. The present study attempts to evaluate the haemodynamic changes after sclerotherapy in addition to the clinical results. Methods In a prospective observation trial, 67 sites (2/3 of which were recurrent varicose [RV] veins after previous treatment) in 53 patients were treated with polidocanol foam, and the results were assessed clinically, by duplex, photoplethysmography and strain gauge plethysmography. Results With the exception of two sites (3.0%), all treatments resulted at least in an improvement, and about 80% of the treated veins were completely occluded as demonstrated by duplex ultrasound examination. The haemodynamical results accordingly reflected a significant improvement of the venous function. Patients with post-thrombotic syndrome showed poorer results. Conclusion Foam sclerotherapy is a highly effective and safe method for the treatment of primary and RV veins.
Collapse
Affiliation(s)
| | - E Rabe
- Departmet of Dermatology, University of Bonn, Germany
| | - F Pannier
- Akademisch Ziekenhuis Maastricht, Afdeling Dermatologie, Maastricht, The Netherlands
| |
Collapse
|
34
|
Geroulakos G, Davies AH. Crossectomy and foam: has it got a role in the contemporary management of primary varicose veins? Phlebology 2009; 24:1-2. [DOI: 10.1258/phleb.2008.081005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- G Geroulakos
- Vascular Surgery, Imperial College of Science Technology and Medicine at Charing Cross Hospital, London, UK
| | - A H Davies
- Vascular Surgery, Imperial College of Science Technology and Medicine at Charing Cross Hospital, London, UK
| |
Collapse
|
35
|
Morrison N, Neuhardt DL, Rogers CR, McEown J, Morrison T, Johnson E, Salles-Cunha SX. Comparisons of side effects using air and carbon dioxide foam for endovenous chemical ablation. J Vasc Surg 2008; 47:830-6. [DOI: 10.1016/j.jvs.2007.11.020] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 11/01/2007] [Accepted: 11/10/2007] [Indexed: 11/26/2022]
|
36
|
Varicose Vein Stripping vs Haemodynamic Correction (CHIVA): a Long Term Randomised Trial. Eur J Vasc Endovasc Surg 2008; 35:230-7. [DOI: 10.1016/j.ejvs.2007.09.011] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Accepted: 09/03/2007] [Indexed: 11/22/2022]
|
37
|
Foam Sclerotherapy for the Treatment of Superficial Venous Insufficiency. Surg Clin North Am 2007; 87:1285-95, xii-xiii. [DOI: 10.1016/j.suc.2007.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
38
|
Kendler M, Wetzig T, Simon JC. Foam sclerotherapy — A possible option in therapy of varicose veins. J Dtsch Dermatol Ges 2007; 5:648-54. [PMID: 17659037 DOI: 10.1111/j.1610-0387.2007.06310.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The therapy of varicose veins is multimodal and depends on the individual clinical findings. In addition to compression therapy, invasive approaches for elimination of reflux for the treatment of varicose veins are available, such as surgical and interventional methods and sclerotherapy. The administration of a sclerosing agent into a varicose vein results in an occlusion of the treated vein. Recently the use of foam sclerotherapy had a renaissance. Several studies have documented the efficacy of foam sclerotherapy in selected patients. The possibility of treating patients in an outpatient setting, with low costs and rapidly, makes foam sclerotherapy very attractive compared to invasive and minimally invasive methods. However long-term follow-ups in properly controlled randomized trials are needed before foam sclerotherapy can be recommended as a routine procedure. This paper introduces the method and the treatment possibilities with foam sclerotherapy in chronic venous insufficiency.
Collapse
Affiliation(s)
- Michael Kendler
- Department of Dermatology, Venereology and Allergy, University of Leipzig, Germany.
| | | | | |
Collapse
|
39
|
Jia X, Mowatt G, Burr JM, Cassar K, Cook J, Fraser C. Systematic review of foam sclerotherapy for varicose veins. Br J Surg 2007; 94:925-36. [PMID: 17636511 DOI: 10.1002/bjs.5891] [Citation(s) in RCA: 202] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
Background and method
Foam sclerotherapy is a potential treatment for varicose veins. A systematic review was undertaken to assess its safety and efficacy.
Results
Sixty-nine studies were included. The median rates of serious adverse events, including pulmonary embolism and deep vein thrombosis, were less than 1 per cent. The median rate of visual disturbance was 1·4 per cent, headache 4·2 per cent, thrombophlebitis 4·7 per cent, matting/skin staining/pigmentation 17·8 per cent and pain at the site of injection 25·6 per cent. The median rate of complete occlusion of treated veins was 87·0 per cent and for recurrence or development of new veins it was 8·1 per cent. Meta-analysis for complete occlusion suggests that foam sclerotherapy is less effective than surgery (relative risk (RR) 0·86 (95 per cent confidence interval (c.i.) 0·67 to 1·10)) but more effective than liquid sclerotherapy (RR 1·39 (95 per cent c.i. 0·91 to 2·11)), although there was substantial heterogeneity between studies.
Conclusion
Serious adverse events associated with foam sclerotherapy are rare. There is insufficient evidence to allow a meaningful comparison of the effectiveness of this treatment with that of other minimally invasive therapies or surgery.
Collapse
Affiliation(s)
- X Jia
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
| | | | | | | | | | | |
Collapse
|
40
|
Kalodiki E, Azzam M, Geroulakos G. Trichophyia and hypertrichosis: A side effect of foam sclerotherapy. J Vasc Surg 2006; 44:1377. [PMID: 17145449 DOI: 10.1016/j.jvs.2006.08.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 08/14/2006] [Indexed: 11/23/2022]
|