Korean J Radiol.  2014 Aug;15(4):481-487. 10.3348/kjr.2014.15.4.481.

Fluoroscopy-Guided Endovenous Sclerotherapy Using a Microcatheter Prior to Endovenous Laser Ablation: Comparison between Liquid and Foam Sclerotherapy for Varicose Tributaries

Affiliations
  • 1Department of Radiology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 143-729, Korea.
  • 2Department of Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 143-729, Korea. ijyun@kuh.ac.kr
  • 3Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 143-729, Korea.

Abstract


OBJECTIVE
To compare the efficacy and adverse effects of endovenous foam sclerotherapy (EFS) and liquid sclerotherapy (ELS) using a microcatheter for the treatment of varicose tributaries.
MATERIALS AND METHODS
From December 2007 to January 2009, patients with venous reflux in the saphenous vein were enrolled. The foam or liquid sclerosant was injected through a microcatheter just before endovenous laser ablation (EVLA). Patients were evaluated for the technical success, clinical success, and procedure-related complications during the procedure and follow-up visits.
RESULTS
A total of 94 limbs were included: 48 limbs (great saphenous vein [GSV], 35; small saphenous vein [SSV], 13) were managed using EFS and EVLA (foam group; FG), and 46 limbs (GSV, 37; SSV, 9) were treated by ELS and EVLA (liquid group; LG). Varicose tributaries demonstrated complete sclerosis in 92.7% with FG and in 71.8% with LG (p = 0.014). Bruising (78.7% in FG vs. 73.2% in LG, p > 0.05), pain or tenderness (75.6% in FG vs. 51.2% in LG, p = 0.0237) were noted. Hyperpigmentation (51.2% in FG vs. 46.2% in LG, p > 0.05) was found.
CONCLUSION
Endovenous foam sclerotherapy using a microcatheter is more effective than ELS for eliminating remnant varicose tributaries prior to EVLA. However, EFS is more commonly associated with local complications such as pain or tenderness than ELS. Furthermore, both techniques seem to prolong the duration of hyperpigmentation along with higher costs.

Keyword

Varicose vein; Sclerotherapy; Laser

MeSH Terms

Catheters/adverse effects
Femoral Vein
Fluoroscopy/methods
Humans
Laser Therapy/methods
Radiography, Interventional/methods
*Saphenous Vein/radiography/surgery
Sclerosing Solutions/*administration & dosage/chemistry
Sclerotherapy/adverse effects/instrumentation/*methods
Treatment Outcome
Varicose Veins/radiography/*therapy
Venous Insufficiency/surgery
Sclerosing Solutions

Figure

  • Fig. 1 Fluoroscopic images after injection of foam (A) or liquid (B) sclerosant. Sclerosing foam (A) or liquid sclerosant (B) mixed with contrast media were injected into varicose tributaries using microcatheter (double arrows) under fluoroscopic guidance. Air bubbles can be seen clearly in foam sclerotherapy (arrows).


Cited by  1 articles

Retrograde Endovenous Laser Ablation through Saphenopopliteal Junctional Area for Incompetent Small Saphenous Vein: Comparison with Antegrade Approach
Jun Seok Kim, Sang Woo Park, Ik Jin Yun, Jae Joon Hwang, Song Am Lee, Hyun Keun Chee, Jin Ho Hwang
Korean J Radiol. 2016;17(3):364-369.    doi: 10.3348/kjr.2016.17.3.364.


Reference

1. Rao J, Wildemore JK, Goldman MP. Double-blind prospective comparative trial between foamed and liquid polidocanol and sodium tetradecyl sulfate in the treatment of varicose and telangiectatic leg veins. Dermatol Surg. 2005; 31:631–635. discussion 635.
2. Goldman MP, Bergan JJ. Sclerotherapy: treatment of varicose and telangiectatic leg veins. 3rd ed. St. Louis: Mosby;2001. p. 1–6.
3. Sigg K. The treatment of varicosities and accompanying complications; (the ambulatory treatment of phlebitis with compression bandage). Angiology. 1952; 3:355–379.
4. Fegan WG. Continuous compression technique of injecting varicose veins. Lancet. 1963; 2:109–112.
5. Uncu H. Sclerotherapy: a study comparing polidocanol in foam and liquid form. Phlebology. 2010; 25:44–49.
6. Park SW, Yun IJ, Hwang JJ, Lee SA, Kim JS, Chang SH, et al. Fluoroscopy-guided endovenous foam sclerotherapy using a microcatheter in varicose tributaries followed by endovenous laser treatment of incompetent saphenous veins: technical feasibility and early results. Dermatol Surg. 2009; 35:804–812.
7. Hardman RL, Rochon PJ. Role of interventional radiologists in the management of lower extremity venous insufficiency. Semin Intervent Radiol. 2013; 30:388–393.
8. Yamaki T, Nozaki M, Iwasaka S. Comparative study of duplex-guided foam sclerotherapy and duplex-guided liquid sclerotherapy for the treatment of superficial venous insufficiency. Dermatol Surg. 2004; 30:718–722. discussion 722.
9. Biemans AA, Kockaert M, Akkersdijk GP, van den Bos RR, de Maeseneer MG, Cuypers P, et al. Comparing endovenous laser ablation, foam sclerotherapy, and conventional surgery for great saphenous varicose veins. J Vasc Surg. 2013; 58:727–734.
10. Hamdan A. Management of varicose veins and venous insufficiency. JAMA. 2012; 308:2612–2621.
11. Barrett JM, Allen B, Ockelford A, Goldman MP. Microfoam ultrasound-guided sclerotherapy treatment for varicose veins in a subgroup with diameters at the junction of 10 mm or greater compared with a subgroup of less than 10 mm. Dermatol Surg. 2004; 30:1386–1390.
12. Zimmet SE. Sclerotherapy treatment of telangiectasias and varicose veins. Tech Vasc Interv Radiol. 2003; 6:116–120.
13. Breu FX, Guggenbichler S. European Consensus Meeting on Foam Sclerotherapy, April, 4-6, 2003, Tegernsee, Germany. Dermatol Surg. 2004; 30:709–717. discussion 717.
14. Breu FX, Guggenbichler S, Wollmann JC. Second European Consensus Meeting on Foam Sclerotherapy. Duplex ultrasound and efficacy criteria in foam sclerotherapy from the 2nd European Consensus Meeting on Foam Sclerotherapy 2006, Tegernsee, Germany. Vasa. 2008; 37:90–95.
15. Schadeck M. Ultrasound guided sclerotherapy. In : Schadeck M, editor. Duplex and Phlebology. Napoli: Gnocchi;1994. p. 115–128.
16. Rabe E, Otto J, Schliephake D, Pannier F. Efficacy and safety of great saphenous vein sclerotherapy using standardised polidocanol foam (ESAF): a randomised controlled multicentre clinical trial. Eur J Vasc Endovasc Surg. 2008; 35:238–245.
17. Alòs J, Carreño P, López JA, Estadella B, Serra-Prat M, Marinel-Lo J. Efficacy and safety of sclerotherapy using polidocanol foam: a controlled clinical trial. Eur J Vasc Endovasc Surg. 2006; 31:101–107.
18. Cavezzi A, Frullini A, Ricci S, Tessari L. Treatment of varicose veins by foam sclerotherapy: two clinical series. Phlebology. 2002; 17:13–18.
19. Hamel-Desnos C, Allaert FA. Liquid versus foam sclerotherapy. Phlebology. 2009; 24:240–246.
20. Coleridge Smith P. Saphenous ablation: sclerosant or sclerofoam? Semin Vasc Surg. 2005; 18:19–24.
Full Text Links
  • KJR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr