Fluoroscopy-Guided Endovenous Foam Sclerotherapy Using a Microcatheter in Varicose Tributaries Followed by Endovenous Laser Treatment of Incompetent Saphenous Veins

Abstract

Endovenous foam sclerotherapy using a microcatheter in varicose tributaries followed by EVLT in incompetent saphenous veins is a safe, effective, and technically feasible treatment for varicose veins. It not only reduces additional sclerotherapy and technical failure, but also makes multiple therapeutic sessions unnecessary.

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

“…We excluded patients younger than 18 years of age and those with nonpalpable pedal pulses, deep vein thrombosis, past history of surgery for varicose vein, inability to ambulate, generally poor health, and those who were pregnant, nursing, or planning to become pregnant at some time during the course of treatment (6). The informed consent was obtained from the patients under the following conditions: the patient had significant venous reflux in the duplex ultrasound with visible varicose tributaries (C2), the patient wanted to remove tributaries, and the patient was applicable to none of the exclusion criteria.…”

“…A 0.035-inch guide wire was then advanced and a 5-Fr catheter (Cordis, Miami, FL, USA) was advanced over the guide wire into the saphenous vein under ultrasound and fluoroscopic guidance. Once the guiding catheter was stabilized and a 2.3-Fr or 2.6-Fr microcatheter was placed into the guiding catheter coaxially, selective catheterization of the varicose tributaries followed by a venogram through the microcatheter was performed, to ascertain the connection to the deep venous system and the exact extent of the varicose tributaries (6). …”

“…The technical success of the endovenous sclerotherapy was defined by the successfully selective catheterization and the adequate injection of the foam into the varicose tributaries (6). The clinical success was considered to have been achieved when the ablated saphenous vein and the varicose tributaries, where the endovenous sclerotherapy was done, were observed to be successfully closed on ultrasound during the follow-up (6).…”

“…The clinical success was considered to have been achieved when the ablated saphenous vein and the varicose tributaries, where the endovenous sclerotherapy was done, were observed to be successfully closed on ultrasound during the follow-up (6). The duplex ultrasound criteria for successful closure included non-compressible veins and absence of blood flow within the entire varicose tributary system and the saphenous vein.…”

“…This obliterated the varicose tributaries and eliminated the need for the additional percutaneous sclerotherapy or phlebectomy during the follow-up period. According to a previous study (6), the degree of hyperpigmentation and pain or tenderness where the sclerotherapy was performed was not low.…”