Ultrasound-guided foam sclero -therapy of the small saphenous vein

Purpose Efficacy and safety of ultrasound-guided foam sclerotherapy (UGFS) for the treatment of primary venous disease is proven, but the main application field of UGFS remains the treatment of recurrent varicose veins (RVV). The aim of this study is to determine the extent to which this treatment indication is evidence-based. Methods In PubMed and other publicly accessible databases, literature was reviewed until June 2018 and checked for relevance. The focus was on results with regard to anatomical success as well as clinical success and perception by patients. Results Several observational studies comprised a subgroup of RVV patients, but systematic stratification for RVV patients were only rarely performed. In most of these studies including the few reports specifically investigating RVV patients anatomical success as the primary outcome measure revealed similar results compared to primary interventions and favourable results in patients with neovascularization. Data on clinical outcome and patient perception were inconclusive due to low study numbers and insufficient stratification. Complications in RVV patients were rare. Conclusion Although the advantages inherent to the UGFS principle provide a strong rationale that this method best meets the requirements of the specific RVV characteristics, concept and previous observations should be supported by more evidence. Systematic studies in RVV patients with sufficient sample size are required.

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Foam sclerotherapy in elderly patients

Kahle¹,

Friedrichsen²,

Recke³

2017

Phlebologie

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A 92-year-old patient was referred to the Department of Dermatology, Venerology and Allergology, Lübeck Campus of the Schleswig-Holstein University Hospitals, with a provisional diagnosis of erysipelas.On admission to hospital, there was clear swelling of the left lower leg with slight distal reddening. Multiple small painful ulcers over the left medial malleolus and the Achilles tendon were noticeable (▶ Fig. 1). The pulses in the left foot were not palpable. The interdigital spaces on both feet were severely macerated. There were obvious striated excoriations consistent with scratch marks, mainly on the left thigh, and the skin appeared very dry, commensurate with the patient's age.Duplex ultrasound scanning of the venous system revealed haemodynamically relevant varicosity of the small saphenous vein (SSV) on the left. Sourcing of the venous reflux showed a clear relationship between the small saphenous varicose vein and the ulceration (1, 2).Examination of the arterial supply found biphasic signals over the femoral and popliteal arteries on both sides. Monophasic signals were present over the posterior tibial artery and the dorsalis pedis artery in the left leg. The ankle-brachial index was 0.88 on the right and 1.06 on the left. Relevant comorbiditiesThe patient had had a transient ischaemic attack (TIA) in the anterior cerebral artery territory two years previously. Following a thalamic bleed in 2008, he had left-sided ataxic hemiparesis, affecting the leg more than the arm, and he also had chronic axonal polyneuropathy. Additional medical conditions included diabetes managed on diet alone with normal HbA 1c levels, a thrombogenic aortic arch, hypertension, and depression controlled on medication. He was also taking platelet aggregation inhibitors.

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Ultrasound-guided foam sclero -therapy of the small saphenous vein

Cited by 3 publications

References 21 publications

Spezifische Indikationen zur Schaumsklerosierung

Spezifische Indikationen zur Schaumsklerosierung

Evidence of Foam Sclerotherapy in the Treatment of Recurrent Varicose Veins

Foam sclerotherapy in elderly patients

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