Ultrasound-guided perisaphenous tumescence infiltration improves the outcomes of long catheter foam sclerotherapy combined with phlebectomy of the varicose tributaries

Cavezzi, Attilio; Mosti, Giovanni; Paolo, Sonia Di; Tessari, L; Campana, Fausto; Urso, S

doi:10.4081/vl.2015.4676

Cited by 11 publications

(15 citation statements)

References 41 publications

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“…These factors, at least theoretically, can result in a higher efficacy and safety of the treatment. Still, high quality studies confirming efficacy and safety of TAES in clinical practice have not yet been released [17,30,34,35]. Sclerotherapy is a standard phlebological procedure [33] and combined treatment (foam sclerotherapy with the application of perivenous tumescent solution) seems to be an interesting alternative for more technically complex and more expensive methods, such as RF and EVLT.…”

Section: Discussionmentioning

confidence: 99%

“…According to previous publications and authors' own experience, foam sclerotherapy can be used as a single treatment method, or in combination with surgical or endoluminal saphenous vein ablation [30][31][32]. In many cases foam sclerotherapy can be successfully used for complex treatments of pathologies of the entire superficial vein system, including obliteration of large veins and sclerotherapy of varicose veins.…”

Section: Tumescent-assisted Echosclerotherapy (Taes) In the Treatmentmentioning

confidence: 99%

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Tumescent-assisted echosclerotherapy (TAES) in the treatment of great saphenous vein incompetence

Hawro¹,

Urbanek²,

Mikusek³

2017

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Objectives: Despite encouraging results of saphenous vein sclerotherapy this method is not free of potential complications and does not guarantee a 100% rate of occlusion. In this paper, the author's own experiences with catheter-directed, tumescent solution-supported echo-guided foam sclerotherapy of the saphenous vein are presented. Material and methods: Thirty-four incompetent great saphenous veins were treated with foam sclerotherapy involving the use of long catheters and perivenous tumescent solution injection prior to foam administration. The mean length of incompetent saphenous veins was 25.5cm (range 14-39 cm). The diameters of the proximal part of the saphenous veins ranged from 5.0 to 15.0 mm. In 25 patients (71.4%), primary varicose veins were diagnosed, and in other patients either post-surgical (recurrent) or post-thrombotic saphenous veins were treated. Results: At 30-day follow up total occlusion of the entire segment of treated vein was achieved in 79.4% of cases. In one case the vein was not occluded, and in 6 patients (17.6%) a partial occlusion was revealed. In the group of 6 patients with partial vein occlusion, a repeated sclerotherapy with the use of a short catheter and ultrasound guided puncture was performed. 6 and 12 months after the procedure, 32 out of 34 obliterated veins (94.1%) remained fully occluded. The mean foam volume used for saphenous vein obliteration was 2.6 ml. No serious adverse events were reported. Conclusions: Tumescent-assisted echo-guided foam sclerotherapy is a safe and clinically effective method of saphenous vein obliteration, particularly for veins with no history of a previous thrombosis or surgical treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Tumescent-assisted Echosclerotherapy (Taes) In the Treatmentmentioning

confidence: 99%

Tumescent-assisted echosclerotherapy (TAES) in the treatment of great saphenous vein incompetence

Hawro¹,

Urbanek²,

Mikusek³

2017

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“…It involves the positioning of a catheter ahead of the saphenous trunk extension with the application of perivenous tumescent local anesthesia (PTLA) and intrasaphenous saline irrigation (ISI) before the SF delivery. 19,20 The aim of this study was to compare two techniques of foam sclerotherapy for the GSV incompetence: CDFS, combined with pre-treatment using PTLA, ISI before SF injection with usual UGFS.…”

Section: Introductionmentioning

confidence: 99%

Catheter-directed foam sclerotherapy with tumescence of the great saphenous vein versus ultrasound-guided foam sclerotherapy: A randomized controlled trial

et al. 2019

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Objectives To compare the effectiveness of two foam sclerotherapy techniques of the great saphenous vein. Methods Fifty subjects with varicose veins, edema, and great saphenous vein incompetence (diameter 6–10 mm) were randomly categorized into two equal groups and were treated with different foam sclerotherapy techniques: A (usual ultrasound-guided) and B (catheter-directed with tumescence). Concomitant phlebectomy was performed in all patients. Patients were seen on days 7 and 28, and at six and 12 months. The primary outcomes were the full success rate of the treated great saphenous vein and the number of patients who required retreatment sessions performed at 28-day follow-up. The secondary-assisted outcomes were the full success rates of the treated great saphenous vein after the retreatment sessions at six- and 12-month follow-up. Secondary outcomes were changes in quality of life and side effects and complications of the intervention. In case of reflux, retreatment sessions were performed at 28 days and six months in both groups. Results Full success rate of the treated great saphenous vein was 36% in group A vs. 80% in group B ( p = 0.012) and the number of patients who required retreatment sessions were n = 14 in group A vs. n = 3 in group B at 28-day follow-up ( p = 0.002). Both were statistically significant. At six and 12 months, the success rates were not statistically significant between the groups. Complication rates were similar between the groups. Quality of life improved in both groups with statistical difference ( p < 0.001). Conclusions Catheter-directed foam sclerotherapy with tumescence was better than usual ultrasound-guided foam sclerotherapy as it reached higher full success rate of the treated great saphenous vein and as a lower number of patients required retreatment sessions in the short-term. Both methods proved to be safe and improved the quality of life.

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“…However, UGFS is easily repeatable, with potentially better secondary results, 9,10 although retreatment increases the final costs. 11,12 Techniques to complement UGFS and increase its efficiency include foam injection with tumescent perivenous infiltration, 13,14 saline wash out 15 via catheter injection, 16 multisegment 'wash in-wash out' technique, 17 selective high compression, 18 and Esmarch bandaging (Alfa technique) 19 before injection.…”

Section: Introductionmentioning

confidence: 99%

Foam sclerotherapy of the great saphenous vein in association with pre-terminal saphenous junction ligation/division as an office-based procedure: 12-Month results

2017

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Objective Ultrasound-guided foam sclerotherapy (UGFS) - one of the most frequently recommended methods for treating great saphenous vein incompetence - is easy and inexpensive. However, it achieves a lower occlusion rate compared to endovenous thermal ablation. The application of UGFS to pre-terminal great saphenous vein interruption, eliminating the saphenous stem wash out effect, enhances the short-term occlusion rate. This study explores the results of this technique at 12 months. Method Thirty great saphenous veins (28 patients) with junction incompetence, with calibres >6 mm and >30 cm reflux stem length were submitted to echo-guided pre-terminal great saphenous vein interruption and foam great saphenous vein occlusion. Participants were subjected to a 12-month post-operative review by ultrasound assessment of great saphenous vein occlusion and terminal stump stability. Comparisons were made between pre-operative and 12-month Validation of Venous Clinical Severity Score (VCSS), photopletismography, Aberdeen questionnaire and complications. Results After 12 months, 28/30 great saphenous veins remained occluded (93%). One complete and one partial recanalization did not require retreatment. Four saphenous stumps showed a reflux during Valsalva (one due to recanalization, one limited to the stump, two with reflux in the anterior accessory saphenous vein). VCSS improved from 3.33 ± 1.64 to 0.67 ± 1.21 ( p < 0.05). Aberdeen questionnaire scores decreased from 9.44 ± 6.18 to 2.47 ± 3.77 ( p < 0.05). For photopletismographic examination, the mean venous refilling time (normal value: > 25 s) improved from 17.94 ± 11.97 to 31.4 ± 11.99 ( p < 0.05). Conclusion Applying pre-terminal great saphenous vein interruption to UGFS of the saphenous stem achieved an occlusion rate at one year similar to that of endovenous thermal ablation. The procedure is simple, effective, office based, and may be used as a 10-min prolongation to a phlebectomy.

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Ultrasound-guided perisaphenous tumescence infiltration improves the outcomes of long catheter foam sclerotherapy combined with phlebectomy of the varicose tributaries

Cited by 11 publications

References 41 publications

Tumescent-assisted echosclerotherapy (TAES) in the treatment of great saphenous vein incompetence

Tumescent-assisted echosclerotherapy (TAES) in the treatment of great saphenous vein incompetence

Catheter-directed foam sclerotherapy with tumescence of the great saphenous vein versus ultrasound-guided foam sclerotherapy: A randomized controlled trial

Foam sclerotherapy of the great saphenous vein in association with pre-terminal saphenous junction ligation/division as an office-based procedure: 12-Month results

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