Color Duplex Ultrasound-Guided Foam Sclerotherapy: An Approach in the Management of Patients with Superficial Varicosities of Lower Extremity

Gamal WM and Mohamed AS

Background: Duplex ultrasonography guided foam sclerotherapy is now considered a valuable option in varicose vein treatment; it is conducted as an outpatient procedure, does not require general anesthesia and compared with surgery results in an earlier return to normal activities. However, for foam treatment several sessions may be required.
Aim of work: The objective of this study is to describe the efficacy, results and safety of Ultrasound guided foam sclerotherapy (UGFS) for treating superficial venous disease of the lower limbs.
Patients and methods: 80 patients (28 males, 52 females) who were diagnosed to have clinical and radiological evidence of lower extremities venous diseases in the Department of Vascular Surgery at Qena and Assiut University Hospitals from November 2014 to November 2015 were included. Their ages ranged from 18 to 57 years. Local ethics committee approval and written informed consent were obtained. As considered suitable for UGFS, the foam was prepared by Tessari’s method. Any residual veins treated with another session.
Results: Eighty patients presenting with symptomatic varicose veins of superficial system. There were 52 females (65%), and 28 males (35%) with a mean age of 55.76 ± 9.67. CEAP grades of the patients were as follows; (60.0%) in C2, (10.0%) in C3, (21.25%) in C4 (2.5%) in C5 and (6.25%) in C6. The affected segments of the superficial system which were treated were; (70.0%) great saphenous, (17.5%) small saphenous, (6.25%) were great saphenous vein and varices and (6.25%) were small saphenous vein and varices. The numbers of sessions needed to eradicate the affected segment were one session in (70%), two sessions in (18.75%) and three in (11.25%). Minor complications encountered were skin discoloration in 30% of patients, superficial thrombophlebitis in 16% and an allergy to the foam sclerosant in 2.5%. After one year follow up by colored duplex ultrasound (CDU) (70%) had complete occlusion, (15%) had partial occlusion and (80%) of patients showed improvement of CEAP classification.
Conclusion: UGFS is a safe and effective treatment as an alternative to surgical treatment for superficial system varicosities. One and infrequently two to three treatment sessions, leads to complete eradication of superficial reflux in virtually 100% of cases. It is considered as an outpatient procedure. Complications are few, and appear mostly self-limiting.