Complications, Indication and Tolerance of Foam Sclerotherapy in Varicose Vein Management Done in A Tertiary Care Centre in South India
Abstract
INTRODUCTION: Foam sclerotherapy is used for treating varicose veins in our institution for patients who are not willing for surgery, debilitated patients, recurrent ulcers, cosmetic & in SFV (Sapheno Femoral Vein) <6 mm size.
AIM: The aim of this study was to find and assess the rate and pattern of post–sclerotherapy complications in our institution compared with international standards.
MATERIALS AND METHOD: The present study was retrospective in nature and case records of patients who underwent foam sclerotherapy [2009-2013, lower limb-Ultrasound (USG) guided and blind] in our hospital [10% Sodiumtetradecylsulfate (STS), Tessari technique] were assessed to look for indication, tolerance to the procedure and immediate outcomes. A pre-tested and pre-validated questionnaire was used and physical examination were done to assess post-procedural complications. Statistical significance was p< 0.05.
RESULTS: Among 112 patients, 62.5 % were aged >50 years and 69% were males. It was observed that 22% had indication as recurrence; 43% had mild pain during procedure and 36.6% developed post-foam sclerotherapy complications. 47.6% of patients whose age were <50 years had CEAP(Clinical Etiological Anatomical Pathological) criteria C2(p=0.007). 48.8% with complications had multiple criteria(p=0.012) and 57.7% C2 had least complication (p=0.000). Cosmetic indication showed least tolerance. Use of 10% STS was found to have lesser complication rate (36%), compared to study which had 76% success with STS 3% and complication-64%.
CONCLUSION: Foam sclerotherapy is less invasive and its efficacy could be improved by performing under USG guidance, selection of sclerosant, appropriate candidate (age>50 years, multiple CEAP criteria, without pre-existing co-morbidities).
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References
Solomon AC, Maurya DK. Ultrasound guided foam sclerotherapy for varicose veins using two needle technique – A case series. Indian J Surg. 2010;72:249-51. https://doi.org/10.1007/s12262-010-0048-x
Bailey, Love. Short practice of surgery. (26th ed.) London: Hodder Arnold; 1991.
Callam MJ. Epidemiology of varicose veins. Br J Surg. 1994 Feb;81(2):167-73.
https://doi.org/10.1002/bjs.1800810204
Eklof B, Rutherford RB, Bergan JJ. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg. 2004;50(6): 1248-52. https://doi.org/10.1016/j.jvs.2004.09.027
Malhotra SL. An epidemiological study of varicose veins in Indian railroad workers from the south and north India with special reference to causation and prevention of varicose veins. Int J Epid. 2011;1(2):177-83. https://doi.org/10.1093/ije/1.2.177
Tan VKM, Tan SG. Technique and early results of ultrasound-guided foam sclerotherapy of the long saphenous vein for treatment of varicose veins. Singapore Med J. 2009;50(3): 284-7.
Robert L. Wrothington-Kirsch. Injection Sclerotherapy. Semin Intervent Radiol. 2005;22(3):209-17. https://doi.org/10.1055/s-2005-921954
Labas P, Ohradka B, Cambal M, Reis R, Fillo J. Long term results of compression sclerotherapy. Bratisl Lek Listy. 2003;104(2):78-81.
Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg. 2001 Jan;27(1):58-60. https://doi.org/10.1111/j.1524-4725.2001.00192.x
Subbarao NT, Aradhya SS, Veerabhadrappa NH. Sclerotherapy in the management of varicose veins and its dermatological complications. Indian J Dermatol Venereol Leprol 2013; 79:383-8. https://doi.org/10.4103/0378-6323.110746
Fun SK. Varicose veins of the lower limbs: A study of aetiology and symptomatology. Hong Kong Pract. 1988;10:3319-26.
Kanter A, Thibault P. Saphenofemoral junction incompetence treated by ultrasound-guided sclerotherapy, Dermatol Surg. 1996. 22: 48-652.https://doi.org/10.1111/j.1524-4725.1996.tb00612.x
Padbury A, Benveniste GL. Foam Echosclerotherapy of the small saphenous vein. Australian and New Zealand Journal of Phlebology. 2004;8:5-8.
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 10mm or greater compared with a subgroup of less than 10 mm. Dermatol Surg 2004; 30 :1386-1390 https://doi.org/10.1111/j.1524-4725.2004.30430.x
Michaels JA, Campbell WB, Brazier JE. Randomised clinical trial, observational study and assessment of cost-effectiveness of the treatment of varicose veins (REACTIV trial). Health Technol Assess. 2006;10(13): 1-196. https://doi.org/10.3310/hta10130
Tisi PV, Beverley C, Rees A. Injection sclerotherapy for varicose veins. Cochrane Database Syst Rev. 2006;(4):CD001732. https://doi.org/10.1002/14651858.CD001732.pub2
Breu FX, Guggenbichler S. European Consensus Meeting on Foam Sclerotherapy, April, 4-6, 2003, Tegernsee, Germany. Dermatol Surg. 2004;30(5):709-17; discussion 717. https://doi.org/10.1111/j.1524-4725.2004.30209.x

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