Sclerosants in microfoam. A new approach in angiology

The aim of this work was to study the outcomes of echosclerosis using sclerosants in microfoam incompetent long saphenous veins, hypertensive venous ulcers and inoperable venous malformations and to record any secondary effects.

We examined the records, pre- and post-treatment and follow-up colour photographs, and echo Doppler images for: 415 patients with incompetent long saphenous veins of diameter more than 9 mm in 265 patients suffering from postsurgical recurrence of varicose saphenous veins; 72 patients with venous ulcers; and 31 with venous malformations. All patients had been treated with ultrasound-guided injections of sclerosants in microfoam.

After 4-6 years follow-up, 80% of the long saphenous veins were obliterated and all superficial branches had disappeared in 95% of legs. In the post-surgical recurrence group, 81% of recurrent veins were obliterated and 90% of the branches had disappeared. Among the patients with ulcers, the latter remain closed after a mean of 2.5 years treatment in 77% of the cases; recurrence in the remainder was due to recanalisation of perforating veins. All venous malformations were reduced in size and 9 of them had disappeared completely. Minor transient adverse effects included coughing, inflammation and photopsia. There were no serious complications, such as deep vein thrombosis or pulmonary embolism or scotoma.

The quality and stability of the outcomes and the low complication rate observed in this preliminary study may make sclerotherapy with microfoam the therapeutic approach of choice for the anatomical and functional elimination of an extensive range of venous pathology. Controlled trials on a standardised sclerosant microfoam are now required to confirm these results to make the method widely available.