Saphenous ablation: sclerosant or sclerofoam?

During the last half of the 20th century, sclerotherapy as a major treatment of varicose veins came and went. At first, it was widely heralded as a substitute for surgery but after a prospective randomized study by Hobbs, interest in sclerotherapy waned. Just before the turn of the 21st century, Cabrera published his experience with foamed sclerosant in patients with great saphenous varices and arteriovenous malformations. Cabrera designed his treatment with the specific aim of obliterating the saphenous trunks. His technique consisted of filling the great saphenous vein in the thigh or the small saphenous vein in the calf with foamed sclerosant injected under ultrasound control. His initial report on long-term follow-up revealed that the results were at least comparable to surgery and perhaps somewhat better and his results have been confirmed by others. Investigations into treatment of small vein varices, including telangiectasias, has resulted in the finding that foam results in a 20% improved appearance compared to liquid sclerosant. The most popular sclerosants currently used as foams are polidocanol and sodium tetradecyl sulfate and of the many techniques used in making foams, the technique of Tessari has proven most popular. No randomized clinical trial comparing this technique to surgery has been published; however, the clinical series reports indicate that 80% to 90% of saphenous trunks remain occluded after 3 years when treated by foam sclerotherapy. Complications are seldom encountered but significant skin darkening and superficial thrombophlebitis are common. Temporary vision changes have occurred after foam and liquid sclerotherapy, with foam, these are always transient. Although the long-term efficacy of foamed sclerotherapy treatment is unlikely to be established for years, a number of phlebologists have taken up the practice because it has the advantage of not requiring general or regional anesthesia and takes much less time than equivalent surgical techniques.