Liquid versus foam sclerotherapy

A systematic review to compare efficacy and safety of foam (F) sclerotherapy versus liquid (L) sclerotherapy for primary varicose veins of the lower limbs.

Systematic searches of electronic databases were conducted in April 2009 to identify relevant published studies. Database searches were augmented with abstracts from conference proceedings and electronic and hand searching of journals not consistently indexed in the major databases.

For treatment of saphenous veins, six trials (four randomized controlled trials) were considered. Despite containing much less sclerosing agent, F was markedly more effective compared with L, the difference being put at between 20% and 50%. Four studies were included in a meta-analysis showing efficacy of F at 76.8% (95% confidence interval [CI] 71-82) versus L at 39.5% (95% CI 33-46), chi(2) = 60.9740; P < or = 0.0001. For reticular veins and telangiectases, only two comparative trials were found and do not at present provide any conclusive evidence to support the superiority of efficacy of one form over the other. Statistically, the side-effects reported in all the available comparative trials do not differ between F and L forms, even if visual disturbances seem to be more common with F.

In the treatment of varices of the lower limbs, F shows much greater efficacy compared to L. Concerning the side effects, no statistical significant differences were found between L and F.