Foam sclerotherapy: cardiac and cerebral monitoring

To investigate and review collected and reported transcutaneous ultrasound, transthoracic echocardiography (TTE) and transcranial Doppler (TCD) data obtained during ultrasound-guided foam sclerotherapy (USGFS) of incompetent saphenous, tributary and perforating veins of the lower extremities.

TTE and/or middle cerebral artery TCD were performed during USGFS. Ultrasound (US) findings and adverse events were recorded. Existing literature was reviewed.

Ultrasound detected emboli circulating in superficial, perforating, communicating and deep veins and into the central circulation. TTE detected bright echoes in the right heart after every injection and in the left heart in up to 65% of selected patients. TCD high-intensity transient signals (HITS) were detected in 14-42% of the patients. Incidence of HITS was higher than patient reports of adverse events. Incidence of HITS was independent of foam volumes injected.

Echogenic signals were detected in non-treated veins, in heart chambers and in the cerebral circulation by transcutaneous US, TTE and TCD. Pathological consequences of such findings remain to be investigated.