Ultrasound-guided foam sclerotherapy vs. open surgical ligation for incompetent perforator veins: a retrospective...

To compare the efficacy and safety of ultrasound-guided foam sclerotherapy (UGFS) vs. open ligation for treating incompetent perforator veins (IPVs) and to identify independent risk factors for IPV recanalization following UGFS.

Clinical data from 97 patients with IPVs treated at Baoji People's Hospital between February 2019 and February 2022 were retrospectively analyzed. Patients were categorized into the UGFS group (Group A, n = 49) and the open surgery group (Group B, n = 48). All patients were followed up for at least 12 months. Perioperative parameters, clinical outcomes [perforator vein occlusion rates, Venous Clinical Severity Score (VCSS), ulcer healing], and postoperative complication rates were compared between groups. Generalized estimating equations (GEE) were employed to identify risk factors for recanalization in Group A, and Receiver operating characteristic (ROC) curves were generated to determine optimal cutoff values for these factors.

Group A had significantly shorter operative time (56.27 ± 9.70 vs. 68.60 ± 9.41 min, P < 0.05), less intraoperative blood loss (4.18 ± 2.37 vs. 8.85 ± 4.48 mL, P < 0.05), and lower 24-hour postoperative visual analogue scale (VAS) score [1 (2) vs. 3 (1), P < 0.05] than Group B, with no significant difference in postoperative hospital stay between the two groups (P = 0.517). Immediate occlusion rates were 100% in both groups. At 12 months, the vein-level occlusion rate was significantly higher in Group B (95.3%) than in Group A (86.8%) (OR = 3.060, 95% CI: 1.086-8.619, P = 0.034). However, no significant differences were found between groups regarding VCSS improvement or ulcer healing rates (P > 0.05). The total complication rate was lower in Group A (10.2%) than in Group B (22.9%), though this difference did not reach statistical significance (OR = 2.616, 95% CI: 0.833-8.213, P = 0.092). Multivariate GEE analysis identified perforator vein diameter >4.5 mm (OR = 5.501, 95% CI: 1.034-29.277, P = 0.046) and body mass index (BMI) > 27.2 kg/m² (OR = 1.385, 95% CI: 1.067-1.798, P = 0.014) as independent risk factors for recanalization in Group A. ROC curve analysis confirmed the predictive utility of these thresholds.

UGFS demonstrated a favorable safety and efficacy profile, supporting its role as a viable minimally invasive alternative. Treatment strategies should be individualized based on patient-specific characteristics, such as vein diameter and BMI.