Foam sclerotherapy without Ultrasound guidance - can be effective ?

We have been performing foam sclerotherapy in our patients who had recurrence after previous varicose vein surgery or varicose veins without SFJ, SPJ reflux. This is also projected as the most cost effective therapy in our patients. During the past few years it was projected that foam sclerotherapy can be better performed under ultrasound guidance. We have performed foam sclerotherapy with and without ultrasound guidance but clinically we did not notice gross differences in both groups of patients. But it is important to do prior venous mapping (adequately) before the foam sclerotherapy is chosen as the treatment of choice. It is good to know that there are people advocating foam sclerotherapy without the ultrasound guidance. I am attaching the abstract - a single center experience of foam sclerotherapy without the ultrasound guidance in support of this concept.  

Dermatol Surg. 2007 Nov;33(11):1334-9; discussion 1339.

Single-center experience with foam sclerotherapy without ultrasound guidance for treatment of varicose veins. Uurto I, Hannukainen J, Aarnio P. Source Department of Surgery, Satakunta Central Hospital, Pori; and Department of Vascular Surgery, Tampere University Hospital, Tampere, Finland. ilkka.uurto@uta.fi. 

Varicose veins are a common disorder and many treatment methods are available.The aim of this study was to evaluate the short-term efficacy of foam sclerotherapy and the safety of performing the treatment in an outpatient clinic without ultrasound guidance. METHODS This was a prospective, nonrandomized study with foam sclerotherapy. All the patients were assessed before and after the procedure with a CEAP (Clinical, Etiology, Anatomy, Pathology) class and clinical score. At the same visit, duplex scanning was performed to evaluate the anatomic distribution of the varicose disease. The mean age of the patients was 49.2 years (SD,+/-10.6 years; median, 50.0 years). Altogether 41% of the legs had undergone a previous operation and 24% were recurrences. The follow-up time was 3 months. Twenty-five patients with 27 legs were treated successfully using foam sclerotherapy without ultrasound guidance. Twenty-one cases (78%) involved the great saphenous vein and 6 cases (22%) involved the small saphenous vein. The mean bandage time was 7.7 days (SD,+/-2.50 days; median, 8.50 days). The CEAP score decreased 73% after the procedure from 2.61 (SD,+/-0.80; median, 2.0) to 0.71 (SD,+/-0.95; median, 0; p<.001). and the mean clinical score decreased 45% from 4.45 (SD,+/-1.96; median, 4.0) to 2.46 (SD,+/-1.50; median, 2.0; p<.001), respectively. Three months after the treatment, duplex scanning showed saphenofemoral reflux in 63% of the legs and saphenopopliteal reflux in 40% of the legs. The most common complication was postoperative thrombophlebitis (66%). Other minor complications included pain (38%) and hematoma (4%). There were no major complications. Subjectively, 71% of the patients assessed the procedure as good or excellent and 29% as acceptable or poor. Foam sclerotherapy is also an effective and safe procedure when performed without duplex guidance. Thrombophlebitis is frequent when using a high concentration of polidocanol and a short bandage time. The high frequency of saphenofemoral and saphenopopliteal junction refluxafter the procedure can have a negative effect on the long-term results.