In India, surgical therapies or endovenous ablative therapies for varicose veins are going to be more expensive than the sclerotherapy under local anesthesia. It is possible to treat more people if the sclerotherapy results are improved further with less primary or secondary failures. Sclerotherapy for the axial veins (GSV) is considered to be inadequate as they have a larger lumen and it is difficult to decide the concentration of the sclerosant solution prior to injection. Catheter directed foam sclerotherapy seems to be good in these patients to maintain the appropriate contact between the foam and venous endothelium. Some times we feel that the vein lumen reduction can help us to achieve better results. I noted a study in which vein (GSV) diameter was reduced by perivenous tumescent local anesthesia before the infection of foam sclerosant in the through a catheter. 8ml of 2% foam was used for occluding the GSV. Patients were followed 1, 6, 12 months period. No benefit could be found using additional TA to reduce the vein diameter before the treatment.
Eur J Vasc Endovasc Surg. 2013 Oct 30. pii: S1078-5884(13)00649-7. doi: 10.1016/j.ejvs.2013.10.017. [Epub ahead of print]
Catheter-directed Foam Sclerotherapy of Great Saphenous Veins in Combination with Pre-treatment Reduction of the Diameter Employing the Principals of Perivenous Tumescent Local Anesthesia.
Source
Department of Dermatology, University of Schleswig-Holstein, Campus Luebeck, Germany.
Abstract
OBJECTIVES:
The aim of this study was to evaluate occlusion rates of great saphenous veins (GSV) with a diameter between 5-10 mm that received a pre-treatment size reduction via perivenous tumescent application (TA) followed by catheter-directed foam sclerotherapy (CDFS).
METHODS:
A prospective blinded randomized clinical trial comparing the occlusion rates of GSV at 1-, 6-, and 12-month follow-up. Fifty patients were included and randomized into two groups. CDFS was performed accessing the GSV at knee level and applying 8 mL of 2% polidocanol-foam (EasyFoam) while the catheter was withdrawn. Strictly perivenous TA was performed in group 1 before applying the sclerosant agent. Occlusion rates and clinical scores were assessed by blinded examiners.
RESULTS:
After 12 months in group 1 full occlusion was achieved in 73.9%, partial occlusion in 8.7%, and 17.4% were classified as treatment failure. In group 2, 75% of the targeted GSV were fully occluded, 20% were partially occluded, and 5% were diagnosed as treatment failure. Both groups showed a significant reduction of the vein diameter. Patient's tolerance and satisfaction with the treatment was high in both groups.
CONCLUSION:
No benefit could be found using additional TA to reduce the vein diameter before the treatment.
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