The sclerosant hydroxy polyethoxy dodecane (HDP) was studied in rats, and the results were compared with those from a previous study of tetradecyl sulphate of sodium (TSS).
There appeared to be no significant difference between the two. The sclerosant efficiency increases with increasing concentration up to 6%, but a higher concentration that 6% in un-likely to be more effective in the rat or in man. In man, good results probably depend on exposure on the endothelium to sclerosant undiluted with blood for 1 second, and the total volume of 6% HPD or 6% TSS at one visit, should not exceed 10ml.
Full article
The current practice of operating upon patients with varicose veins as the treatment of choice costs more than £15 million a year.
The bulk of this expense is due to the length of time that patients are kept in the ward. If they were treated as outpatients, either by Fegan's method or by operation, the cost would be reduced to one-tenth of what is now spent. Even if the operation were done on a 'short-stay' basis, the cost would be reduced to one-third or less.
Although the long-term results of Fegan's method are uncertain, there is no doubt that it gives better immediate results than an operation. Moreover, there is no particular type of varicosity or shape of limb, which precludes its use.
Although the long term results of Fegan's method are uncertain there is no doubt that it gives better immediate results than an operation. Moreover, there is no particular type of varicosity or shape of limb which precludes its use.
Full articleChronic venous insufficiency is a common disease in adulthood. One recently developed therapy for varicose veins is foam sclerotherapy.
We used foam sclerotherapy in a 51-year-old man and a 33-year-old woman, who had symptomatic varicose great saphenous veins and were otherwise healthy. Immediately after the initiation of treatment, transient scotomas developed in the man, and a migraine attack in the woman.
Full article Letters RepliesBackground: The results of surgery for small saphenous varicose vein (SSV) varicosities may be suboptimal in terms of recurrence and complications.
Eighty-six patients (92 legs) undergoing UGFS for SSV were assessed before, and 1, 6 and 12 months after treatment. Outcome measures were occlusion of, and abolition of reflux, the SSV (technical success), absence of visible varicose veins (clinical success) and improvement in disease-specific health-related quality of life (HRQL), following treatment (Aberdeen Varicose Vein Symptom Severity Score (AVSS).
The technical and clinical success rates at 12 months were 91 and 93 percent respectively; only three patients required a second treatment. After treatment of isolated SSV varicosities, there was a significant improvement in AVSS, from a median of 19·0 (interquartile range 13·4 26·8) before treatment to 10·2 (4·0 18·3) and 9·7 (3·5 19·1) at 6 and 12 months respectively. The only complication was a popliteal vein thrombosis, that required anticoagulation.
UGFS was an effective treatment for SSV, with abolition of reflux and visible varicose veins, and improvement in HRQL for at least 12 months.
Background: Injection sclerotherapy is widely used for superficial varicose veins. The treatment aims to obliterate the lumen of varicose veins or thread veins. There is limited evidence regarding its efficacy.
To determine whether sclerotherapy is effective in improving symptoms and cosmetic appearance and has an acceptable complication rate; to define rates of symptomatic or cosmetic varicose vein recurrence following sclerotherapy.
The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2006), MEDLINE and EMBASE (both inception to October 2006) and reference lists of articles. Manufacturers of sclerosants were contacted for additional trial information.
Randomised controlled trials (RCTs) of injection sclerotherapy versus graduated compression stockings (GCS) or 'observation', or comparing different sclerosants, doses, formulations and post-compression bandaging techniques on people with symptomatic and/or cosmetic varicose veins or thread veins were considered for inclusion in the review.
Data were extracted by authors and Review Group Co-ordinators independently. Main results seventeen studies were included. One study, comparing sclerotherapy to GCS in pregnancy found, that sclerotherapy improved symptoms and cosmetic appearance. Three studies, comparing sodium tetradecyl sulphate (STD) to alternative sclerosants, found no significant differences in outcome or complication rates; another study found that sclerotherapy with STD led to improved cosmetic appearance compared with polidocanol, although there was no difference in symptoms.
Sclerosant plus local anaesthetic reduced the pain from injection (one study),but had no other effects. Two studies compared foam- to conventional sclerotherapy; one found no difference in failure rate or recurrent varicose veins; a second showed short-term benefit from foam in terms of elimination of venous reflux. The recanalisation rate was no different between the two treatments. One study comparing Molefoam and Sorbo pad pressure dressings, found no difference in erythema or successful sclerosis. The degree and duration of elastic compression had no significant effect on varicose vein recurrence rates, cosmetic appearance or symptomatic improvement.
Evidence from RCTs suggests, that the choice of sclerosant, dose, formulation (foam versus liquid), local pressure dressing, degree and length of compression have no significant effect on the efficacy of sclerotherapy for varicose veins. The evidence supports the current place of sclerotherapy in modern clinical practice, which is usually limited to treatment of recurrent varicose veins, following surgery and thread veins. Surgery versus sclerotherapy is the subject of a further Cochrane Review.
Induced spreading depression in rats is associated with a micro-area of selective neuronal necrosis: Two different theories of migraine aura exist: In the vascular theory of Wolff, intracerebral vasoconstriction causes...
...migraine aura via energy deficiency, whereas in the neuronal theory of Lea˜o and Morison, spreading depression (SD) initiates the aura.
Recently, it has been shown that the cerebrovascular constrictor endothelin-1 (ET-1) elicits SD, when applied to the cortical surface, a finding that could provide a bridge between the vascular and the neuronal theories of migraine aura. Several arguments support the notion that ET-1–induced SD results from local vasoconstriction, but definite proof is missing. If ET-1 induces SD via vasoconstriction/ ischemia, then neuronal damage is likely to occur, contrasting with the fact that SD in the otherwise normal cortex is not associated with any lesion.
To test this hypothesis, we have performed a comprehensive histologic study of the effects of ET-1 when applied topically to the cerebral cortex of halothane-anesthetised rats. Our assessment included: histologic stainings and immunohistochemistry for glial fibrillary acidic protein, heat shock protein 70, and transferase dUTP nick-end labelling assay. During ET-1 application, we recorded (i) subarachnoid direct current (DC) electroencephalogram, (ii) local cerebral blood flow by laser- Doppler flowmetry, and (iii) changes of oxyhemoglobin and deoxyhemoglobin by spectroscopy. At an ET-1 concentration of 1 lM, at which only 6 of 12 animals generated SD, a micro-area with selective neuronal death was found only in those animals demonstrating SD.
In another five selected animals, which had not shown SD in response to ET-1, SD was triggered at a second cranial window by KCl and propagated from there to the window exposed to ET-1. This treatment also resulted in a micro-area of neuronal damage. In contrast, SD invading from outside did not induce neuronal damage in the absence of ET-1 (n = 4) or in the presence of ET-1 if ET-1 was coapplied with BQ-123, an ETA receptor antagonist (n = 4). In conclusion, SD in presence of ET- 1 induced a micro-area of selective neuronal necrosis, no matter where the SD originated. This effect of ET-1 appears to be mediated by the ETA receptor.
Introduction: Foam sclerotherapy has gained a great popularity among phlebologists worldwide, although a major lack of homogeneity in the material used to produce sclerosant foam (SF) and to inject SF has been reported.
To highlight the literature data and a few personal clinical and experimental outcomes concerning the main variables in SF production and injection.
A review of the published literature and of our own 12 year clinical and experimental experience have been undertaken, in order to focus on a few variables of the material and methods used to produce SF with Tessari'smethod and to inject SF.
n SF production, differences in gas components, liquid to gas ratio, as well in disposable material can variably influence the resulting SF. Similarly, SF injection through ultrasound guidance, with needle, or with short/ long catheter may exhibit different foam behaviours, according to the variable material and techniques which are employed. More recently the introduction of long catheters, possibly together with hook phlebectomy, seems to potentiate the short- to mid-term outcomes of foam sclerotherapy.
SF formation is greatly influenced by the choice of the gas component, the liquid-to-gas ratio, the type of syringes; also, larger needles are to be preferred for injection of SF, while long catheters seem to represent a valid alternative, especially when combined with tumescence to minimise saphenous diameter.
Background: Foam sclerotherapy is a potential treatment for lower limb venous disease.
A systematic review, with no restriction on study design, to assess the safety and efficacy of foam sclerotherapy.
67 studies were included. For serious adverse events, including pulmonary embolism and deep vein thrombosis, the median event rates were less than 1%. Median rate for visual disturbance was 1.4%. Median rates for some other adverse events were more common, including headache (4.2%), thrombophlebitis (4.7%), matting/ skin staining/ pigmentation (17.8%) and pain at the site of injection (25.6%).
Median rate for complete occlusion of treated veins was 87.0% and for recurrence or development of new veins was 8.1%. Evidence from meta-analysis for complete occlusion suggests, that foam sclerotherapy is associated with a lower rate compared with surgery (RR 0.86, 95% CI 0.67 to 1.10) and a higher rate compared with liquid sclerotherapy (RR 1.39, 95% CI 0.91 to 2.11). However, there was substantial heterogeneity across the studies in the meta-analysis.
Serious adverse events were rare. A high quality RCT with follow-up of at least three years is required to determine the comparative effectiveness of foam sclerotherapy and its place in clinical practice.
Objective: The objective of this study is to review the methods and outcome of ultrasound guided foam sclerotherapy (UGFS) for the treatment of superficial venous incompetence.
Medical literature databases, including Medline, were searched for recent literature concerning UGFS. Papers describing methods and outcomes have been assessed and their main findings included in this summary. A detailed description of the methods used by the author has been included, as an example of what success may be achieved by the treatment.
A diverse range of practice is described in published literature in this field. Each group of authors used their own variation of the methods, described in the published literature, with good results. It is clear that foam sclerotherapy is far more effective than liquid sclerotherapy and that ultrasound imaging allows the treatment to be delivered accurately to affected veins. There is evidence that 3% policocanol foam is no more effective than 1% polidocanol foam. The optimum ratio of gas to liquid is 4:1, although a range of ratios is reported in published work.
There is a wide variation in the volume used, as well as the method by which it is injected. The use of carbon dioxide foam reduces the systemic complications, particularly visual disturbance, when compared with air foams. Very few serious adverse events have been reported in the literature, despite the widespread use of this method. Rates of recanalisation of saphenous trunks following UGFS are similar to those observed after endovenous laser and endovenous radiofrequency ablation of veins, as well as the residual incompetence after surgical treatment.
UGFS is a safe and effective method of treating varicose veins. The relative advantages or disadvantages of this treatment in the longer term are yet to be published.
Cost-effectiveness of tradition and endovenous treatments for varicose vein. The aim of this study was to evaluate the cost-effectiveness of traditional and endovenous treatments for patients with primary great saphenous varicose veins.
A Markov model was constructed to compare costs and quality-adjusted life years (QALYs) for great saphenous vein (GSV) reflux. Eight popular treatment strategies were compared up to 5 years. Estimates for the effectiveness of treatments were obtained from published randomized studies and cost values were obtained from published National Health Service (NHS) healthcare resource group tariffs and device manufacturers. Parameter uncertainty was tested using sensitivity analysis and Monte Carlo simulation.
Ultrasound-guided foam sclerotherapy (UGFS) had the lowest initial cost, but a higher requirement for further interventions. Day-case surgery (with concomitant treatment of varicosities), endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) performed in an outpatient or office setting (with staged treatment of varicosities) were likely to be cost-effective treatment strategies. The incremental cost-effectiveness ratio (ICER) for UGFS (versus conservative care), EVLA (versus UGFS) and RFA (versus EVLA) were £1366, £5799 and £17 350 per QALY respectively. The ICER for traditional surgery (performed on a day-case basis) was £19 012 compared with RFA. Other strategies were not cost-effective using the NHS threshold of £20 000 per QALY.
Day-case surgery or endovenous ablation using EVLA or RFA performed as an outpatient are likely to be cost-effective treatment strategies for patients with primary unilateral GSV reflux requiring treatment.
Comparison of tetradecyl sulphate of sodium with other sclerosants in rats. Abstract:
The two sclerosants widely used in the treatment of varicose veins of the leg are tetradecyl sulphate of sodium and ethanolamine oleate.
Tetradecyl sulphate of sodium is also used in the treatment of haemorrhoids and in this situation its competitor is five percent phenol in almond oil. Hitherto no comparison of the effects of these three sclerosants appears to have been published, despite their very extensive use. The present work, in rats, reports on their efficiency as vein sclerosants, the mortality following intravenous injection and the incidence of ulceration following intradermal or subcutaneous injection. A detailed study of the effect on the veins of injection of tetradecyl sulphate of sodium is reported elsewhere.
Chronic venous disease treated by ultrasound guided foam sclerotherapy. Aim: To report the outcome of a series of patients with chronic venous disease due to incompetence of saphenous trunks managed by ultrasound guided foam sclerotherapy (UFS).
A group of 808 patients comprise this series. CEAP clinical class for limbs was C1: 15%, C2: 81%, C3: 0.5%, C4: 2%, C5: 0.2%, C6: 0.4%. UFS using 1% polidocanol (107 limbs), 1% sodium tetradecyl (102 limbs), 3% sodium tetradecyl (900 limbs) was employed to treat incompetent saphenous trunks. In patients with unilateral varices 1 treatment was required in 43% of patients and 2 treatments in 48% of patients to obliterate incompetent saphenous trunks and varices. For bilateral varices 2 treatments were required in 40% of patients and 3 treatments in 46% of cases. The clinical outcome and patency of treated veins on duplex ultrasonography was assessed at a mean follow-up interval of 11 months.
A total of 459 limbs were available for assessment at a follow-up interval of 6 months or greater. The CEAP clinical stage was C0:182 limbs, C1: 241, C2: 22, C3: 0, C4: 11, C5: 2, C6:1. The GSV had remained obliterated in 88% of limbs and the SSV in 82% of limbs. Recurrent venous incompetence following previous surgery was as effectively treated by UFS as primary incompetence.
This technique is useful in the management of chronic venous disease as an alternative to surgery.
A decade ago, a doctor's advice to a patient with varicose veins was easy: the alternatives are injection sclerotherapy or surgery. Only these techniques have existed long enough to know about both their short andlong-term results. Results have generally been disappointing, with high recurrence rates as time goes by.
The past few years have witnessed an explosion in types of minimally invasive treatment technique and this has made decisions about varicose vein treatment more difficult. These techniques include thermal ablation in the form of endovenous laser ablation or radiofrequency ablation (RFA), and foam sclerotherapy.
The introduction of these new methods has been rapid, before any adequate scientific evaluation. It is based on the enthusiasm of practitioners and some short-term trials that demonstrate equivalence of outcome with conventional surgery, but with less postoperative discomfort and speedier return to normal activity. In addition, the new techniques can be employed under local anaesthetic, often in an outpatient setting, thereby freeing operating theatre time and potentially improving cost efficacy. Increasing access to information has encouraged patients to seek these new treatments, often after visiting commercially sponsored websites. Many feel bewildered by the available choice, while being seduced by the prospect of involvement in decision making.
Ultrasound-guided foam sclerotherapy combined with sapheno-femoral ligation compared to surgical treatment of varicose veins. Aim: This study is a prospective randomised controlled trial comparing sapheno-femoral ligation, great saphenous stripping and multiple avulsions with sapheno-femoral ligation and ultrasound guided foam sclerotherapy to the saphenous vein.
Primary end points were patient recovery period and quality of life and secondary end points frequency of complications on the two arms of the trial and the cost of the treatment.
Sixty patients with primary varicose veins due to GSV incompetence and suitable for day case surgery were randomly allocated to undergo ultrasound-guided sclerotherapy with sapheno-femoral ligation under local anaesthesia (nZ30) or sapheno-femoral ligation, stripping and multiple avulsions under general anaesthesia (nZ30). The study protocol included history, physical examination, assignment of CEAP class and assessment venous clinical severity score (VCSS), completion of the Aberdeen Vein Questionnaire (AVQ) and colour duplex ultrasound.
All treatments were completed as intended. Median time to return to normal activities was significantly reduced in the foam sclerotherapy group (2 days) compared to the surgical group (8 days) (p!0.001, Mann–Whitney). AVQ score was also significantly reduced at 3 months by 46% in the sclerotherapy group, and by 40% in the conventional surgery group (p!0.001, Wilcoxon).
The time taken to complete treatment was shorter in the foam sclerotherapy plus SFJ ligation group: 45 vs. 85 min (p!0.001, Mann–Whitney). The overall cost of the procedure in the sclerotherapy group (£672.97) was significantly less compared to conventional surgery (£1120.64).
At 3 weeks, there was no statistical difference in the complication rate between the two groups. At 3 months, median CEAP class dropped from four pre-operatively to one following treatment in both groups and the median VCSS score dropped from five to one in group one and from seven to three in group two (p!0.001, Wilcoxon test). In group one four patients (13%) had a recanalised vein, which needed further sessions of foam sclerotherapy, resulting in a short-term closure rate of 87%.
Ultrasound guided sclerotherapy combined with sapheno-femoral ligation was less expensive, involved a shorter treatment time and resulted in more rapid recovery compared to sapheno-femoral ligation, saphenous stripping and phlebectomies.
Objectives: The aim was to explore the current experience and practice of vascular surgeons in the United Kingdom and Ireland regarding foam sclerotherapy for varicose veins.
A postal questionnaire was sent to 609 members of the Vascular Society of Great Britain and Ireland.
There were 281 responses (47%). Seventy surgeons (25%) used foam sclerotherapy. Most use it selectively; few (29%) offer it to all patients. It was more likely to be used for recurrent varices (71%), in older patients (61%) and for smaller non-saphenous varices (67%). The majority of surgeons (69%) used sodium tetradecyl sulphate and up to a maximum of 10e12 ml of foam. The majority used ultrasound guidance (95%), leg elevation (69%) and direct pressure over the saphenofemoral or saphenopopliteal junction during injection (63%). Eighty percent used compression bandaging after treatment, usually for 7 days (44%). Ninety percent advised compression stockings, usually Class II (64%) for 14 days (39%). Serious complications were few, but eleven surgeons had seen a deep vein thrombosis, two had seen a patient with a stroke and one a transient ischaemic attack.
Foam sclerotherapy was used by a quarter of surgeons, who replied to the survey. Aspects of technique varied considerably and studies to determine optimal techniques are needed. Serious complications with the technique were rare.
Background:
Varicose veins are a relatively common condition and account for around 54,000 in-patient hospital episodes per year.
The two most common interventions for varicose veins are surgery and sclerotherapy. However, there is little comparative data regarding their effectiveness.
To identify whether the use of surgery or sclerotherapy should be recommended for the management of primary varicose veins.
Thirteen electronic bibliographic databases were searched covering biomedical, science, social science, health economic and grey literature (including current research). In addition, the reference lists of relevant articles were checked and various health services research-related resources were consulted via the internet. These, included health economics and HTA organisations, guideline producing agencies, generic research and trials registers, and specialist sites.
All studies, that were described as randomised controlled trials comparing surgery with sclerotherapy for the treatment of primary varicose veins, were identified.
Two authors independently extracted and summarised data from the eligible studies, using a data extraction sheet for consistency. All studies were cross-checked independently by the authors.
A total of 2306 references were found from our searches, 61 of which were identified as potential trials,comparing surgery and sclerotherapy. However, only nine randomised trials, described in a total of 14 separate papers, fulfilled the inclusion criteria. Fifty trials were excluded and one trial is ongoing and is due for completion in 2004. The trials used a variety of outcome measures and classification systems, which made direct comparison between trials difficult. However, the trend was for sclerotherapy to be evaluated as significantly better than surgery at one year; after one year (sclerotherapy resulted in worse outcomes) the benefits with sclerotherapy were less, and by three to five years surgery had better outcomes. The data on cost-effectiveness was not adequately reported.
There was insufficient evidence to preferentially recommend the use of sclerotherapy or surgery. There needs to be more research that specifically examines both costs and outcomes for surgery and sclerotherapy.
Objectives: Increasing interest in foam sclerotherapy (FS) for saphenous insufficiency has highlighted the need to study the side-effects and complications of this treatment. The aim of this study is to better assess their nature and incidence.
A multicentre, prospective and controlled study was carried out, in which patients treated with FS for great (GSV) and small saphenous veins (SSV) trunk incompetence were included. Immediate untoward events were reported. Duplex ultrasound (DUS) examination was carried out to assess all patients between the eighth and 30th day. In addition, 20% of patients were called by an external auditor.
In total, 818 GSV and 207 SSV were treated in 1025 patients in 20 phlebology clinics. Ninety-nine percent of patients were controlled with DUS and non-duplex-checked patients were all called. The saphenous trunk was occluded in 90.3% of patients. Twenty-seven (2.6%) side-effects were reported: migraine (n ¼ 8, 4 with visual disturbance); visual disturbance alone (n ¼ 7); chest pressure alone (n ¼ 7); and chest pressure associated with visual disturbance (n ¼ 5). Eleven thrombo-embolic events occurred: 10 deep vein thrombosis (DVT), but only five in symptomatic patients, and one pulmonary embolism that occurred 19 days following the FS without DVT identified by DUS. One transient ischaemic stroke, with complete clinical recovery in 30 minutes, and one septicaemia with satisfactory outcome were reported as well.
This study demonstrates in a large sample of patients a low rate of adverse reactions after FS of great and small saphenous trunks. However, but the eventuality of exceptional, but more serious complications has to be taken into account in the management of patients. A multicentre study like this one takes into account different practices and reports all possible complications, thus demonstrating the need for a common validated protocol.
Pathophysiology of visual disturbances occurring after foam sclerotherapy. Background: Visual disturbances (VDs) are reported with an average rate of 1.4% after foam sclerotherapy (FS). Some clinical clues indicate that they could correspond to migraine with aura (MA).
To validate the hypothesis that VDs occurring after FS correspond to MA and are not transient ischaemic cerebro-vascular events.
A prospective multicentre study was carried out by the French Society of Phlebology in collaboration with the Neurology Department of the Marseille University Hospital (France). We included prospectively and consecutively all patients, who experienced VDs after FS, using air to make the foam. The patients were assessed (1) clinically with a specific form describing procedures of FS and recording neurological symptoms, later analysed by a neurologist specialised in migraine; and (2) by a brain diffusion-weighted magnetic resonance imaging (MRI) (T1, T2, T2∗, diffusion) carried out within two weeks and analysed by a neuroradiologist.
Twenty patients, 16 women and four men, were included in 11 phlebology clinics. All kinds of veins were treated. VDs occurred in average seven minutes after FS. Clinical assessment showed that VDs presented characteristics of MA in all patients, with headache in 10 and without in 10. Paresthesia was observed in five patients and dysphasic speech disturbance in one. Fifteen patients (75%) had a personal history of migraine. Fifteen MRIs were performed within two weeks (mean: 8 days) and three were late (26 days). All of them were normal. MRI was not performed in two patients.
These results show that VDs occurring after FS correspond to MA and are not transient ischaemic cerebro-vascular events. We suggest a pathophysiological hypothesis resting on the release of endothelin that would reach the cerebral cortex through a patent foramen ovale.
Objectives: The objective was to analyse the effectiveness of foam ultrasound-guided sclerotherapy treatment in saphenous veins and tributary veins with a diameter at the saphenofemoral or saphenopopliteal junction of <10 mm and compare these results with a subgroup of veins with diameters of <10 mm.
A subgroup of 17 saphenous veins with a diameter at the saphenofemoral or saphenopopliteal junction of <10 mm were compared with a subgroup of 98 saphenous veins with a diameter of <10 mm at the saphenofemoral or saphenopopliteal junction for clinical efficacy and patient satisfaction at a mean 2-year follow-up.
A mean number of 2.15 treatments utilising an average of 8.37 mL of foam sclerosing solution (3% sodium tetradecyl sulfate) were required to close all incompetent varicose veins in the <10-mm group versus a mean of 2.8 treatments and 13.9 mL foam (3% sodium tetradecyl sulfate) for the <10-mm group. A total of 27.5% of saphenous veins of o10 mm and 37.5% of saphenous veins 10 mm required a second treatment at 3 months. One-hundred percent of patients believed that their legs were successfully treated at 2-year follow-up in both groups with 94% of the <10-mm group noting improvements in quality of life and 100% in the 10-mm group.
Ultrasound-guided foam sclerotherapy is effective in treating all sizes of varicose veins with high patient satisfaction and improvement in quality of life. Duplex ultrasound findings demonstrated a small increase in failure to close the saphenofemoral or saphenopopliteal junction with increasing size of junction diameter, but this does not significantly alter the results with respect to clearance of visible varicosities and patient satisfaction with results.
Patients expectations before and satisfaction after ultrasound guided foam sclerotherapy for varicose veins. Objectives: Ultrasound guided foam sclerotherapy (UGFS) is a minimally invasive treatment for varicose veins (VV) whose clinical and cost-effectiveness remains incompletely defined.
Ultrasound guided foam sclerotherapy (UGFS) is a minimally invasive treatment for varicose veins (VV),whose clinical and cost-effectiveness remains incompletely defined.
The aim of the current study was to examine patients' expectations before and satisfaction after UGFS for VV in terms of relief of lower limb symptoms, improvement in appearance, and beneficial effect on life-style.
A consecutive series of 351 patients (464 limbs) undergoing UGFS for VV completed questionnaires one week prior to and six months after treatment.
Pre and post-treatment response rates were 80%; 60% returned both questionnaires. Virtually all patients were expecting improvement in lower limb symptoms; these were exceeded in a third. Most patients expected cosmetic improvement and these were largely met. Two-thirds of patients expected significant life-style (clothes, work, social) benefits and outcomes were slightly less than expected. A quarter expected improvement in their interpersonal relationships. This benefit was greater than expected, occurring in one-third of patients. Overall, a quarter of patients had their expectations exceeded and 10% (appearance and relationships) to 25% (clothing, work and social and leisure activities) were left with unmet expectations.
When specifically asked most patients admit to having a wide range of expectations in relation to their VV treatment, many of them probably unanticipated by the clinician. However, present data indicate that UGFS is usually able to meet, and often exceeds, these physical and psychosocial needs and expectations. UGFS is, therefore, a highly effective treatment for VV from the patients' perspective.
Prospective five-year study of ultrasound-guided foam sclerotherapy in the treatment of great saphenous vein reflux.
The purpose of this study was to determine the long-term efficacy, safety and rate of recurrence for varicose veins associated with great saphenous vein (GSV) reflux treated with ultrasound-guided foam sclerotherapy (UGFS).
A five-year prospective study was performed, recording the effect on the GSV and saphenofemoral junction (SFJ) diameters, and reflux in the superficial venous system over time. UGFS was the sole treatment modality used in all cases, and repeat UGFS was performed where indicated, following serial annual ultrasound.
No serious adverse outcomes were observed – specifically no thromboembolism, arterial injection, anaphylaxis or nerve damage. There was a 4% clinical recurrence rate after five years, with 100% patient acceptance of success. Serial annual duplex ultrasound demonstrated a significant reduction in GSV and SFJ diameters, maintained over time. There was ultrasound recurrence in 27% at 12 months, and in 64% at five years, including any incompetent trunkal or tributary reflux even 1 mm in diameter being recorded. Thirty percent had pure ultrasound recurrence, 17% new vessel reflux and 17% combined new and recurrent vessels on ultrasound. Of all, 16.5% required repeat UGFS treatment between 12 and 24 months, but less than 10% in subsequent years. The safety and clinical efficacy of UGFS for all clinical, aetiological, anatomical and pathological elements classes of GSV reflux was excellent.
The popularity of this outpatient technique with patients reflects ease of treatment, lower cost, lack of downtime and elimination of venous signs and symptoms. Patients accept that UGFS can be repeated readily,if required, for recurrence in this common chronic condition. The subclinical ultrasound evidence of recanalisation or new vein incompetence needs to be considered in this light.
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