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A Journal on Phlebology
Acta Phlebologica 2008 August;9(2):47-54
The point on: an international on line debate foam sclerotherapy and patent foramen ovale
Aquarius Diagnostic Centre, Naples, Italy
The Sclerosing Foam and Patent Foramen Ovale on-line Event was held on the Internet from February 12th to 23rd, 2007. Participation was organised in two groups: the Vascular Experts Panel and the Participants. An electronic Survey was submitted to the Foam_PFO/Vasculab Communities. M.V. Forlee, whose paper was submitted for discussion, thoroughly detailed his clinical case. The reported event is very rare and essentially does not affect Ultrasound-Guided-Sclerotherapy practice. However, if PFO-screened, the patient could have been selected for an alternative venous surgery. Data on collateral effects are inconsistent. In many series they are practically absent, while in others a high incidence decreases by using preventive procedures after UGS. In a simple experimental protocol Bergan shows their disappearance after leg elevation, compared to supine leg position (P<0.000299). However, others have practically no collateral effects without leg elevation or using high quality foam or physiological gas mixtures. The following procedures were considered a complete preventive set: leg elevation (10’), avoid patient dressing or putting on shoes/stockings by-himself, avoid Valsalva and constipation. Patient selection can easily be introduced into daily practice through anamnesis, alternative surgical solutions and preventive measures, eventually adding a screening/monitoring procedure and high-quality foam. Foam UGS is very safe and effective in treating varicose veins. Well conducted studies are needed to make reliable comparisons with alternative treatment methods.