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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
REVIEW CONTROVERSIES IN VENOUS DISEASES
Italian Journal of Vascular and Endovascular Surgery 2010 Settembre;17(3):207-16
Ultrasound guided foam sclerotherapy for superficial venous disease: evolution and controversies
Cooper D. G., Earnshaw J. J.
Department of Vascular Surgery, Gloucester Royal Hospital, Gloucester, UK
The use of sclerotherapy in the treatment of superficial venous disorders has undergone something of a revolution over the last ten years. This has been driven largely by the acceptance of the increased efficacy of sclerosant foam (SF) in the ablation of both truncal incompetence as well as varicose tributaries, under ultrasound guidance. The technique has evolved rapidly alongside other endovenous therapies, namely endovenous laser ablation (EVLA) and radiofrequency ablation (RFA), to challenge traditional surgery as the treatment of choice in the management of symptomatic superficial venous disease. Studies report the best method of foam preparation and delivery to achieve optimal results. Comparative data, including a limited number of small randomized controlled trials, suggest ultrasound guided foam sclerotherapy (UGFS) can achieve equivalent results to these other modalities in the treatment of all degrees of venous disease severity. Multiple treatment sessions are, however, frequently needed to obtain the best results and efficacy is often limited by target vein diameter. Major side effects are rare and the treatment generally well tolerated, although more minor problems such as skin staining can be problematic. With few costly consumables and no dependence on general anesthesia UGFS appears the most cost effective treatment for varicose veins. Furthermore it is probably the most versatile, being amenable to both primary and recurrent disease, truncal reflux and varicose tributaries and also as an adjunct to other modalities that are limited to the treatment of the saphenous trunks alone.