A modified polidocanol endovenous microfoam (M-PEM) technique for the treatment of incompetent anterior saphenous vein and its large tortuous incompetent tributaries: A pilot study.

Abstract

ObjectivesTo describe a modified polidocanol endovenous microfoam (M-PEM) technique incorporating cold saline-induced vasospasm and perivenous tumescent infiltration for the treatment of large, incompetent accessory saphenous veins (ASV) and tortuous large tributaries (>8 mm diameter) not amenable to conventional endothermal ablation, not ideal for standard microfoam technique, and for whom phlebectomy was declined.MethodsA retrospective, single-center chart review identified consecutive patients with symptomatic incompetent ASV and large tortuous tributaries (>8 mm) in whom endothermal ablation was not technically feasible, and who had declined phlebectomy. The M-PEM protocol involves limb elevation and manual drainage, intraluminal cold saline (5-10°C) infusion to induce vasospasm, intravenous polidocanol endovenous microfoam (Varithena) injection, and concurrent perivenous tumescent infiltration to mechanically compress the vein wall onto the intraluminal microfoam. The primary outcome was technical success, defined as duplex ultrasound-confirmed closure at 7 and 30 days.ResultsSeven patients (mean age 49 years; 4 male, 3 female) whose largest ASV tributary had a mean diameter of 9.8 mm were treated. Mean Varithena dose was 8.1 mL. Technical success with closure was achieved in all seven patients (100%) at 7- and 30-day duplex follow-up. No major procedural complications, thrombotic events, or episodes of phlebitis were identified at 7 and 30 days.ConclusionsThis pilot study of 7 patients of the M-PEM technique to treat symptomatic incompetent ASV and its large tortuous tributaries achieved 100% technical success, with closure confirmed at 7 and 30 days in a preliminary series of seven patients. A larger prospective, multicenter, randomized controlled non-inferiority trial comparing M-PEM with standard phlebectomy with or without delayed truncal ablation with longer follow-up may extend the treatable range of polidocanol endovenous microfoam and offer a less invasive alternative to phlebectomy and truncal ablation.