Foam sclerotherapy of saphenous veins—Results and side effects

Abstract

Ultrasound-guided foam sclerotherapy (UGFS) has become a common treatment of sephenous veins incompetence. The use of homemade foam is world-wide widespread though it is off-label in many countries.

Objective

The objective of this review is to present the results and the main side effects and complications of UGFS of saphenous veins.

Method

The method of this review is based on analyses of prospective randomized controlled trials (RCT) and case control studies including a large number of patients.

Results—efficacy

RCTs have demonstrated that UGFS is more efficient than liquid sclerotherapy. 1% polidocanol foam is not statistically less efficient than 3% polidocanol foam. Compared with the other methods of treatment of saphenous veins, RCTs have demonstrated that, though the failure rate was slightly higher after UGFS, the rate of recurrence and the clinical outcome were similar at 2 and 3-year follow-up.

Complications

Severe thromboembolic events are very rare. The frequency of deep vein thrombosis (DVT) is estimated at 0.6%. Most of DVTs are distal. However we recommend applying prophylactic measures in patients with a high risk of thromboembolism.

Neurological complications—while millions of foam sclerotherapy sessions have been performed worldwide, only a few cases of stroke have been reported. No death or stroke with significant after-effects related to the injection of foam has been reported to date. Prevention is based on the quality of foam and the injected volume (maximum of 10 mL per session according to the recommendations). Visual disturbances correspond to migraine with aura and are not transient ischemic attacks.

Conclusion

UGFS is a safe and cost-effective therapy for patients with saphenous vein incompetence.