title: Effectiveness and safety of ultrasound-guided foam sclerotherapy for recurrent varicose veins: immediate results.
abstract: OBJECTIVE
  To evaluate the effectiveness and safety of ultrasound-guided foam sclerotherapy in treating recurrent varicose veins.
  
  
  METHODS
  Between July 2003 and January 2005, 38 outpatients (25 women; median age 59 years, interquartile range 53.5-66.0) with recurrent varicose veins in 45 legs were treated. Ultrasound was used to identify sites of reflux. The Tessari method was used to produce foam using 3% sodium tetradecyl sulphate; up to 6 mL of foam was injected per session under ultrasound control. Results are shown as median (interquartile range).
  
  
  RESULTS
  A single sclerotherapy session was adequate in 26 (58%) legs. In 87% of all legs, complete elimination of both varicose veins and all reflux points was achieved. A positive association between the amount of injected foam and CEAP class (r=0.45, p=0.002) and venous clinical severity score (r=0.37, p=0.012) was found. There was a trend for more sclerotherapy sessions [median 2 (1-2)] in legs with incomplete saphenofemoral junction/ great saphenous vein (GSV) ligation or accessory GSV (n=16) to achieve varicose vein ablation versus legs with other primary sites of reflux [median 1 (1-2), p=0.12]. There were no instances of deep vein thrombosis or systemic complications; superficial thrombophlebitis occurred in 6 (8.2%) of the 73 injection sessions. Legs with proximal reflux due to previous incomplete ligation or fed by an incompetent pelvic vein experienced superficial thrombophlebitis more frequently (4/12, 33%) than legs without proximal reflux [1/33 (3%); OR 16, 95% CI 1.6-164, p=0.014].
  
  
  CONCLUSIONS
  In most patients, ultrasound-guided foam sclerotherapy is a safe treatment for recurrent varicose veins, with an excellent immediate result. However, the presence of proximal reflux may decrease the immediate results and predispose to superficial thrombophlebitis.
authors.affiliation: Vascular Unit, Ealing Hospital and Department of Vascular Surgery, Imperial College, London, UK.
authors.forename: Stavros K
authors.initials: SK
authors.lastname: Kakkos
authors.forename: Dimitrios G
authors.initials: DG
authors.lastname: Bountouroglou
authors.forename: Mustafa
authors.initials: M
authors.lastname: Azzam
authors.forename: Evi
authors.initials: E
authors.lastname: Kalodiki
authors.forename: Marios
authors.initials: M
authors.lastname: Daskalopoulos
authors.forename: George
authors.initials: G
authors.lastname: Geroulakos
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000009:adverse effects / Q000627:therapeutic use*; D015911:Sclerotherapy; D012720:Severity of Illness Index; D012981:Sodium Tetradecyl Sulfate / Q000009:adverse effects / Q000627:therapeutic use*; D013924:Thrombophlebitis / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000628:therapy*
chemical_list: D012597:Sclerosing Solutions; D012981:Sodium Tetradecyl Sulfate