title: Transient adverse events positively associated with patent foramen ovale after ultrasound-guided foam sclerotherapy.
abstract: OBJECTIVE
  To prospectively study the association between patent foramen ovale (PFO) detected by contrast transcranial Doppler (cTCD) and adverse events (AEs) reported by patients after ultrasound-guided foam sclerotherapy (UGFS) for the treatment of varicose veins.
  
  
  METHODS
  All patients reporting AEs after UGFS were studied using cTCD directed at the middle cerebral artery to determine the Spencer grading score by counting high-intensity transient signals. Agitated saline was used as the contrast medium. The Spencer grading score determined the presence or absence of PFO. All patients undergoing UGFS received follow-up phone calls within 24 hours and again two weeks after the procedure.
  
  
  RESULTS
  Of the 3259 patients who underwent UGFS, AEs were reported by seven (0.21%) patients at their first session. These included visual disturbance, migraine and chest discomfort. Five (71.4%) of these seven patients tested positive for PFO by cTCD. The two-week follow-up confirmed no permanent symptoms. Published studies show high sensitivity and specificity for cTCD when compared with contrast transesophageal echocardiography (cTEE).
  
  
  CONCLUSIONS
  The overall rate of AEs reported is consistent with published results. The presence of a PFO was detected in most patients reporting AEs after undergoing UGFS. While PFO screening with high sensitivity and specificity can be performed efficiently in the clinic setting, based on the literature, further investigation is warranted.
authors.affiliation: Dallas Non-Invasive Vascular Laboratory, Dallas, TX, USA. pmartimbo@aol.com
authors.forename: Pauline
authors.initials: P
authors.lastname: Raymond-Martimbeau
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000209:etiology; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000209:etiology; D011446:Prospective Studies; D015911:Sclerotherapy / Q000009:adverse effects* / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity; D017585:Ultrasonography, Doppler, Transcranial; D014648:Varicose Veins / Q000453:epidemiology* / Q000628:therapy*; D014786:Vision Disorders / Q000209:etiology; D055815:Young Adult