Foam sclerotherapy techniques: different gases and methods of preparation, catheter versus direct injection.
BACKGROUND
Foam sclerotherapy has gained a great popularity among phlebologists worldwide, although a major lack of homogeneity in the material used to produce sclerosant foam (SF) and to inject SF has been reported.


OBJECTIVE
To highlight the literature data and a few personal clinical and experimental outcomes concerning the main variables in SF production and injection.


METHODS
A review of the published literature and of our own 12 year clinical and experimental experience has been undertaken in order to focus on a few variables of the material and methods used to produce SF with Tessari method and to inject SF.


RESULTS
In SF production, differences in gas components, liquid to gas ratio, as well in disposable material can variably influence the resulting SF. Similarly SF injection through ultrasound guidance, with needle, or with short/long catheter may exhibit different foam behaviours according to the variable material and techniques which are employed. More recently the introduction of long catheters, possibly together with hook phlebectomy, seems to potentiate the short-mid term outcomes of foam sclerotherapy.


CONCLUSIONS
SF formation is greatly influenced by the choice of the gas component, the liquid-to-gas ratio, the type of syringes; also larger needles are to be preferred for injection of SF, while long catheters seem to represent a valid alternative especially when combined with tumescence to minimise saphenous diameter.
Cavezzi
A
A
Vascular Unit, Poliambulatorio Hippocrates, Via Gioranni XXIII 7, 63039 San Benedetto del Tronto (AP), Italy. info@cavezzi.it
Tessari
L
L
D000388:Air; D002245:Carbon Dioxide / Q000008:administration & dosage; D002406:Catheterization, Peripheral; D003902:Detergents; D004304:Dosage Forms; D004867:Equipment Design; D005740:Gases; D006801:Humans; D007275:Injections, Intravenous; D045423:Microbubbles; D009339:Needles; D010100:Oxygen / Q000008:administration & dosage; D012501:Saphenous Vein; D012597:Sclerosing Solutions / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015911:Sclerotherapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013594:Syringes; D018084:Ultrasonography, Interventional; D014648:Varicose Veins / Q000628:therapy*
D003902:Detergents; D004304:Dosage Forms; D005740:Gases; D012597:Sclerosing Solutions; D002245:Carbon Dioxide; D010100:Oxygen