title: Ultrasound-guided foam sclerotherapy is a safe and clinically effective treatment for superficial venous reflux.
abstract: OBJECTIVE
  To test the hypothesis that ultrasound-guided foam sclerotherapy (UGFS) is a safe and durable treatment for superficial venous reflux (SVR) associated with CEAP clinical grade 2-6 disease.
  
  
  METHODS
  This was an interrogation of a prospectively gathered computerized database.
  
  
  RESULTS
  Between March 23, 2004 and December 31, 2009, 977 patients (1252 legs) underwent UGFS for unilateral (702 legs) or bilateral (550 legs) SVR in association with CEAP clinical grade 2-3 (n = 868), 4 (n = 232), or 5/6 (n = 152) disease. The following reflux in 1417 venous segments was treated: primary great saphenous vein (GSV) (n = 745); recurrent GSV (n = 286), primary small saphenous vein (SSV) (n = 189), recurrent SSV (n = 50); primary anterior accessory saphenous vein (AASV) (n = 93); recurrent AASV (n = 46); vein of the popliteal fossa (VOPF) (n = 5), and Giacomini vein (GV) (n = 3). Three hundred forty-eight legs (27.8%) had undergone previous surgery. Three patients suffered post-UGFS deep vein thrombosis (DVT) and one a pulmonary embolus (PE), all within the first month (0.4% venous thrombo-embolic complication rate). Five patients (0.5%) had transient visual disturbance at the time of, or shortly after, treatment. No other neurologic or serious complications were reported. During a mean (range) follow-up of 28 (<1 to 68) months, 161 (12.9%) legs underwent a further session of UGFS for truncal VV at a mean (range) of 17 (<1 to 63) months following the first treatment. In 52 legs, retreatment was due to the development of new SVR and in 109 legs was for true recurrence (8.7% complete or partial recanalization rate leading to treatment). There was no significant difference in retreatment rates between UGFS for GSV and SSV reflux or between UGFS for primary or recurrent disease.
  
  
  CONCLUSIONS
  UGFS for CEAP 2-6 SVR is associated with a low complication and retreatment rate. However, as patients are at risk of developing recurrent and new SVR they should be kept under review. Further UGFS for new or recurrent disease is simple, safe, and effective.
authors.affiliation: Department of Vascular Surgery, Birmingham University, Birmingham, UK. andrew.bradbury@btinternet.com
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Bradbury
authors.forename: Gareth
authors.initials: G
authors.lastname: Bate
authors.forename: Karl
authors.initials: K
authors.lastname: Pang
authors.forename: Katy A
authors.initials: KA
authors.lastname: Darvall
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Adam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019992:Databases as Topic; D004739:England; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000209:etiology; D012008:Recurrence; D012501:Saphenous Vein / Q000000981:diagnostic imaging*; D015911:Sclerotherapy / Q000009:adverse effects; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014689:Venous Insufficiency / Q000000981:diagnostic imaging / Q000628:therapy*; D020246:Venous Thrombosis / Q000209:etiology; D055815:Young Adult