Foam sclerotherapy

Summary

Methods to improve the efficacy of foam sclerotherapy might include: more vigorous agitation methods to produce more stable foam with smaller bubble size, increasing the volume and/or concentration of the sclerosing agent, use of an intravenous catheter, and leg elevation to evacuate as much blood as possible. Methods to improve the safety of foam sclerotherapy might include: use of an intravenous indwelling catheter; saphenofemoral junction occlusion; low foam volume; use of low silicon syringes; use of non airbased foam; avoidance of high concentration sclerosing agents in patients with duplicated femoral vein segments; leg elevation before or after injection of foam; and maintaining patient immobility after injection.

A series of studies and exercises are described which call into question many methods proposed to limit the dispersal of injected foam. The use of non air-based foam may reduce the incidence of side effects.

Zusammenfassung

Verfahren zur Verbesserung der Wirksamkeit der Schaumsklerotherapie sind: turbulente Mischverfahren, um stabilen Schaum mit kleinen Blasen zu erzeugen, Erhöhung des Volumens und/oder der Konzentration des Sklerosierungsmittels, Einsatz eines Venenkatheters, Hochlagern der Beine, um Blutleere zu erzeugen. Verfahren zur Verbesserung der Sicherheit der Schaumsklerotherapie sind: Einsatz von Venenverweilkathetern, saphenofemorale Ligatur, geringes Schaumvolumen, Einsatz von Spritzen mit niedrigem Silikonanteil, Verwendung von Schaum, der als Gaskomponente keine Luft enthält, Vermeidung hoher Sklerosierungsmittel-Konzentrationen bei Patienten mit doppelt angelegten Segmenten der Oberschenkelvene, Hochlagern der Beine vor und nach Schauminjektion und Einhaltung der Liegezeit nach Injektion.

Mehrere Studien und Tests werden beschrieben, die viele Verfahren in Frage stellen, die zur Begrenzung der Ausbreitung des injizierten Schaums empfohlen wurden. Mit Schaum ohne Luft als Gaskomponente kann die Inzidenz von Nebenwirkungen verringert werden.

Résumé

Les méthodes pour améliorer l’efficacité de la sclérothérapie à la mousse sont nombreuses : il faut mélanger avec vigueur le liquide pour obtenir les bulles les plus petites possibles, augmenter le volume et/ou la concentration de l’agent sclérosant, utiliser un cathéter intraveineux et surélever la jambe pour en vider le maximum de sang possible. Pour augmenter la sécurité du traitement il faut : placer correctement le cathéter intraveineux, obtenir l’occlusion de la jonction saphéno-fémorale, utiliser un faible volume de mousse, avoir des seringues faiblement siliconées. La mousse ne doit pas être mélangée à de l’air; il faut éviter les fortes concentrations d’agent sclérosant chez des patients avec des segments veineux fémoraux dupliqués; la surélévation de la jambe doit être faite avant ou après l’injection de mousse; le patient doit rester immobile après l’injection. Il existe une série d’études et de méthodes dont le but est de limiter la dispersion de la mousse injectée. L’usage d’une mousse produite sans air doit réduire le nombre des effets secondaires.

Keywords

Foam sclerotherapy - transthoracic echocardiography - transcranial Doppler

Schlüsselwörter

Schaumsklerotherapie - transthorakale Echokardiographie - transkranieller Doppler

Mots clés

Sclérothérapie à la mousse - échocardiographie trans-thoracique - doppler trans-crânien

• References

• 1 Orbach EJ. Contributions to the therapy of the varicose complex. J Int Coll Surg 1950; 29: 765-771.
• 2 Cabrera Garrido J, Cabrera JR J, Garcia-Olmedo MA. Elargissement des limites de la sclerotherapie: nouveaux produits sclerosants. Phlebologie 1997; 50: 181-188.
• 3 Monfreux A. Treatement sclerosant des troncs sapheneis et leurs collaterales e gros calibre par la methode MUS. Phlebologie 1997; 50: 351-353.
• 4 Tessari L. Nouvelle technique d’obtention de la sclero-mousse. Phlebologie 2000; 53: 129-133.
• 5 Cabrere AL. Endoluminal therapy with echoguided sclerosing foam – Current situation after 30 years of experience. UIP World Congress Chapter Meeting. San Diego, California: 2003
• 6 Hamel-Desnos C, Ouvry P, Benigni J-P, Boitelle G, Schadeck M, Desnos P, Allaert F-A. Comparison of 1% and 3% polidocanol foam in ultrasound guided sclerotherapy of the great saphenous vein: A randomised, double-blind trial with 2-year follow-up. ‘‘The 3/1 Study’’. Eur J Vasc Endovasc Surg 2007; 34: 723-729.
• 7 Yamaki T, Nozaki M, Iwasaka S. Comparative study of duplex-guided foam sclerotherapy and duplex-guided liquid sclerotherapy for the treatment of superficial venous insufficiency. Dermatol Surg 2004; 30: 718-722.
• 8 Hamel-Desnos C, Allaert FA, Benigni J, Boitelle G, Chleir F, Ouvry P. et al. Polidocanol foam 3% versus 1% in the great saphenous vein: Early results. Phlebologie 2005; 58: 175-182.
• 9 Belcaro G, Cesarone MR, Di Renzo A, Brandolini R, Coen L, Acerbi G. et al. Foam-sclerotherapy, surgery, sclerotherapy, and combined treatment for varicose veins: A 10-year, prospective, randomized, controlled, trial (VEDICO trial). Angiology 2003; 54: 307-315.
• 10 Cabrera J, Cabrera Jr J, Garcia-Olmedo A. Treatment of varicose long saphenous veins with microfoam form: Long-term outcomes. Phlebology 2000; 15: 19-23.
• 11 McDonagh B, Huntley DE, Rosenfeld R, King T, Harry JL, Sorenson S. et al. Efficacy of the comprehensive objective mapping, precise image guided injection, anti-reflux positioning and sequential sclerotherapy (COMPASS) technique in the management of greater saphenous varicosities with saphenofemoral incompetence. Phlebology 2002; 17: 19-28.
• 12 Grondin L. Foam echosclerotherapy of incompetent saphenous veins. Phlebolymphology 2003; 42: S24.
• 13 Morrison N. The Interaction and Complimentary Role of Surgery, Sclerotherapy and Thermal Ablation in the Managment of Varicose Veins – The US Perspective. The Australian and New Zealand Society for Vascular Surgery. Melbourne: August 2007
• 14 Rabe E, Otto J, Schliephake D, Pannier F. Efficacy and safety of great saphenous vein sclerotherapy using standardised polidocanol foam (ESAF): A randomised controlled multicentre clinical trial. Eur J Vasc Endovasc Surg 2008; 35: 238-245.
• 15 Myers KA, Jolley D, Clough A, Kirwan J. Outcome of ultrasound-guided sclerotherapy for varicose veins: Medium-term results assessed by ultrasound surveillance. Eur J Vasc Endovasc Surg 2007; 33: 116-121.
• 16 Wollmann JC. An Experimental Model to Pinpoint Properties and Behavior of Sclerosing Foams. 17th Annual Congress of the American College of Phlebology. San Diego, California: 2003
• 17 Sierra A, Redondo P, Cabrera J, Cabrera Jr J, Garcia-Olmedo MA. Large volume microfoam therapy for recurrent variscose veins. 16^th Annual Congress of the American College of Phlebology. Fort Lauderdale, Florida: 2002
• 18 Morrison N. Large-volume, ultrasound-guided, polidocanol foam sclerotherapy: A prospective study of toxicity and complications. International Vein Congress 2004. Key Biscayne, Florida: 2004
• 19 Jia X, Mowatt G, Burr JM, Cassar K, Cook J, Fraser C. Systematic review of foam sclerotherapy for varicose veins. Br J Surg 2007; 94: 925-936.
• 20 Gobin JP. French experience with sclerotherapy. Angiologia E Cirurgia Vascular, Ubelandia, Brazil: 2008
• 21 Breu FX, Guggenbichler S, Wollmann JC. Second European Consensus Meeting on Foam Sclerotherapy. Duplex ultrasound and efficacy criteria in foam sclerotherapy from the 2^nd European Consensus Meeting on Foam Sclerotherapy 2006. Tegernsee, Germany: Vasa; 2008. 37 90-95.
• 22 Frullini A, Cavezzi A. Sclerosing foam in the treatment of varicose veins and telangiectases: history and analysis of safety and complications. Dermatol Surg 2002; 28: 11-15.
• 23 Wollmann JC. The history of sclerosing foams. Dermatol Surg 2004; 30: 694-703.
• 24 Coleridge Smith P. Saphenous ablation: sclerosant or sclerofoam?. SeminVasc Surg 2005; 18: 19-24.
• 25 Fegan WG. Injection with compression as a treatment for varicose veins. Proc R Soc Med 1965; 58: 874-876.
• 26 Barrett JM, Allen B, Ockelford A, Goldman MP. Microfoam ultrasound-guided sclerotherapy of varicose veins in 100 legs. Dermatol Surg 2004; 30: 6-12.
• 27 Cabrera J, Redondo P, Becerra A, Garrido C, Cabrera Jr J, Garcia-Olmedo MA. et al. Ultrasoundguided injection of polidocanol microfoam in the management of venous leg ulcers. Arch Dermatol 2004; 140: 667-673.
• 28 Cavezzi A, Frullini A. The role of sclerosing foam in ultrasound guided sclerotherapy of the saphenous veins and of recurrent varicose veins: Our personal experience. Aust NZ J Phlebol 1999; 3: 49-50.
• 29 Kakkos SK, Bountouroglou DG, Azzam M, Kalodiki E, Daskalopoulos M, Geroulakos G. Effectiveness and safety of ultrasound-guided foam sclerotherapy for recurrent varicose veins: Immediate results. J Endovasc Ther 2006; 13: 357-364.
• 30 Kern P, Ramelet AA, Wutschert R, Bounameaux H, Hayoz D. Single-blind, randomized study comparing chromated glycerin, polidocanol solution, and polidocanol foam for treatment of telangiectatic leg veins. Dermatol Surg 2004; 30: 367-372.
• 31 Rabe E, Pannier-Fischer F, Gerlach H, Breu FX, Guggenbichler S, Zabel M. Guidelines for sclerotherapy of varicose veins (ICD 10: 183.0, 183.1, 183.2, and 183.9). Dermatol Surg 2004; 30: 687-693.
• 32 Coleridge Smith P. Chronic venous disease treated by ultrasound guided foam sclerotherapy. Eur J Vasc Endovasc Surg 2006; 32: 577-583.
• 33 Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg 2001; 27: 58-60.
• 34 Wright D, Gobin JP, Bradbury AW, Coleridge Smith P, Spoelstra H, Berridge D. et al. Varisolve polidocanol microfoam compared with surgery or sclerotherapy in the management of varicose veins in the presence of trunk vein incompetence: European randomized controlled trial. Phlebology 2006; 21: 180-190.
• 35 Henriet JP. Expérience durant trois années de la mousse de polidocanol dans le traitement des varices réticulaires et des varicosities. Phlébologie 1999; 52: 277-282.
• 36 Guex JJ, Allaert FA, Gillet JL, Chleir F. Immediate and midterm complications of sclerotherapy: Report of a prospective multicenter registry of 12, 173 sclerotherapy sessions. Dermatol Surg 2005; 31: 123-128.
• 37 Hamel-Desnos C, Guias B, Jousse S, Desnos P, Bressollette L. Foam echosclerotherapy by puncture-direct injection: Technique and quantities. J Mal Vasc 2006; 31: 180-189.
• 38 O’Hare JL, Earnshaw JJ. The use of foam sclerotherapy for varicose veins: A survey of the members of the Vascular Society of Great Britain and Ireland. Eur J Vas Endovasc Surg 2007; 34: 232-235.
• 39 Eckmann DM, Kobayashi S, Li M. Microvascular embolization following polidocanol microfoam sclerosant administration. Dermatol Surg 2005; 31: 636-643.
• 40 Hoffman K. An unusual complication of facial sclerotherapy. Dermatol Surg 2003; 29: 423-424.
• 41 Benigni JP, Ratinahirana H, Bousser MG. Polidocanol 400 foam injection and migraine with visual aura. 16^th Annual Congress of the American College of Phlebology. Ft Lauderdale, Florida: 2002
• 42 Scurr J, Gilling-Smith G, Fisher R. Letter to the editor: Systematic review of foam sclerotherapy for varicose veins. Br J Surg 2007; 94: 925-936 1306–1309.
• 43 Alòs J, Carreño P, López JA, Estadella B, Serra-Prat M. Efficacy and safety of sclerotherapy using polidocanol foam: A controlled clinical trial. Eur J Vas Endovasc Surg 2006; 31: 101-107.
• 44 Brodersen J, Geismar U. Catheter-assisted vein sclerotherapy: A new approach for sclerotherapy of the greater saphenous vein with a double-lumen balloon catheter. Dermatol Surg 2007; 33: 469-475.
• 45 Neuhardt D. Incidence of deep vein thrombosis in a duplicated femoral vein following Foam USG of the GSV. First Days of Phlebology. Parma, Italy: 2006
• 46 Morrison N, Neuhardt DL, Rogers CR, McEown J, Morrison T, Johnson E, Salles-Cunha SX. Comparisons of side effects using air and carbon dioxide foam for endovenous chemical ablation. J Vasc Surg 2008; 47: 830-836.
• 47 Lai SW, Goldman MP. Does the relative silicone content of different syringes affect the stability of foam in sclerotherapy?. J Drugs Dermatol 2008; 7: 399-340.
• 48 Tessari L. 8° International Phlebological Symposium. Bologna, Italy: 2006
• 49 Morrison N. Relative incidence of side effects with CO₂/O₂ foam sclerotherapy comparison air, CO₂, & CO₂/O₂-based foam. 21^st Annual Congress, American College of Phlebology. Tucson, Arizona: 2007
• 50 Creton D, Uhl JF. Foam sclerotherapy combined with surgical treatment for recurrent varicose veins: Short term results. Eur J Vas Endovasc Surg 2007; 33: 619-624.
• 51 Pascarella L, Bergan JJ, Mekenas LV. Severe chronic venous insufficiency treated by foamed sclerotherapy. Ann Vasc Surg 2006; 20: 83-91.
• 52 Dona E, Fletcher JP, Hughes TM, Saker K, Batiste P, Ramanathan I. Duplicated popliteal and superficial femoral veins: incidence and potential significance. Aust N Z J Surg 2000; 70: 438-440.
• 53 Meier B, Lock JE. Contemporary management of patent foramen ovale. Circulation 2003; 107: 5-9.
• 54 Breu FX, Guggenbichler S. European Consensus Meeting on Foam Sclerotherapy, April 4–6, 2003, Tegernsee, Germany. Dermatol Surg 2004; 30: 709-717.