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. 2020 Jan 6:47:83-86.
doi: 10.1016/j.ejvssr.2019.12.001. eCollection 2020.

Effect of Transluminal Injection of Foam Sclerotherapy Combined with Endovenous Thermal Ablation of Varicose Veins

Satoshi Watanabe  1 , Soji Nishio  1 , Takafumi Tsuji  1 , Shinya Fujita  1 , Eisho Kyo  1
Affiliations

Effect of Transluminal Injection of Foam Sclerotherapy Combined with Endovenous Thermal Ablation of Varicose Veins

Satoshi Watanabe et al. EJVES Vasc Forum. .

Abstract

Objective: The combination of endovenous therapies with stab avulsion or ultrasound guided foam sclerotherapy is widely performed. However, these conventional techniques tend to result in incomplete avulsions or persistent varicosities.

Methods: One hundred and thirteen legs in 97 consecutive patients who underwent 1470 nm laser ablation for great saphenous varicose veins were enrolled. The foam sclerosing agent was injected via the sheath after endovenous laser ablation (EVLA). Patients were divided into two groups: EVLA only group (Control; n = 50) and EVLA and transluminal injection of foam sclerotherapy (TLFS) group (SCL; n = 63).

Results: At three month follow up, reflux was abolished throughout all treated great saphenous veins (GSVs) when assessed with Duplex ultrasound. Thrombophlebitis was observed in two patients in the SCL group (p = .13). Additional second stage sclerotherapy was needed in the Control group (n = 33, 66%) vs. SCL group (n = 2, 3%; p < .0001). The venous clinical severity score (VCSS) was significantly improved in the SCL group (changes of VCSS, Control -3.3 ± 1.7 and SCL -4.4 ± 1.0; p < .0001). Univariable and multivariable analyses revealed that, among age, sex, Clinical-Etiology-Anatomy-Pathophysiology classification, linear endovenous energy density, and TLFS, TLFS was the only significant factor of improved VCSS (hazard ratio = -0.96; 95% confidence interval = -1.4 to -0.58; p < .0001).

Conclusions: TLFS combined with EVLA may be an easy, safe, and effective procedure with acceptable complications vs. EVLA alone and reduces additional second stage interventions.

Keywords: Endovenous laser ablation; Foam sclerotherapy; Varicose veins.

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Figures

Figure 1
Figure 1
(A) EVLA temporarily stopped at 2–4 cm proximal to targeted TV (red line; EVLA site). Simultaneously, the tip of the sheath was placed 1–2 cm proximal to targeted TV. Then, sclerosing foam was injected via the side port (green arrow). (B) Sclerosing foam was injected into the next target by a similar method.
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