Single-Center Experience of Treatment of Varicose Veins and Foam Sclerotherapy

Abstract

From 1993 to 2007, 1928 patients (478 males, 1450 females) with varicose veins consulted our hospital. Of them a total of 1314 patients were treated. In treatments of non-saphenous varicose veins, sclerotherapy was the most often carried out. The number of the patients treated with sclerotherapy alone was 250. In the early years we used to treat patients with saphenous vein incompetence by high-ligation of sapheno-femoral junction combined with sclerotherapy using 14.5% hyperosmotic saline. In some cases ligation at the above and below knee was also done as an additional procedure to prevent recurrence. However, in recent years, the incidence of stripping increased, while that of ligation decreased, because recurrence rate of high-ligation was higher than that of stripping. If the diameter of the saphenous vein was greater than 8 mm, stripping was performed. Low invasive selective stripping was recommended rather than standard stripping as a surgical procedure. The number of the high-ligation and stripping were 704 and 360 respectively for the past 15 years.

From 2003 we began foam sclerotherapy using 1% and 3% polidocanol. The sclerosing foam was formed using a three-way stopcock and two syringes, mixing air with liquid polidocanol. The mixing ratio for sclerosant: air is 1:4. We use polyurethane trapezoidal pads and self-adhesive bandage for compression following sclerotherapy. Post-treatment compression was used for 2 days. The results obtained with foam sclerotherapy are better than those with fl uid sclerotherapy. Because the foam has a stronger sclerosing action, the treatment goal can be achieved with a sclerosant of a lower concentration than in the case of sclerotherapy with a fluid sclerosant.

After injection of foam, the foamed sclerosant remains locally in the venous segment to be sclerosed for a longer period of time. Although some phlebitis and hyperpigmentation can be seen after treatment, foam sclerotherapy is useful, noninvasive and cost effective for the treatment of varicose veins.

Nowadays we primarily treat the patients with saphenous vein incompetence by the selective stripping combined with foam sclerotherapy. The recurrence rate of stripping with sclerotherapy was equivalent to that of stripping with varicectomy. Hence varicectomy can be replaced with sclerotherapy. The use of sclerosing foam may become an established therapy in the treatment of varicose veins with a high success rate, low cost and low major complication rate.