Papers reviewed in April 2015April 23, 2015
Tanase A et al
Ultrasound guided foam sclerotherapy (UGFS) for active venous ulceration – A 5-year cohort
Int J Surg. 2013 Oct;11(8):740
Aim: Ultrasound guided foam sclerotherapy (UGFS) for treatment of CVU (chronic venous ulceration) has demonstrated favourable results in preliminary studies. This study analyses healing and recurrence rates in CEAP6 ulcers treated with UGFS.
Method: Between 2007 and 2012, 60 patients (63 legs) underwent UGFS with sodium tetradecyl-sulphate (STS) for CEAP6 ulcers. All patients were followed up at 2.5 months both clinically and venous duplex was performed before and after treatment. We analysed a prospectively collected database and calculated venous occlusion rates, 12 month healing and recurrence rates.
Results: 63 legs, 43 primary; 20 recurrent. Median time ulcer active 15 months (IQR 9 – 24); range 5 months – 17 years. At a median follow-up 2.5 months 57(90.5%) achieved full occlusion; 3(4.8%) short segment occlusion, 4(4.8%) failed to occlude. 13 required repeat treatment. 2 pts reported thrombophlebitis. 10 patients excluded from outcome analysis. 37(70%) healed at a median time of 4months; 13(24.5%) at 3months, 24(45.3%) at 6months, 30(56.6%) at 12months. 14(28.3%) significantly reduced and healing; 7 almost healed and discharged; 12 month recurrence rate 2(3.7%).
Conclusions: USFS is a feasible component of the leg ulcer service and a safe and effective means of securing superficial vein occlusion as an alternative to surgery.
van der Vleuten CJ et al
Effectiveness of sclerotherapy, surgery, and laser therapy in patients with venous malformations: a systematic review.
Cardiovasc Intervent Radiol. 2014 Aug;37(4):977-89.
Purpose: Because the best possible treatment for venous malformations is unclear, this study systematically reviews the available literature regarding the effectiveness of different treatment options for the patient group. Venous malformations result from incorrect development of the veins during embryogenesis and are present at birth. Venous malformations may exhibit symptoms, such as pain, swelling, and inflammation of the vessel.
Materials and Methods: A systematic literature search in PubMed and Embase was performed. Data regarding the design, participants, intervention and, treatment outcome (success and complications) were extracted. The validity of the studies was assessed with the Cochrane Collaboration’s risk of bias tool.
Results: Thirty-five studies were identified studying the effectiveness of eight treatments: sclerotherapy/embolization with ethanol, gelified ethanol, bleomycin, polidocanol, sodium tetradecyl sulfate (STS), Ethibloc, surgery, and laser therapy. All of the included studies have a high or unclear risk of bias. The average biased reported success rates for ethanol, gelified ethanol, bleomycin, polidocanol, STS, Ethibloc, surgery, and laser therapy were 74, 89, 88, 90, 86, 65, 90, and 94 %, respectively.
Conclusions: Until more valid evidence is available, the choice for treatment remains a shared decision between the patient and a multidisciplinary treatment group. From a cost perspective, sclerotherapy with STS or polidocanol should be the treatment of choice.