Papers reviewed in June 2015

Posted on by Mike

Friedmann D.P et al
Foam sclerotherapy for reticular veins of the chest: a retrospective review of efficacy and safety.
Dermatol Surg. 2015 Jan;41(1):126-30.

Background: No study has evaluated the use of foam sclerotherapy in treating clinically conspicuous reticular chest veins.
Objective: This retrospective study evaluates patient-rated efficacy, safety, and satisfaction after foam sclerotherapy for reticular veins of the chest.
Materials and Methods: A telephone-based questionnaire was used for patient self-assessment of overall improvement, satisfaction, and adverse events. All patients had been treated with 0.25% to 0.50% sodium tetradecyl sulfate (STS) foam using room air (1:4 ratio). The mean length of follow-up was 3.7 years.
Results: Twelve of 23 patients were successfully contacted, with a total of 14 treatment sessions. Overall, patients reported scores of 2.4 ± 0.8 for overall improvement (0 = none, 1 = mild, 2 = moderate, and 3 = complete resolution) and 1.75 ± 0.6 for satisfaction with results (0 = not satisfied at all, 1 = mildly satisfied, and 2 = very satisfied), with minor treatment-related adverse events.
Conclusion: Foam sclerotherapy with STS is effective for management of reticular veins of the chest with an excellent safety profile and high long-term patient satisfaction.

 

Weiss MA et al
Consensus for sclerotherapy.
Dermatol Surg. 2014 Dec;40(12):1309-18

Background: The American Society for Dermatologic Surgery (ASDS) periodically develops consensus documents for its members concerning various aspects of dermatologic surgery. Unwanted and painful leg veins are a very widespread problem. Many advances in sclerotherapy of varicose and telangiectatic leg veins have occurred since the previous consensus documents.
Objective: In 2013, the ASDS Board of Directors voted to have a committee of experts in the field to develop consensus documents on sclerotherapy.
Materials and Methods: An expert panel reviewed the literature on sclerotherapy and discussed the findings. A consensus was reached with evidence-based recommendations on diagnostic evaluation and treatment of varicose and telangiectatic leg veins.
Results: The consensus documents include discussion of indications for treatment, patient selection, contraindications, diagnostic testing, treatment approaches, use of compression, and expected outcome. Common sclerosants and their mechanisms of action, advantages and disadvantages of foam sclerotherapy, and minimizing and treating complications are presented.
Conclusion: The ASDS consensus documents on sclerotherapy will be helpful in educating their members on safe and effective sclerotherapy of varicose and telangiectatic leg veins.

 

Atasoy MM
Fill and aspirate foam sclerotherapy (FAFS): a new approach for sclerotherapy of large superficial varicosities concomitant to endovenous laser ablation of truncal vein.
Clin Radiol. 2015 Jan;70(1):48-53.

Aim: To define and assess the short-term clinical feasibility of fill and aspirate foam sclerotherapy (FAFS) for treating large superficial varicose veins concomitant to endovenous laser ablation (EVLA).
Materials and Methods: Twenty-seven patients who refused to have phlebectomies with great saphenous vein reflux and large superficial varicosities were included in the study. Both EVLA and FAFS were performed concomitantly. FAFS is a technique in which all or most of the bubbles and blood-foam mixture are removed from the targeted large varicose veins immediately after the foam has caused sufficient damage to the endothelial cells. Patients were reviewed 1 month and 6 months after the treatment. Improvement in the clinical, aetiological, anatomical, and pathological classification (CEAP), and clinical severity was graded using the revised venous clinical severity score (rVCSS) and cosmetic results were investigated at the 6 month visit.
Results: Ablation of GSV was performed in 27 limbs in 27 patients (19 males, 70.3%; mean age 44 years; range 21-69 years). All patients had a technically successful FAFS treatment. The CEAP classification score, the rVCSS values, and the cosmetic results showed prominent improvement 6 months after the treatment. There were no significant complications, such as stroke, skin burns, necrosis, paresthesia, deep-vein thrombosis, or allergic reaction. None of the patients experienced neurological events.
Conclusions: FAFS is a promising safe and effective technique for treating large superficial varicosities concomitant to EVLA of the truncal veins with excellent clinical results. Randomized prospective studies with larger series are required to compare the FAFS with ambulatory phlebectomy and standard foam sclerotherapy.

 

van Eekeren RR
Histological observations one year after mechanochemical endovenous ablation of the great saphenous vein.
J Endovasc Ther. 2014 Jun;21(3):429-33.

Purpose: To report histological analysis of a great saphenous vein (GSV) 1 year after undergoing mechanochemical endovenous ablation (MOCA) and compare the findings with those of a healthy vein.
Case Report: A 59-year-old patient with bilateral GSV incompetence was treated with MOCA using the ClariVein catheter, which has a dispersion wire that rotates as liquid sclerosant is injected in the vein. After 1 year, the patient had recurrent edema of the right leg; duplex ultrasound was suspicious for recanalization. The patient was reoperated, and the deep femoral vein was explored. The GSV was completely obliterated, and its proximal part was excised and sent for histological processing. Microscopic evaluation of the MOCA-treated vein showed a circumferential disappearance of the endothelial layer and fibrosis of the vein. The media was considerably damaged, with changes in collagen structure, supporting the therapeutic effect of MOCA.
Conclusion: MOCA is a novel endovenous treatment modality for saphenous vein insufficiency. Results of MOCA on the cellular level are essential to optimize treatment.

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