Korean J Radiol.  2014 Aug;15(4):481-487. 10.3348/kjr.2014.15.4.481.

Fluoroscopy-Guided Endovenous Sclerotherapy Using a Microcatheter Prior to Endovenous Laser Ablation: Comparison between Liquid and Foam Sclerotherapy for Varicose Tributaries

• Park SW
• Yun IJ
• Hwang JJ
• Lee SA
• Kim JS
• Chee HK
• Chang IS

• KMID: 1731052
• DOI: http://doi.org/10.3348/kjr.2014.15.4.481

Abstract

OBJECTIVE
To compare the efficacy and adverse effects of endovenous foam sclerotherapy (EFS) and liquid sclerotherapy (ELS) using a microcatheter for the treatment of varicose tributaries.
MATERIALS AND METHODS
From December 2007 to January 2009, patients with venous reflux in the saphenous vein were enrolled. The foam or liquid sclerosant was injected through a microcatheter just before endovenous laser ablation (EVLA). Patients were evaluated for the technical success, clinical success, and procedure-related complications during the procedure and follow-up visits.
RESULTS
A total of 94 limbs were included: 48 limbs (great saphenous vein [GSV], 35; small saphenous vein [SSV], 13) were managed using EFS and EVLA (foam group; FG), and 46 limbs (GSV, 37; SSV, 9) were treated by ELS and EVLA (liquid group; LG). Varicose tributaries demonstrated complete sclerosis in 92.7% with FG and in 71.8% with LG (p = 0.014). Bruising (78.7% in FG vs. 73.2% in LG, p > 0.05), pain or tenderness (75.6% in FG vs. 51.2% in LG, p = 0.0237) were noted. Hyperpigmentation (51.2% in FG vs. 46.2% in LG, p > 0.05) was found.
CONCLUSION
Endovenous foam sclerotherapy using a microcatheter is more effective than ELS for eliminating remnant varicose tributaries prior to EVLA. However, EFS is more commonly associated with local complications such as pain or tenderness than ELS. Furthermore, both techniques seem to prolong the duration of hyperpigmentation along with higher costs.

Keyword

Varicose vein; Sclerotherapy; Laser

MeSH Terms

Catheters/adverse effects
Femoral Vein
Fluoroscopy/methods
Humans
Laser Therapy/methods
Radiography, Interventional/methods
*Saphenous Vein/radiography/surgery
Sclerosing Solutions/*administration & dosage/chemistry
Sclerotherapy/adverse effects/instrumentation/*methods
Treatment Outcome
Varicose Veins/radiography/*therapy
Venous Insufficiency/surgery
Sclerosing Solutions

Figure

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  Fig. 1 Fluoroscopic images after injection of foam (A) or liquid (B) sclerosant. Sclerosing foam (A) or liquid sclerosant (B) mixed with contrast media were injected into varicose tributaries using microcatheter (double arrows) under fluoroscopic guidance. Air bubbles can be seen clearly in foam sclerotherapy (arrows).

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