George Sfyroeras MD, MSc, PhD, FEBVS

Vascular Surgery Department

Attikon University Hospital

George Sfyroeras MD, MSc, PhD, FEBVS

Vascular Surgery Department

Attikon University Hospital

ULTRASOUND GUIDED FOAM SCLEROTHERAPYULTRASOUND GUIDED FOAM SCLEROTHERAPY

Sclerotherapy Sclerotherapy Old technology, used a new way

• Ultrasound-Guided foam sclerotherapy (USGS) is a revolution in the management of varicose vein.

• Ultrasound-Guided foam sclerotherapy (USGS) is a revolution in the management of varicose vein.

• In trained hands it is simple, affordable, safe, efficient and easily repeatable.

• In trained hands it is simple, affordable, safe, efficient and easily repeatable.

• Ideal sclerosing must ensure appropriate concentration of the agent with integral contact to the entire venous wall.

• Ideal sclerosing must ensure appropriate concentration of the agent with integral contact to the entire venous wall.

• Liquid sclerosing agent gets washed away by blood quickly when the vein diameter is over 3 mm.

• Liquid sclerosing agent gets washed away by blood quickly when the vein diameter is over 3 mm.

• Injection with foam has the advantage of filling the vein and staying longer and causing spasm.

• Injection with foam has the advantage of filling the vein and staying longer and causing spasm.

• In the past attempts were made to clear the blood from the vein, prior to injection by using “air block” technique, i.e.; injecting air before the sclerosant.

• In the past attempts were made to clear the blood from the vein, prior to injection by using “air block” technique, i.e.; injecting air before the sclerosant.

• Cabrera introduced foamed sclerosant in 1997 using CO2.

• Tessari simplified using liquid sclerosant into foam using two syringes and a three-way stopcock in 2000.

• Cabrera introduced foamed sclerosant in 1997 using CO2.

• Tessari simplified using liquid sclerosant into foam using two syringes and a three-way stopcock in 2000.

• Only detergent sclerosing agents such as Sotradecol and Polidocanol can be used to foam. One part of sclerosant with four parts air is used with two 5 CC syringes. Foam can be used in different size of the veins using concentration from 0.25% to 3%.

• Only detergent sclerosing agents such as Sotradecol and Polidocanol can be used to foam. One part of sclerosant with four parts air is used with two 5 CC syringes. Foam can be used in different size of the veins using concentration from 0.25% to 3%.

Foam SclerotherapyPreparationFoam SclerotherapyPreparation

• Multiple, repeated treatment may be necessary and therefore results should be assessed from a life-long point of view, rather than ablation of target vein alone.

• Multiple, repeated treatment may be necessary and therefore results should be assessed from a life-long point of view, rather than ablation of target vein alone.

Foam Sclerotherapy of the GSVFoam Sclerotherapy of the GSV

Foam Sclerotherapy for lateral thigh branchFoam Sclerotherapy for lateral thigh branch

CannulationCannulation

Ultrasound GuidedUltrasound Guided

Ultrasound Guided Foam Sclerotherapy for the Small Saphenous Vein

Ultrasound Guided Foam Sclerotherapy for the Small Saphenous Vein

• Success of foam is attributed to its prolonged contact with the vein wall endothelium.This leads to sub endothelial layer exposure and irreversible venous fibrosis.

• Success of foam is attributed to its prolonged contact with the vein wall endothelium.This leads to sub endothelial layer exposure and irreversible venous fibrosis.

Post OpPost OpPre OpPre Op

RESULTSRESULTS

• Primary occlusion is better than 80% in most published data. Initial failure can be treated with repeated injection, thus approaching over 95% success.

• Primary occlusion is better than 80% in most published data. Initial failure can be treated with repeated injection, thus approaching over 95% success.

• Complications are rare, occasional DVT of the muscular veins have been reported making the incidence to be 0.03%.

• Complications are rare, occasional DVT of the muscular veins have been reported making the incidence to be 0.03%.

• Ophthalmic migraine, visual disorders such as transient hemianopsia and dry cough are more common. Patients with patent foramen ovale have these occur more frequently.

• One death due to stroke has been reported.

• Ophthalmic migraine, visual disorders such as transient hemianopsia and dry cough are more common. Patients with patent foramen ovale have these occur more frequently.

• One death due to stroke has been reported.

Patent foramen ovale

Patent foramen ovale

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