Technique and early results of ultrasound-guided foam sclerotherapy of the long saphenous vein for treatment of varicose veins

Tan VKM, Tan SG
Correspondence: Dr Veronique KM Tan, vquetan@gmail.com

ABSTRACT
Introduction The aim of this study was to describe an original technique of using ultrasound-guided foam sclerotherapy in the long saphenous veins (LSV) for the treatment of varicose veins, and report the early results.
Methods Only patients with lower limb varicose veins and demonstrable incompetent saphenofemoral junction with reflux down the LSVs underwent ultrasound-guided injection of foam sclerosant into the LSV. Foam sclerosant was made by the Tessari’s method using three percent sodium tetradecyl sulphate to air in a 1:3 ratio. The LSV was accessed below the knee with a micropuncture set. A Headhunter angiographic catheter was cut to length and advanced over a guide wire to the saphenofemoral junction (SFJ). With the patient in the Trendelenburg position and the leg raised, the SFJ was manually compressed and foam was injected into the Headhunter catheter while the tip was withdrawn. Direct ultrasound visualisation ensured accurate catheter placement.
Results 66 lower limbs in 62 patients were treated in the manner described above. The diameter of the treated LSV ranged from 4 to 13.4 mm. Ultrasound duplex assessment one day post-treatment showed complete occlusion in 62 veins (94 percent). Early complications included superficial thrombophlebitis, skin pigmentation, cellulitis and thrombosis of the superficial femoral vein.
Conclusion Immediate results using our method of ultrasound-guided foam sclerotherapy showed a high obliteration rate of the LSV.

Keywords: foam sclerotherapy, long saphenous vein, ultrasound-guided sclerotherapy, varicose veins
Singapore Med J 2009; 50(3): 284-287