Congrès SFP décembre 2014

Foam sclerotherapy under tumescence – the solution?


University of Schleswig-Holstein, Campus Luebeck, Clinic for Dermatology, Allergology and Venerology

The diameter of varicose veins infl uences the effi cacy of foam sclerotherapy. The smaller the size of the
targeted veins the better the outcome of foam sclertherapy. Thus manouvres to reduce the caliber of
varicose veins are to be evaluated to improve the outcome of foam sclerotherapy.

Peri-venous tumescent local anesthesia (TLA), routinely performed in endovenous thermal procedures,
does not only provide anaesthesia

and disperses the generated heat, but also compresses the target vein concentrical and ensures minimal vessel diameter at the time of treatment. The benefi t of pretreatment
size reduction with the aid of tumescent application (TA) can also be used for catheter-directed
foam-sclerotherapy (CDFS) of truncal veins.

The aim of this study was to evaluate occlusion rates of great saphenous veins (GSV) with a diameter
between 5-10 mm that receivedreceivingthat received a pre-treatment size reduction via perivenous
tumescent application (TA) followed by catheter-directed foam sclerotherapy (CDFS).

A prospective blinded randomized clinical trial comparing the occlusion rates of GSV in 1, 6 and 12
months follow up.
Material and Methods
50 patients were included and randomized into two groups. CDFS was performed accssessing the GSV
at knee level and applying 8 ml of 2% polidocanol-foam (EasyFoam®) while the catheter was withdrawn.
Strictly perivenous TA was performed in group 1, before applying the sclerosant agent. Occlusion rates
and clinical scores were assessed by blinded examiners.

After 12 months in group 1 73.9% achieved full occlusion, 8.7% partial occlusion and 17.4% were
classifi ed as treatment failure. In group 2 75% of the targeted GSV were fully occluded, 20% partially
occluded and 5 % had a treatment failure. Both groups showed a signifi cant reduction of the vein
diameter. The rate of hyperpigmentation was lower in the tumescence group. Patient’s tolerance and
satisfaction with the treatment was high in both groups.

No benefi t could be found using additional tumescent application to reduce the vein diameter before the
treatment. May be if we would have been allowed by the … to use tumescence with local anesthetics
and adrenaline the results would have been better.