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Background: This is a retrospective analysis of the results of treatment for varicose veins using the sandwich technique with cyanoacrylate glue and foam sclerotherapy. This novel method allows for a substantial reduction in the amount of glue needed for vein closure, and minimizes the risk of granuloma formation and allergic reaction related to the epifascial administration of cyanoacrylate. Methods: This technique was used in 60 patients, 77 intrafascial veins were managed. Vein closures were performed with Venex cyanoacrylate glue and 1–3% polidocanol foam. All procedures were performed under ultrasonographic control, through direct percutaneous punctures of target veins. Follow-ups were scheduled 1–3 weeks after the procedure. If revealed, unclosed segments of the target veins were obliterated at these follow-up visits, with glue and/or sclerotherapy. Results: There were no serious adverse events intra- or postprocedurally. The technical success rate was 100%. The primary success rate at 1–3 weeks follow-up was 84.4%. The primary assisted success rate, after additional closures, was 100%. Conclusions: We demonstrated that the treatment for varicose veins, using a sandwich technique, which combines cyanoacrylate glue and foam sclerotherapy, can be safe and efficient.

Background: Lauromacrogol foam sclerotherapy is characterized by a high success rate in obliterating varicose veins and a low frequency of adverse effects. Most of these parts consist of minor effects, and few data are available about significant effects (e.g., vein thrombosis), pointing out the technical safety of ultrasound-guided foam sclerotherapy. Case Presentation: a 78-year-old woman was evaluated for chronic vein disease; at ultrasonographic and Doppler scan (USDS), severe GSV dilatation and GSV reflux were documented in both legs below the knee. After meticulous anamnesis and physical examination, informed consent was obtained, and ultrasound-guided percutaneous polidocanol foam (one part of 2% lauromacrogol solution + one part of the air, mixed with Double Syringe System) sclerotherapy was performed in the right leg; best medical therapy was given after the procedure. After five days, USDS pointed out thrombosis extending to the thigh upper region to saphenous-femoral junctions, consisting of deep vein thrombosis. Appropriate anticoagulant therapy was promptly dispensed, and the patient had no aftermaths. Conclusion:The prevalence of vein thrombosis after lauromacrogol sclerotherapy is unknown, and their correlation is uncertain, but, in our experience, it should be suspected in patients who referred lower limb pain after this procedure despite the best medical therapy dispensation.

PURPOSEThis study investigates the usefulness of antegrade variceal embolization using sclerosant foam to evaluate technical success and clinical outcomes in cases of hypertensive variceal bleeding.METHODSA total of 16 patients underwent percutaneous antegrade variceal embolization using foam sclerotherapy from August 2019 to January 2022. Among the patients, 12 cases were of gastroesophageal varices, two were rectal varices, and one case each was duodenal and jejunal varices, respectively. Sodium tetradecyl sulfate (STS) foam was used as a detergent for variceal bleeding sclerotherapy at various anatomical locations. The detergent was used in a foam form to promote clinical outcomes and enable the effective embolization of the entire blood vessel wall, including the ventral side, against gravity. Furthermore, STS foam could be used to help sufficiently deliver the drug to distal segments. A balloon catheter was also used to block the antegrade flow and prevent the dilution of the sclerosant. Technical success was defined as the completion of sclerotherapy for variceal bleeding as planned before the procedure to achieve the disappearance of variceal bleeding. Clinical success was defined as the complete obliteration of varices without recurrent bleeding during the follow-up period after the procedure.RESULTSTechnical success was 81.3%, and clinical success was 84.6%. Additionally, 15/16 of the procedures were emergencies, and there were no complications related to the procedure.CONCLUSIONAntegrade foam sclerotherapy using 3% STS for variceal bleeding is clinically safe and effective. Moreover, antegrade foam sclerotherapy can be a useful treatment option for patients with active variceal bleeding in emergency cases.

Objective To compare the effects of traditional open surgery and laser therapy combined with foam sclerotherapy on immune system in patients with primary saphenous varicose veins. Methods A total of 104 patients who underwent elective varicose vein surgery were divided into the laser therapy combined with foam sclerotherapy group （MIS group，n=53） and traditional open surgery group（OS group，n=51） according to the surgical method.Venous blood sample was collected before and 24 h after operation for the measurement of superoxide dismutase （SOD）， interleukin （IL）-1β， IL-6 and IL-8， IL-10， tumor necrosis factor-α （TNF-α） and interferon-γ （IFN-γ） levels. The changes in the proportion of T cell subsets and NK cells were detected by flow cytometry. The expression levels of differentially-expressed genes （DEGs） of immune cells in peripheral blood were determined by single-cell RNA sequence （scRNA-seq） technology. Results In the MIS group， no significant differences were observed in the levels of SOD， IL-6， IL-10， TNF-α and IFN-γ before and after operation （all P > 0.05） except that IL-1β and IL-8 levels were increased after operation （both P < 0.05）. In the OS group， significant differences were noted in the above indicators before and after operation （all P < 0.05）. No significant differences were found in the proportion of T lymphocyte subsets and NK cells before and after surgery in the MIS group （both P > 0.05）， while the proportion of CD8+T cells was increased at postoperative 24 h， and that of NK cells was significantly reduced in the OS group （both P < 0.05）. Functional enrichment analysis of the DEGs in peripheral blood immune cells at postoperative 24 h indicated that postoperative hypoxia response， IFN response， and NF-κB inflammatory signaling pathways in the OS group were significantly up-regulated compared with those in the MIS group. Conclusion Laser treatment combined with foam sclerotherapy exerts slight effect on the immune inflammation and hypoxic response of the body system in patients with primary saphenous varicose veins. MIS can better maintain the body’s immune balance and preserve the capability of original immune system to resist microbial invasion to a greater extent compared with traditional OS.

Introduction This study aimed to investigate the outcome of hybrid endovenous laser ablation (EVLA, 1470 nm) and radiofrequency ablation (RFA) procedures for varicose veins (VVs). Material and methods We retrospectively analysed the clinical data of patients from July 2019 to December 2020. Eighty-four patients (121 limbs) underwent a hybrid EVLA procedure, and 108 patients (151 limbs) underwent an RFA procedure. The outcomes, venous clinical severity score (VCSS), chronic venous disease quality-of-life questionnaire (CIVIQ-20) score, and recurrence at 1, 6, and 12 months were collected. Results No differences in complications or 24-h pain scores were noted between the 2 procedures, but a lower dosage of foam sclerosant was used in the EVLA procedure than in the RFA procedure (p < 0.02). The postoperative VCSS and CIVIQ-20 scores in the 2 groups were significantly decreased compared with the scores before the procedure, and no differences in scores were noted between the 2 procedures at 1 month. However, the VCSS and CIVIQ-20 scores for the EVLA procedure were significantly better than those for the RFA procedure at 6 and 12 months (p < 0.05). Both procedures showed a similar great saphenous vein closure rate at 12 months. The EVLA procedure showed lower rates of overall recurrence (4.96% vs. 14.57%, OR = 3.27, 95% CI: 1.33–8.00, p = 0.01) and recurrence below the knee (4.13% vs. 11.92%, OR = 3.14; 95% CI: 1.18–8.35, p = 0.02). Moreover, the patient satisfaction score was greater for the EVLA procedure than for the RFA procedure (p < 0.02). Conclusions The hybrid EVLA (1470 nm) procedure reduces VV recurrence below the knee and results in better quality-of-life scores.

Klippel-Trénaunay Syndrome (KTS) is a vascular disorder characterized by a combination of vascular malformations (capillary, lymphatic, and venous) and limb overgrowth. Pelvis involvement is less frequent and is often underrecognized. We report a case of a patient affected by KTS with persistent sciatic pain. Phlebography demonstrated significant pelvic venous congestion mainly due to reflux at the level of the sacral plexus venous. A minimally invasive approach was successfully utilized to treat reflux with complete pain regression.

Background: Pulsatile varicose veins of the lower extremities are rare in clinical practice. The indications and therapy for pulsating varicose veins remain unclear, and most cases are managed conservatively, with fewer reports of endovenous approaches. However, the treatment of pulsating varicose veins combined with ulcer bleeding remains unclear in the relevant literature. Case presentation: We report a case of sudden rupture and bleeding from a pulsatile varicose vein with a lower extremity ulcer. The patient was a 74-year-old male with atrial fibrillation, pulmonary hypertension, and tricuspid regurgitation. Emergency compression was first applied to stop the bleeding. Wound cleansing, antimicrobial treatment and bacterial control were performed. Elastic compression stockings (23–32 mmHg) were also prescribed. After a comprehensive duplex ultrasound examination and heart disease evaluation, high ligation of the great saphenous vein, radiofrequency ablation and foam sclerotherapy were performed. After the procedure, the chronic venous insufficiency symptoms improved significantly at the 1-month follow-up, and the ulcer was completely healed by postoperative month 5. The patient had mild lower limb swelling, and no ulcer recurrence was reported during the 18-month follow-up. Duplex scans at the 3- and 18-month follow-ups showed complete obliteration of the treated great saphenous vein. Conclusions: Pulsatile varicose veins with ulcer bleeding are a rare pathological condition. It usually results from reflux from the heart and may also be a consequence of hydraulic transmission dysfunction. We believe that comprehensive duplex ultrasound examination of the peripheral vascular system and complex surgical treatment allow the correction of superficial venous reflux and achieve favorable early and mid-term outcomes.

Abstract. Treatment results of primary varicose disorders has been shown in article. The experience of using of thermal (endovenous laser ablation, radiofrequency ablation) and non-thermal methods (endovenous mechanochemical ablation, echo-controlled introduction of bioglue) in treatment of stage C2-С6 chronic venous is shown. The purpose of this work is to evaluate the efficiency of endovenous ablation techniques. The treatment of 218 patients was analyzed. In the group of patients who underwent EVLA, reflux was detected in 2 cases at the follow-up after week. In our opinion, this is due to insufficient exposure of the laser irradiation using a single-ring type of light guide. To correct the detected reflux, a single injection of foam scleroterapy. Foam form (3%) was used. In the group of patients after RFA, inflow reflux was detected in 1 patient (5.2%), in other cases complete obliteration was observed (17 patients - 89.4%). In the group of patients with mechanochemical obliteration, recanalization was determined in 5 patients (19.2%) with control ultrasound after 1 month. It was corrected by carrying out the procedure of foam scleroobliteration. In the group of patients with the cyanoacrylate obliteration, inflow reflux was detected in 2 patients (14.2%) on examination after 1 month. The received results lead to conclusion, that endovenous laser coagulation of affected veins is a more reliable method of threatment and the gold standard. The advantage of non-thermal methods is the absence of thermal effects on the paravenous structures, respectively, patients have no pain during the procedure, increases comfort, and there is no risk of damage to the paravenous nerves. Another advantage of non-thermal techniques is no need to use of tumescent anesthesia, since only one puncture is required for the operation, which is comfortable for patients. The use of adhesive vein obliteration is justified in patients with signs of a short reflux duration and has an advantage for the patient due to the absence of the need for compression in the postoperative period. In our study, foam sclerotherapy was the method of choice for treatment correction, if necessary.

Introduction: Varicose veins are one of the most common distressing situations, affecting almost 30-50% of the adult population. Patients experience throbbing pain, heaviness of the limb, bleeding on trivial trauma, and even ulceration. There are many treatment modalities like compression stocking, radiofrequency ablation, sclerotherapy, and open surgical treatment. Among them, ultrasound-guided sclerotherapy has been a widely accepted procedure. It is simple, minimally invasive, and allows patients to return to their baseline activity level quickly. Foam sclerotherapy is the newest addition. Here air is mixed with the liquid sclerosant to create the “foam”, which is injected into the vein under ultrasound guidance. Aims and Objectives: To compare the effectiveness of foam sclerotherapy in treating axial and collateral varicosities. Methods: This study was conducted between August 2020 and July 2022 in Midnapore Medical College and Hospital. 100 patients having varicosity of the lower limb were divided into two groups of 50 patients each: patients having Axial varicosity and Collateral varicosity. Both the groups were treated with foam sclerotherapy and a serial ultrasound was obtained on the 2nd week, 1st month, 6th month, 12th month, and 24th month to see the effectiveness. Result: The p-value was statistically insignificant, which implied that there was no significant difference in the outcome of treatment of both axial and collateral varicosities by foam sclerotherapy. Conclusion: Foam sclerotherapy is equally effective in treating both axial as well as collateral varicosities. Recommendation: To increase the general safety of foam sclerotherapy injection of very viscous foam in the varicose veins should be considered. Also, the patient should not move, specifically their leg for several minutes, and also should not carry out the Valsalva maneuver.

Aim: This study aims to explore the effects of three techniques on postoperative symptom recurrence and clinical outcome and define the predictors. Material and Methods: A total of 121 patients (63 males, 58 females; mean age: 47.4±11.3 years; range, 32 to 73 years) who underwent stripping (n=45), ligation alone (n=36), or ligation and foam sclerotherapy (2% polidocanol, n=40) for varicosities due to small saphenous vein (SSV) insufficiency between January 2004 and December 2011 were included in the retrospective study. Preoperative and postoperative CEAP (Clinical, Etiological, Anatomical, and Pathophysiological), symptom recurrence, and Doppler findings were evaluated with univariate and multivariate analyses. Results: The mean follow-up was 25.8±20.4 months. The operation type did not have any effect on postoperative symptom recurrence, high CEAP (≥3), or clinical outcomes. Predictor of postoperative symptom recurrence was preoperative high CEAP (p=0.001, relative risk [RR]: 4.8); predictor of high postoperative CEAP was postoperative perforating vein insufficiency (p=0.001, RR: 5.148). In the ligation group, a preoperative SSV diameter >5 mm was predictive for both postoperative symptom recurrence (p=0.039, RR: 7.8) and high postoperative CEAP (p=0.002, RR: 1.901), and preoperative deep vein insufficiency was also predictive for postoperative symptom recurrence (p=0.044, RR: 1.304). In the stripping group, postoperative neuropathy was significant (p=0.041, RR: 4.168). There was no difference in Kaplan-Meier symptom-free survival curves (p=0.651), venous clinical severity scores, or Aberdeen Varicose Vein Questionnaire scores among groups. Conclusion: High ligation is not a good option for patients with large SSV diameters or deep vein insufficiency. High ligation with stripping comes with an increased risk of sural neuropathy. High ligation with foam sclerotherapy should be considered an effective method with the ability of the foam to spread over the branches and microvenous structures. Performing operations before progression to high CEAP classes or greater SSV diameters is considerable. [Turk J Vasc Surg 2022; 31(3.000): 140-7]

Objective: The combination of endovenous therapies with stab avulsion or ultrasound guided foam sclerotherapy is widely performed. However, these conventional techniques tend to result in incomplete avulsions or persistent varicosities. Methods: One hundred and thirteen legs in 97 consecutive patients who underwent 1470 nm laser ablation for great saphenous varicose veins were enrolled. The foam sclerosing agent was injected via the sheath after endovenous laser ablation (EVLA). Patients were divided into two groups: EVLA only group (Control; n = 50) and EVLA and transluminal injection of foam sclerotherapy (TLFS) group (SCL; n = 63). Results: At three month follow up, reflux was abolished throughout all treated great saphenous veins (GSVs) when assessed with Duplex ultrasound. Thrombophlebitis was observed in two patients in the SCL group (p = .13). Additional second stage sclerotherapy was needed in the Control group (n = 33, 66%) vs. SCL group (n = 2, 3%; p < .0001). The venous clinical severity score (VCSS) was significantly improved in the SCL group (changes of VCSS, Control −3.3 ± 1.7 and SCL -4.4 ± 1.0; p < .0001). Univariable and multivariable analyses revealed that, among age, sex, Clinical-Etiology-Anatomy-Pathophysiology classification, linear endovenous energy density, and TLFS, TLFS was the only significant factor of improved VCSS (hazard ratio = −0.96; 95% confidence interval = −1.4 to −0.58; p < .0001). Conclusions: TLFS combined with EVLA may be an easy, safe, and effective procedure with acceptable complications vs. EVLA alone and reduces additional second stage interventions.

BACKGROUND & OBJECTIVE: Varicose veins are the commonest vascular problem both in men and women worldwide. Lack of timely management, inadequate treatment, and maltreatment of varicose veins can lead to the development of nonhealing ulcers and affects the quality of life in terms of health. Surgery, heat therapy, chemical therapy, and endoscopic treatment are the options of treatment. Foam sclerotherapy is relatively a new technique being practiced all over the world and has promising results.The objective was to determine the outcomes of foam sclerotherapy in the treatment of non-healing varicose ulcers. METHODOLOGY:In this descriptive study, 240 patients with chronic leg ulcers with varicose veins had been managed with foam sclerotherapy under ultrasound and compression bandage. All patients were reviewed at 7 days, 1month, 3 months, 6 months, 1 year, and 18 months both clinically and radiologically with a doppler ultrasound to assess the ulcer healing rates. RESULTS:The overall healing after 04 weeks of foam sclerotherapy was 83%. Two hundred and twenty-nine patients (95.4%) with ulcers healed within 02 months of the start of ultrasound-guided foam sclerotherapy. Delayed healing occurred after four months in11 cases. All those cases had either previous varicose veins surgery or deep vein thrombosis,or extensive perforator disease. During 18 months of follow-up, seven patients showed recurrence with a mean symptom-free period of 07 months. CONCLUSION:Chronic venous ulcers treated with foam sclerotherapyunder ultrasound guidance are associated with a high healing rate and low recurrence rate.

Tufted angioma is a rare vascular tumor with cutaneous angiomatous proliferation, commonly localized in the skin and subcutaneous tissues. Most cases are usually acquired in childhood, having protracted course with minimal tendency for spontaneous regression. Various treatment modalities have been described in the literature in the management of tufted angioma with variable response. Thus, there is an urge for simple yet effective and less invasive procedure for tufted angioma, particularly involving aesthetically important areas such as face, head, and neck. We report a case of a large tufted angioma over the neck of a young girl, successfully treated with a combined approach of oral propranolol and foam sclerotherapy.

Abstract Background Ambulatory phlebectomies and foam sclerotherapy are two of the most common treatments for varicose vein tributaries. Many studies have been published on these treatments, but few comparative studies have attempted to determine their relative effectiveness. Methods/design This is a prospective single-centre randomised clinical trial. Patients with primary truncal vein incompetence and varicose vein tributaries requiring treatment will be assigned randomly to either ambulatory phlebectomies or foam sclerotherapy. The primary outcome measure is the re-intervention rate for the varicose vein tributaries during the study period. The secondary outcomes include the degree of pain during the first two post-operative weeks and the time to return to usual activities or work. Improvements in clinical scores, quality of life scores, occlusion rates and cost-effectiveness for each intervention are other secondary outcomes. The re-intervention rate will be considered from the third month. Discussion This study compares ambulatory phlebectomies and foam sclerotherapy in the treatment of varicose vein tributaries. The re-intervention rates, safety, patient experience and the cost-effectiveness of each intervention will be assessed. This study aims to recruit 160 patients and is expected to be completed by the end of 2019. Trial registration ClinicalTrials.gov, NCT03416413. Registered on 31 January 2018.

This preliminary study investigated the clinical safety and efficacy of foam sclerotherapy during shunt surgery to treat portal hypertension and gastroesophageal varices.

Foam sclerotherapy is clinically employed to treat varicose veins. It involves intravenous injection of foamed surfactant agents causing endothelial wall damage and vessel shrinkage, leading to subsequent neovascularization. Foam production methods used clinically include manual techniques, such as the Double Syringe System (DSS) and Tessari (TSS) methods. Pre-clinical in-vitro studies are conducted to characterize the performance of sclerosing agents; however, the experimental models used often do not replicate physiologically relevant physical and biological conditions. In this study, physical vein models (PVMs) were developed and employed for the first time to characterize the flow behavior of sclerosing foams. PVMs were fabricated in polydimethylsiloxane (PDMS) by replica molding, and were designed to mimic qualitative geometrical characteristics of veins. Foam behavior was investigated as a function of different physical variables, namely (i) geometry of the vein model (i.e., physiological vs. varicose vein), (ii) foam production technique, and (iii) flow rate of a blood surrogate. The experimental set-up consisted of a PVM positioned on an inclined platform, a syringe pump to control the flow rate of a blood substitute, and a pressure transducer. The static pressure of the blood surrogate at the PVM inlet was measured upon foam administration. The recorded pressure-time curves were analyzed to quantify metrics of foam behavior, with a particular focus on foam expansion and degradation dynamics. Results showed that DSS and TSS foams had similar expansion rate in the physiological PVM, whilst DSS foam had lower expansion rate in the varicose PVM compared to TSS foam. The degradation rate of DSS foam was lower than TSS foam, in both model architectures. Moreover, the background flow rate had a significant effect on foam behavior, enhancing foam displacement rate in both types of PVM.

Introduction : Ultrasound-guided foam sclerotherapy (UGFS) of varicose veins is a useful treatment option. It is a relatively safe method in the case of limited, small varicose veins. In theory, a justified concern could be raised that the injection of an active drug into the large superficial venous vessels may potentially cause life-threatening consequences. Aim : To assess the safety and efficacy of UGFS using a 2% solution of polidocanol (Aethoxysklerol 2%) in the case of great saphenous vein incompetence. Material and methods : Fifty-two patients with great saphenous vein incompetence underwent ultrasound-guided foam sclerotherapy. The efficacy criterion was the elimination of reflux measured ultrasonographically and withdrawal or decrease of complaints: 1 week, and 1, 3, 6 and 12 months after the treatment. Complications of sclerotherapy were reported during follow-up. Results : Decrease or withdrawal of complaints of chronic venous insufficiency was reported in 96% of cases (50 patients). Disappearance or decrease of varicose veins was noted in all patients (100%). During examination after 12 months, full success of ultrasound was achieved in 38 (73%) cases, and 11 (21%) patients presented a partial desired effect according to the consensus from Tegernsee. Persistence of reflux longer than 1 s in the treated great saphenous vein was reported in 3 (6%) cases. Serious complications, such as deep vein thrombosis, pulmonary embolism, dyspnea, anaphylaxis, or neurological abnormalities, were not recorded. Conclusions : Ultrasound-guided foam sclerotherapy of incompetent great saphenous vein and varicosities with 2% polidocanol was found to be an effective and safe method of treatment during 1 year of observation. However, longer observation is necessary.

In the literature cases of stroke and transient neurological symptoms have been described after sclerotherapy for chronic venous disease The initial interpretation of these phenomena was that of a micro air embolism in association with a patent foramen ovale. This explanation did not always manage to justify all neurological manifestations. Recent theories have demonstrated that in the area of sclerosis, a significant amount of endothelin 1. We carried out a retrospective assessment of sclerotherapy case studies on 540 patients at ten phlebological centres to search for a relationship between the use of aminaftone (a venotropic drug with demonstrated anti-endothelin action) and the occurrence of side effects after sclerotherapy was performed. Significant reduction of side effects was observed in sclerotherapy for teleangectasias and in patients with migraine history.

Background: Foam sclerotherapy (foam) and endovenous laser ablation (EVLA) have emerged as alternative treatments to surgery for patients with varicose veins, but uncertainty exists regarding their effectiveness in the medium to longer term. Objectives: To assess the clinical effectiveness and cost-effectiveness of foam, EVLA and surgery for the treatment of varicose veins. Design: A parallel-group randomised controlled trial (RCT) without blinding, and economic modelling evaluation. Setting: Eleven UK specialist vascular centres. Participants: Seven hundred and ninety-eight patients with primary varicose veins (foam, n = 292; surgery, n = 294; EVLA, n = 212). Interventions: Patients were randomised between all three treatment options (eight centres) or between foam and surgery (three centres). Primary outcome measures: Disease-specific [Aberdeen Varicose Vein Questionnaire (AVVQ)] and generic [European Quality of Life-5 Dimensions (EQ-5D), Short Form questionnaire-36 items (SF-36) physical and mental component scores] quality of life (QoL) at 6 months. Cost-effectiveness as cost per quality-adjusted life-year (QALY) gained. Secondary outcome measures: Quality of life at 6 weeks; residual varicose veins; Venous Clinical Severity Score (VCSS); complication rates; return to normal activity; truncal vein ablation rates; and costs. Results: The results appear generalisable in that participants’ baseline characteristics (apart from a lower-than-expected proportion of females) and post-treatment improvement in outcomes were comparable with those in other RCTs. The health gain achieved in the AVVQ with foam was significantly lower than with surgery at 6 months [effect size −1.74, 95% confidence interval (CI) −2.97 to −0.50; p = 0.006], but was similar to that achieved with EVLA. The health gain in SF-36 mental component score for foam was worse than that for EVLA (effect size 1.54, 95% CI 0.01 to 3.06; p = 0.048) but similar to that for surgery. There were no differences in EQ-5D or SF-36 component scores in the surgery versus foam or surgery versus EVLA comparisons at 6 months.: The trial-based cost-effectiveness analysis showed that, at 6 months, foam had the highest probability of being considered cost-effective at a ceiling willingness-to-pay ratio of £20,000 per QALY. EVLA was found to cost £26,107 per QALY gained versus foam, and was less costly and generated slightly more QALYs than surgery. Markov modelling using trial costs and the limited recurrence data available suggested that, at 5 years, EVLA had the highest probability (≈ 79%) of being cost-effective at conventional thresholds, followed by foam (≈ 17%) and surgery (≈ 5%).: With regard to secondary outcomes, health gains at 6 weeks (p

Background: Varicose veins are enlarged, visibly lumpy knotted veins, usually in the legs. Uncomplicated varicose veins can cause major discomfort and some complications. They are part of chronic venous disease (CVD), which is reported to have a substantial negative impact on health-related quality of life (HRQoL). Traditional treatments for varicose veins involve surgical stripping and ligation and liquid sclerotherapy (LS), but can be invasive and painful. New minimally invasive treatments offer an alternative. These treatments typically involve use of laser, radiofrequency or foam sclerosant. They are increasingly widely used and offer potential benefits such as reduced complications, faster recovery, fewer physical limitations and improved quality of life. Objective: The aim of this report is to evaluate the clinical effectiveness, safety and cost-effectiveness of the minimally invasive techniques of foam sclerotherapy (FS), endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in comparison with other techniques, including traditional surgical techniques, LS and conservative management, in the management of varicose veins. Data sources: A systematic search was made of 11 bibliographic databases of published and unpublished literature from their inception to July 2011: MEDLINE; EMBASE; Cumulative Index to Nursing and Allied Health Literature; The Cochrane Library; Biological Abstracts; Science Citation Index (SCI); Social Sciences Citation Index; Conference Proceedings Citation Index-Science; UK Clinical Research Network; Current Controlled Trials; and ClinicalTrials.gov. Review methods: A systematic review of randomised controlled trials (RCTs) to assess the clinical effectiveness of minimally invasive techniques compared with other treatments, principally surgical stripping, in terms of recurrence of varicose veins, retreatment and clinical symptoms, as measured by the Venous Clinical Severity Score (VCSS), pain and quality of life. Network meta-analysis and exploratory cost-effectiveness modelling were performed. Results: The literature search identified 1453 unique citations, of which 34 RCTs (54 papers) satisfied the criteria for the clinical effectiveness review. The minimally invasive techniques reported clinical outcomes similar to surgery. Rates of recurrence were slightly lower for EVLA, RFA and FS, especially for longer follow-up periods; VCSS score was lower for EVLA and FS than for stripping, but slightly higher for RFA; short-term pain was less for FS and RFA but higher for EVLA; higher quality-of-life scores were reported for all evaluated interventions than for stripping. Differences between treatments were therefore negligible in terms of clinical outcomes, so the treatment with the lowest cost appears to be most cost-effective. Our central estimate is that total FS costs were lowest and FS is marginally more effective than stripping. However, this result was sensitive to the model time horizon. Threshold analysis indicated that EVLA and RFA might be considered cost-effective if their costs are equivalent to stripping. These findings are subject to uncertainty on account of the risk of bias present in the evidence base and the variation in costs. Limitations: The relative clinical effectiveness and cost-effectiveness of the techniques are principally based on rates of post-operative technical recurrence rather than symptomatic recurrence, as this was the reported outcome in all trials. The true proportion of treated individuals who are likely to present with symptoms of recurrence requiring retreatment is therefore not certain. A figure reflecting the likely proportion of treated individuals who would experience symptomatic recurrence requiring retreatment (with its associated costs), therefore, had to be calculated by the authors based on a small number of studies. The findings of this report also need to be verified by data from future trials with longer follow-up and using more standardised outcome measures. Conclusions: This assessment of the currently available evidence suggests there is little to choose between the minimally invasive techniques in terms of efficacy or cost, and each offers a viable, clinically effective alternative to stripping. FS might offer the most cost-effective alternative to stripping, within certain time parameters. High-quality RCT evidence is needed. Future trials should aim to measure and report outcomes in a standardised manner, which would permit more efficient pooling of their results. Study registration: PROSPERO number CRD42011001355. Funding: The National Institute for Health Research Health Technology Assessment programme.

La úlcera varicosa es una de las complicaciones más temidas y frecuentes de la insuficiencia venosa crónica, por la sintomatología y discapacidad que provoca en el paciente y los elevados costos que ocasiona. Se presenta un caso de un paciente con antecedentes de de várices en miembros inferiores, y una úlcera varicosa de varios años de evolución en el miembro inferior izquierdo rebelde a diferentes tratamientos, a la cual se le realiza la técnica escleroterapia con espuma y se logra su cicatrización con una evolución favorable.The varicose ulcer is one of the more frequent and fearsome complications of chronic venous insufficiency due to its symptomatology and disability provoked in a patient with a history of lower extremities varices and the high related costs. This is the case a patient with a background of lower extremities varices and a varicose ulcer of some years of evolution in the left lower limb unmanageable for different treatments being necessary to perform the foam sclerotherapy technique achieving its healing with a favorable course.

La escleroterapia con espuma es un método de tratamiento para las várices de miembros inferiores. Se presenta el caso de una mujer de 73 años tratada con este método. La paciente tenía antecedentes de várices en miembros inferiores debido a insuficiencia de la vena safena interna izquierda. Este método, efectivo, satisfactorio y económico, erradicó la várice y una de las principales causas de muerte.Foam sclerotherapy is treatment method for lower extremities varices. This is the case of a woman aged 73 treated with this method. Patient had varices backgrounds in lower extremities due to an insufficiency of left internal saphena vein. This effectiveness, satisfactory and economic method eradicates the varix and one of the leading death causes.

OBJECTIVES: This pilot study investigated the safety and efficacy of a novel shunt surgery combined with foam sclerotherapy of varices in patients with prehepatic portal hypertension. METHODS: Twenty-seven patients who were diagnosed with prehepatic portal hypertension and underwent shunt surgeries were divided into three groups by surgery type: shunt surgery alone (Group A), shunt surgery and devascularization (Group B), and shunt surgery combined with foam sclerotherapy (Group C). Between-group differences in operation time, intraoperative blood loss, portal pressure decrease, postoperative complications, rebleeding rates, encephalopathy, mortality rates and remission of gastroesophageal varices were compared. RESULTS: Groups A, B and C had similar operation times, intraoperative bleeding, and portal pressure decrease. The remission rates of varices differed significantly (p