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Background: To describe the treatment of patients with great saphenous vein (GSV) incompetence and varicose veins (VVs), utilizing an Automated Microfoam Preparation System (AMPS, Varixio®, VB Devices, Barcelona, Spain). Methods: Adults between January and June 2021 were included. The AMPS system was used for foam preparation. Sclerotherapy treatment followed international recommendations. The primary endpoint was GSV closure rate after 36 months. Results: 164 patients were enrolled. During the 7-day follow-up period, all GSVs showed complete closure, which was maintained at the 1-year mark. No major complications were reported. A cumulative complete GSV recanalization rate of 6.1% and a partial recanalization rate of 26.8% after 36 months were noted. Some patients (9.7%) required additional treatment. A higher BMI was associated with complete recanalization. Conclusion: The AMPS offers an easy-to-use and standardized procedure, potentially enhancing treatment outcomes if compared with manual preparation. Caution is advised when treating obese patients. [ABSTRACT FROM AUTHOR]

Aim: To compare the ablation techniques' efficacy of endovenous microwave ablation (EMA) combined with high ligation (HL), foam sclerotherapy (FS) and compression therapy (CT) and endovenous laser ablation (EVLA) combined with HL-FS-CT in the treatment of VLUs. Method: 301 consecutive patients with VLUs from 2013 to 2022 in a 3200-bed hospital were intervened by EMA combined with HL-FS-CT and EVLA combined with HL-FS-CT were retrospectively compared. Results: One hundred thirty-four patients underwent EMA+HL-FS-CT and 167 patients underwent EVLA+HL-FS-CT. The primary outcome of the ulcer healing time was 1.45(0.75–1.5) months and 1.86(0.5–2.5) months, respectively, in the two groups (HR for ulcer healing was 1.26, 95% CI [0.96–1.66], p = 0.097). Secondary outcomes included that no significant difference was found in ulcer recurrence and GSV recanalization and complications between the two groups, and the postoperative VCSS and AVVQ were significantly lower than the baseline values in the respective groups (p = 0.0001). Conclusion: EMA+HL-FS-CT and EVLA+HL-FS-CT are both effective at treating VLUs. Both of the two comprehensive treatments were beneficial to the healing of ulcers, but no evidence showed which one was superior in the ulcer healing time. [ABSTRACT FROM AUTHOR]

The article focuses on microsclerotherapy as a treatment for chronic venous disease, particularly addressing technical considerations and management recommendations. Topics discussed include the necessity of duplex ultrasound assessment for symptomatic patients, the use of liquid and foam sclerosants, and post-procedural compression to improve outcomes and reduce complications.

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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.

The article discusses the indications and safe volumes for sclerotherapy in the treatment of chronic venous disease, emphasizing the need for careful patient selection and tailored treatment approaches. Topics include contraindications for sclerotherapy, diagnostic evaluation using duplex ultrasound, and recommendations for sclerosant type and concentration based on target vessel characteristics.

Varicose veins are common disorders that affect the quality of life of sufferers due to the symptoms they cause. The efficacy of different varicose vein treatments has been studied extensively, with varying success rates. Less invasive treatments, such as sclerotherapy, can be mentioned among the proposed therapies. This study investigates the efficacy of ultrasound-guided foam sclerotherapy (UGFS) for treating varicose veins. In this study, the results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of the Meta-analysis of Observational Studies in Epidemiology (MOOSE) protocol. By searching in 11 databases as well as the Google Scholar search engine using the keywords "varicose vein," "foam sclerotherapy," "occlusion," "success," "Duplex-guided foam sclerotherapy," "efficacy," and "Ultrasound-Guided Foam Sclerotherapy," randomized clinical trial (RCT) and cohort articles published until July 2022 were collected. The required information was extracted and analyzed using Comprehensive Meta-analysis (CMA) software version 2. Data analysis of 35 randomized clinical trial articles showed that the success rate of ultrasound-guided foam sclerotherapy in the treatment of varicose veins is 78% (95% CI: 73–83; P value < 0.001) (I2 = 89.11, P value < 0.001). The subgroup analysis showed that the success of this method is more in the form of sodium tetradecyl sulfate and polidocanol 2% foam and in a period of fewer than 3 months from the start of treatment and in the Asian race. Also, the analysis of 8 cohort studies showed that the success rate of ultrasound-guided foam sclerotherapy in the treatment of varicose veins is 81% (95% CI: 65–91; P value < 0.001). The most prevalent complications of this method in the treatment of varicose veins were induration, thrombophlebitis, bruising, dyspigmentation, hematoma, pain, and phlebitis. Present study illustrated that the effectiveness of ultrasound-guided foam sclerotherapy in the treatment of varicose veins is high. However, it was significantly less successful than published meta-analyses on other less invasive methods such as radiofrequency ablation (RFA) and endovenous laser ablation (EVLA). Also, this method showed more major complications than our previous study on the effect of endovenous laser ablation in the treatment of varicose veins. Factors such as foam type, follow-up duration, and racial differences can affect the study's results. [ABSTRACT FROM AUTHOR]

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.

Background: The prevalent issue of varicose veins in the lower extremities necessitates exploring effective and efficient treatment methods. This study aims to evaluate the efficacy of foam sclerotherapy, focusing on improvements in the venous clinical severity score and the swift return to work posttreatment. Through this research, we intend to ascertain whether foam sclerotherapy can serve as a cost-effective, safe, and satisfactory alternative to traditional treatments. Methodology: A universal sampling method was implemented to select the sample size for the study. The study cohort consisted of 31 patients who visited the outpatient department and met the established inclusion criteria. These patients underwent comprehensive history evaluation and physical examinations. Subsequent to the preliminary evaluations, the patients were subjected to necessary hematological and biochemical analyses along with appropriate radiological investigations, including USG venous Doppler studies, dictated by clinical suspicions. All participants underwent USG-guided foam sclerotherapy and their progress was monitored based on predefined outcomes. Results: The study predominantly involved males aged between 30 and 60 years. A significant enhancement in patient satisfaction was documented, with notable reductions in ulcer size in 3 out of the 31 patients who initially presented with ulcers. Moreover, the therapy ensured a 100% reduction in reported pain and swelling, with no hospital stays extending beyond one day. Remarkably, 28 out of the 32 patients managed to resume their work within a span of less than 7 days, showcasing no side effects from the treatment. Conclusion: The data gleaned from the study underscore the considerable patient satisfaction derived from foam sclerotherapy, especially concerning alleviation in pain, swelling, and enhanced ulcer healing. Furthermore, patients reported a significant reduction in lower limb pigmentation following the therapy. Not only is foam sclerotherapy cost-effective and safe, but it also facilitates a quicker return to work coupled with shorter hospital stays, establishing itself as a potent alternative in managing symptomatic varicose veins. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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.

The article discusses various techniques for truncal vein ablation, focusing on both thermal and non-thermal approaches, and provides management recommendations based on evidence grades for each technique. Topics include recommendations for great saphenous vein treatment, options for small saphenous vein and accessory veins, and the consideration of secondary procedures for veins not treatable with thermal ablation.

Foam sclerotherapy is considered an acceptable method to treat great saphenous vein (GSV) insufficiency, promoting occlusion of its trunk and eradicating reflux. Yet, certain technical points have not been standardized while issues regarding the ultrasonographic appearance of successful or acceptable GSV obliteration or the end-points of the method are not clearly defined. This article comments on the aforementioned using examples based on personal experience. [ABSTRACT FROM AUTHOR]

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.

Objective: This study aimed to investigate the efficacy of foam sclerotherapy in the treatment of tortuous Great Saphenous Vein (GSV) insufficiency. Methods: In this prospective non-randomized study 62 patients with tortuous GSV insufficiency were included. All patients were delivered sclerosant agent in the form of foam into the GSV through a cannula above the knee level. Characteristics of patients, diameter of veins, reflux grades, Venous Clinical Severity Score (VCSS) and Clinical, Etiological, Anatomical, Pathological (CEAP) scores, concentration of sclerosant agent, complications and follow-up results were recorded. Results: Foam sclerotheraphy was performed with 100% technical success in all patients at operative room. There were no allergic reactions or neurological complications during and after the operations. Ecchymosis was the most common complication with 37.1% frequency.. VCSS scores significantly decreased from 6.43% to 2.53%, during follow-up from initial admission to sixth months, respectively (P <0.05).In the first month parameters, successful occlusion rate was 88.7%, whereas its rate was 82.3% in sixth month. Recanalization rate significantly increased from 11.3% to 17.7% during follow-up from first to sixth months, respectively (P <0.05). Conclusions: Due to its low complication rate, low cost, acceptable total occlusion rate and reproducibility; Foam sclerotherapy can be considered a reliable treatment for patients with tortuous GSV insufficiency. [ABSTRACT FROM AUTHOR]

Background: To retrospectively analyze the short-term outcomes of catheter-based versus direct foam sclerotherapy when combined with high ligation (HL) for the treatment of great saphenous vein (GSV) incompetence. Methods: From July 2018 to October 2019, a total of 82 lower limbs of 70 patients with GSV incompetence received HL combined with catheter-based foam sclerotherapy (CFS group) or direct foam sclerotherapy (DFS group) for GSV proximal trunk. Among them, 40 limbs of 36 patients were treated with CFS, and 42 limbs of 34 patients were treated with DFS. The occlusion of GSV proximal trunk was evaluated with venous duplex ultrasound examinations; Venous Clinical Severity Scores (VCSS) was used to assess clinical improvement; Aberdeen Varicose Veins Questionnaire (AVVQ) was used to assess quality-of-life scores; and Complications was used for the safety evaluation. Results: At day 7 post-operatively, complete occlusion of proximal trunk of the GSV was achieved in 92.5% legs of the CFS group and 71.4% of the DFS group (p = 0.014). Additionally, anterograde flow was found in 7.5% legs of the CFS group and 26.2% of the DFS group (p = 0.025). No significant differences in the occurrence of complications were observed between the two groups. The median follow-up was 285.5 days in the DFS group and 318 days in the CFS group (p = 0.140). VCSS and AVVQ reduction were significant in both CFS group and DFS group (5.3 ± 2.5, 5.5 ± 2.4, p < 0.001 for VCSS; 15.9 ± 8.0, 16.3 ± 8.6, p < 0.001 for AVVQ), but no significant difference were observed between two groups (p = 0.655 for VCSS, p = 0.934 for AVVQ). Conclusions: Although the occlusion of great saphenous vein proximal trunk were different, two modalities result in similar clinical and quality-of-life improvements. DFS is a feasible alternative to CFS when combined with HL. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

We aimed to explore the efficacy and safety of ultrasound‐guided foam sclerotherapy combined with endoluminal radiofrequency closure in patients with varicose veins of lower extremities (VVLEs); furthermore, we aimed to provide a theoretical basis for the effective management of VVLE patients in clinical work. From January 1, 2020, to March 1, 2021, 88 patients with VVLE admitted to Third Hospital of Shandong Province were included in this retrospective study. Depending on the type of treatment, the patients were divided into study groups and control groups. The study group consisted of 44 patients who were given ultrasound‐guided foam sclerotherapy combined with endoluminal radiofrequency closure. The control group consisted of 44 patients who were given high ligation and stripping of the great saphenous vein. Efficacy indicators included postoperative venous clinical severity score (VCSS) of affected limb and postoperative visual analogue scale (VAS) score. Safety indicators included length of operation, intraoperative blood loss, length of postoperative rest in bed, length of hospital stay, postoperative heart rate, preoperative blood saturation (SpO2), preoperative mean arterial pressure (MAP), and complications. The VCSS score 6 months after operation in the study group was significantly lower than that in the control group (P <.05). The pain VAS score in the study group was significantly lower than that in the control group at 1 and 3 days after operation (both P <.05). Compared with the control group, the study group was significantly lower in length of operation, intraoperative blood loss, postoperative in‐bed time, and hospital stays (all P <.05). Heart rate and SpO2 were significantly higher, and MAP was significantly lower in the study group compared with that in the control group 12 hours after surgery (all P <.05). The overall postoperative complication rate in the study group was significantly lower than that in the control group (P <.05). In conclusion, compared with surgical treatment of high ligation and stripping of the great saphenous vein, ultrasound‐guided foam sclerotherapy combined with endoluminal radiofrequency ablation for the treatment of VVLE disease has better efficacy and safety, which is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

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.

Background Venous leg ulcers are a considerable health problem because of their high incidence, slow healing, high recurrence rate, and high cost of treatment. Minimally invasive treatments such as endovenous thermal ablation and foam sclerotherapy proved to be safe and effective. However, there is a paucity in studies focusing on the management of postphlebitic venous ulcers using endovenous thermal ablation of the superficial system in combination with foam sclerotherapy. Objectives The aim of our study was to assess the healing time, procedure-related complications and recurrence rate in patients having a postphlebitic venous leg ulcer after being treated with EVLA associated with ultrasound-guided foam sclerotherapy to incompetent perforators with compression therapy. Subjects and methods This is a prospective observational study, conducted at Ain Shams University Hospitals and Nasser institute hospital in Cairo on 30 patients presented with postphlebitic venous leg ulcers. Results After one year, 90% of cases had a totally healed ulcers, 10% with ulcer decrease in size of more than 50%, and recurrence rate 6.7%. The adverse events of this procedure were DVT (6%), hematoma (6%), ecchymosis (43%), thrombophlebitis (6%), and pain (70%). There was significant improvement of the VCSS as regard pain, edema, inflammation, ulcer size, and number. There was highly significant (P < 0.0001) improvement in the mean (SD) VCSS (preoperative 18 [2.808] vs. postoperative 6.367 [2.3449]). Conclusion Patients with totally recanalized deep venous system post deep venous thrombosis, presenting with nonhealing venous leg ulcers, may benefit from thermal ablation of superficial varicose veins combined with ultrasound-guided foam sclerotherapy. This combined approach is a feasible, safe, and effective modality in terms of improved healing rate, low recurrence rate, low complications, and significant improvement in quality of life. [ABSTRACT FROM AUTHOR]

Varicose veins are common problems and there are many ways of treatment starting from life style modification, medications, compression therapy, surgical treatment, endovenous treatment etc. One of the endovenous treatments is sclerotherapy, a method which can be applied to the telengiectasia, reticular veins, and varicose veins. In the past, it was used only for smaller veins but now with the help of ultrasound guidance, it can be used for main truncal veins as well. It destroys the vein endothelium leading to occlusion and subsequent fibrosis of the target vessel. Injection sclerotherapy has assumed a major role in the treatment of venous insufficiency, particularly in the treatment of smaller veins such as telengiectasias and spider veins and smaller diameter tributaries. This is a very important treatment for recurrent veins and it can be combined with various other treatments. In the procedure of sclerotherapy, sclerosant agent is injected in veins. It may be injected direct undiluted, diluted, or in a form of foam. Depending on the type of vein and diameter of vein, different dilutions are used. Though the recurrence with sclerotherapy is high but being a minimal invasive technique with low cost, it is a favorable technique for varicose veins. [ABSTRACT FROM AUTHOR]

Varicose veins are a common presentation, and its treatment has been a challenge for surgeons. Many studies have evaluated the efficacy of foam sclerotherapy with a high failure rate. One of the postulated reasons is inadequate obliteration of saphenofemoral junction with foam sclerotherapy. To test this hypothesis we compared whether there is a decrease in reflux with saphenofemoral junction ligation, along with foam sclerotherapy. Forty-eight patients (50 legs) with primary varicosities of the Great saphenous vein system were randomized into two groups: saphenofemoral junction ligation with foam sclerotherapy (SFJL + FS) and foam sclerotherapy alone (FS), and followed up at 2 months. There was complete disappearance of varicose veins in great saphenous vein territory in 96% of patients in SFJL + FS group, and 88% of patients in FS group. Veins ≥ 8 mm in diameter were incompletely occluded with sclerotherapy. Patient satisfaction score was comparable in both the groups. The addition of saphenofemoral junction ligation to foam sclerotherapy offers no additional patient benefit, particularly with regard to disappearance of varicose veins, relief of symptoms, recurrence, and morbidity. However, in large diameter veins (≥ 8 mm), saphenofemoral junction ligation with foam sclerotherapy gives better results. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated the results of polidocanol sclerotherapy in the treatment of venous malformations (VM) including patient satisfaction, perceived improvement, and predictors of satisfaction. Material and Method: Patients with VM that underwent polidocanol foam sclerotherapy between June 2013 and July 2021 in a single center were retrospectively evaluated. Patient demographics, VM, and treatment characteristics were analyzed. Patient-reported outcomes and satisfaction were analyzed with a questionnaire. Results: This study included 232 (136, 58.6%, female) patients. The mean age was 24.49 ± 12.45 years (range 3–72). The clinical response rate was 82.3%. The rate of satisfaction was 82.3%, and 116 (50%) patients were significantly satisfied. There were no major complications. Clinical response and VM margin were related to satisfaction (p < 0.01, p = 0.012, respectively). Clinical response to pretreatment swelling was related to significant satisfaction (p = 0.02). Conclusion: Polidocanol sclerotherapy was safe and effective in VM treatment with high satisfaction and low complication rates. [ABSTRACT FROM AUTHOR]

Background: This study aimed to discuss common complications of medical aesthetic treatments, which require ophthalmological intervention. Methods: This literature study evaluated published journal articles (clinical trials or scientific reviews) that were extracted from electronic databases (MEDLINE and PubMed) and reference lists of related articles. Only articles available in English were considered for this review. Results: Unskillful interference in the eye area can cause severe, irreversible complications, including blindness. This is a constant risk because of anatomical deviations, and retrograde blood flow. Conclusions: Accurate knowledge of anatomy, especially the vascular anatomy of high-risk sites, and the understanding of the depth and plane of injection, and various injection techniques minimize the risk of these complications. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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]

Objectives: To present results for the use of an automated microfoam preparation system (AMPS) in the treatment of varicose veins in a real-world setting.Method: We performed a descriptive study based on a prospective database of patients treated with foam sclerotherapy between February 2021 and December 2022. Polidocanol foam was prepared using a capsule containing sterile air or a low-nitrogen mix. We recorded volume per session, percentage of sclerosing drug, number of sessions, release of thrombus entrapment, complications, and adverse events. A univariate descriptive analysis was performed using Stata V.16.Results: Over a 23-month period, 185 patients (84.9% women, 15.1% men) underwent 685 sessions. Median age was 51.6 years (range, 16-79 years). Thread veins were the condition treated in 68.9% of sessions, tributaries in 7.2%, and truncal veins in 22.6%. The average volume per session was as follows: thread veins, 8 mL; great saphenous vein (GSV), 6.9 mL; and small saphenous vein (SSV), 4.3 mL. The average drug concentration was as follows: thread veins, 0.18%; GSV, 1.49%; and SSV, 1.63%. The average number of sessions was 3.4 for thread veins, 2 for tributaries, 2.7 for the GSV, and 2.9 for the SSV. The occlusion rate at 15 months was 93.2% (41/43) for the great saphenous vein and 86% (13/15) for the small saphenous vein. We recorded a total of 21 complications (3.1% of sessions), 14 of which were minor complications (2% sessions), and 7 moderate adverse events (1% of sessions).Conclusions: This new device is highly versatile and can be used for preparing foam at all concentrations. It contributes to a high rate of occlusion in saphenous trunks, with a minimal number of sessions required for thread veins indicating that the system is a favorable option in the treatment of venous diseases. Additionally, the low frequency of residual pigmentation may be attributed to the system’s ability to tailor the foam concentration to the individual case, thus supporting optimal outcomes. [ABSTRACT FROM AUTHOR]

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The purpose of this article was to review the different preventive measures and treatments for varicose veins disease. Varicose veins are tortuous, enlarged veins that are usually found in the lower extremities damages blood vessels leading to its painful swelling cause's blood clots, affecting people over increasing prevalence with age and affects the proficiency, productivity, and life quality of a person. Prolonged standing and obesity are the major reason for varicose vein disease. The mechanisms, prevention, risk factors, complications, and treatment of varicose veins are explained in this review. Various types of treatments such as endovascular, surgical, and herbal treatments improve quality of life and reduce the secondary complications of varicose veins. Besides these methods of treatments, varicose vein disease can be prevented by doing regular yoga/exercise and consumption of several fruits and vegetables such as Grapes, blackberries, avocados, ginger, and rosemary. Typically, varicose veins can be a benign process with several problems that can influence the life quality of an individual that can lead to potentially life-threatening complications. However, there are numerous surgical, endovascular, and chemical treatments that improve quality of life and decrease secondary complications of varicose veins. Patients with varicose veins should take an antioxidant medicament from the flavonoid groups to reduce the arterial blood pressure value, risk of atherosclerosis development, prevent thrombotic incidents. Chronic venous disease is a pathological state of vein circulatory systems of the lower limbs Prolonged standing and obesity are the major reason for varicose vein disease Endovascular, surgical, and herbal treatments improve quality of life and reduce the secondary complications of varicose veins Venoactive drugs such as flavonoids, saponins, and others have a therapeutic effect on chronic venous disorders Phlebotropic drugs are semi-synthetic substances widely used in different states of chronic venous insufficiency Food rich in phytoconstituents are more effective in varicose veins. [ABSTRACT FROM AUTHOR]

Background: The benefits of postoperative compression are not well established following radiofrequency ablation of the truncal vein and concomitant foam sclerotherapy. Methods: A total of 104 patients were randomized: Postoperatively, 54 patients received no compression and 50 patients received class II thigh-high compression. The primary outcome for this study was the difference between means on postoperative pain scores over the first 10 days follow-up measured on a visual analog scale (VAS) from 0 to 100 mm (prespecified delta 10 mm). Results: The difference between means in no compression and compression group on postoperative pain scores over the 10 days follow-up was 2.1 mm (95% confidence interval −5.1–9.3 mm; p = 0.28) indicating non-inferiority. Patients in the no compression group were more satisfied with the visual appearance of the treated leg at 1 month (p = 0.003). Conclusion: Over the first 10 postoperative days, no compression was non-inferior to compression on pain scores. [ABSTRACT FROM AUTHOR]

Background: Ultrasound guided foam sclerotherapy (UGFS) is a flexible and highly utilised tool in the treatment of varicose veins (VVs), both as a primary treatment and as an adjunct to other treatments. Concern remains regarding the risk of neurological adverse events (AEs) such as migraine, visual disturbance and serious adverse events (SAEs) such as cerebrovascular accident that have been reported after UGFS treatments. Aim: To determine the incidence of neurological AEs and SAEs after UGFS. Methods: A prospective, multicentre, post-authorisation safety study across Europe (both private and government) was performed between January 2015–2020. Neurological adverse events after UGFS with Fibrovein® (Sodium Tetradecyl Sulfate) 1 and 3% physician generated foam. Results: 8056 patients underwent treatment. There were 46 AE (including 5 SAEs), 30 (65%) SAEs were in female patients. Mean age was 55 years with mean body mass index (BMI) of 27. Univariable logistic regression demonstrate that UGFS only treatment (i.e. no adjunctive treatment), liquid-to-gas ratio, gas type and total foam volume (1% sodium tetradecyl sulfate, STS) were significantly associated with the odds of experiencing the outcome. Multivariable logistic regression model exhibits that migraine and total foam volume (1% STS) maintained statistical significance thus associated with the odds of adverse events. Conclusions: This study demonstrates that UGFS with Fibrovein is safe with a very low incidence of neurological AEs and SAEs. Past history of migraine, use of physiological gas (O2/CO2) and increasing volumes of 1% foam increase the risk of AEs. [ABSTRACT FROM AUTHOR]

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.

Objective: Puig types 2 through 4 venous malformations (VMs) are challenging to treat with sclerotherapy given their robust systemic outflow. Endovenous balloon occlusion offers a means of temporarily occluding systemic venous outflow to allow for more complete sclerotherapy. This study reviews our experience of implementing this technique in patients with Puig advanced (types 2 through 4) VMs. Methods: An IRB approved review of treated venous malformations from 2013–2016 revealed 10 patients fitting inclusion criteria. Patient demographics, pre-procedural imaging, intra-procedural technical parameters, and post-procedural follow-up outcomes were recorded. All patients underwent temporary balloon occlusion of a systemic or major draining vein during sclerotherapy. Embolic agents included n-butyl cyanoacrylate glue, sodium tetradecyl sulfate foam, and coils. Standard 5 French angioplasty balloons ranged from 4 to 8 mm diameter and 2 to 8 cm length depending on vessel requiring occlusion. All patients underwent minimum 3-year follow-up questionnaire administration re-assessing resolution of lesion symptomology and post-procedural quality of life (QoL) measures. Results: Of the 10 VMs treated, 2 were Type 2, 6 were Type 3, and 2 were Type 4. More than one sclerotherapy session was required in 7/10 patients (mean: 2, range: 1–4). Most common sites of VM systemic drainage included subclavian, popliteal, internal/external jugular, and basilic veins. All patients had no indication for further sclerotherapy following adjunctive balloon occlusion. No non-target embolization or immediate post-procedural complications occurred. Follow-up questionnaires (mean interval: 3 years 6 months, range: 3 years–3 years 11 months) confirmed the persistence of embolization effects, improved QoL, and no additional sclerotherapy sessions for all patients in the cohort. Conclusions: Endovenous balloon occlusion as an adjunct to sclerotherapy can be considered when treating patients with types 2–4 venous malformations. This technique lowers the risk of non-target systemic venous embolization, allowing for operator-driven deeper intralesional sclerosant penetration and subsequently maintained treatment efficacy. [ABSTRACT FROM AUTHOR]

Objective: The use of cyanoacrylate products (CA) in incompetent perforator vein (IPV) treatment has not been thoroughly examined. The primary objective of this study is to describe the technique of ultra sound guided direct injection of IPV with CA, and secondarily to determine early closure rates and safety of this technique. Methods: A retrospective analysis of patients undergoing IPV injection at two centres between 2015-2018 was conducted. Demographics, CEAP classification and IPV location were collected. Outcomes were assessed at two follow-up appointments. Results: A total of 83 perforator vein injections were completed. CEAP classifications include C2 – C6 classes. Location of perforators were posteromedial (6%), femoral canal (9%), paratibial (14%), and posterior-tibial (71%). IPV closure rates were 96.3% at initial follow-up (16 ± 2 days). Closure rates decreased to 86.5% at second follow-up (72 ± 9 days). There were no deep vein thromboses during follow-up. One patient developed septic thrombophlebitis that was successfully managed with antibiotics. Conclusion: Ultrasound-guided CA glue injection is a simple and low risk procedure that effectively closes incompetent perforator veins. [ABSTRACT FROM AUTHOR]

Objective. To compare and analyze the therapeutic effect of 980 nm laser endovascular thermal ablation (EVTA) combined with foam sclerotherapy on day surgery (local anesthesia) and high ligation of great saphenous vein+810 nm laser EVTA combined with foam sclerotherapy on inpatient surgery (general anesthesia) for patients with lower extremity varicose vein. Methods. Data of the patients who underwent the above different surgical procedures respectively in the Department of General Surgery, The First Hospital of Xuzhou Mining Group from March 2019 to March 2020 were retrospectively analyzed, including 111 day surgery patients (980 nm group) and 107 inpatient surgery patients (810 nm group). The baseline data, postoperative data and follow-up data were collected, and the differences between the two groups were compared. Results. There was no significant difference between the two groups in baseline data and follow-up data. After operation, the 980 nm group was better than the 810 nm group in pain score, duration of pain, the proportion of using painkillers, the time required to resume daily life and economic cost (all P<0.05). Conclusion. Endovascular thermal ablation (980 nm laser) combined with foam sclerotherapy in the day surgery for lower extremity varicose vein has certain advantages in postoperative comfort, hospitalization time and cost, which will provide a new option for patients who are not suitable for general anesthesia. [ABSTRACT FROM AUTHOR]

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.

Objectives: Little is known how calibre and length of needles affect the stability of sclerosing foam. Methods: Foams were made of 0.5%, 1%, 2% and 3% polidocanol, and 0.2%, 0.5%, 1% and 3% sodium tetradecyl sulfate (STS), which were mixed with air in the proportion of 4:1. These foams were ejected through needles with the length of: 4 mm, 6 mm and 13 mm, and diameter of: 0.26 mm, 0.3 mm and 0.4 mm. Results: Foams made of more concentrated polidocanol were more stable. Regarding STS an opposite relationship was revealed. Foams made of polidocanol were more stable if ejected through a longer needle, while the length of needle did not significantly affect stability of STS foams. Foams ejected through 0.26 mm diameter needles were very unstable. In the case of 0.5% polidocanol, 0.3x6mm needle provided atypically stable foam. Conclusion: In order to inject maximally stable foam, calibre and length of needle should be taken into account. [ABSTRACT FROM AUTHOR]

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.

Objective: To analyze prevalence of venous thromboembolism (VTE) after ultrasound guided foam sclerotherapy. Method: Clinical retrospective study with patients treated from 2004 to 2014. Charts with incomplete data and follow-up less than 60 days were excluded. Polidocanol foam (Tessari method) was used. The primary outcome was the prevalence of VTE and the secondary were possible risk factors. Chi-square test and Marascuillo prodecure were applied at a significance level of 5%. Results: 2,616 patients were included with 4,712 lower limbs treated. The mean age was 50.7±0.86, in majority female, 83.7%. VTE occurred in 0.49% (pulmonary embolism 0,3%) in a mean time of 44.0±42.2 days. Male gender, personal or family history of phlebitis or DVT and high caliber varicose veins were significantly associated to VTE. Conclusion: incidence of VTE is low, male gender, personal or family history of VTE and caliber of varicose veins greater than 7 mm increased the risk. [ABSTRACT FROM AUTHOR]