Treatment of Recurrent Symptomatic Saphenous Trunk Reflux with Catheter Directed Foam Sclerotherapy and Tumescent Anaesthesia

Abstract

Objective: The aim was to assess short and midterm efficacy and safety of catheter directed foam sclerotherapy (CDFS) with tumescent anaesthesia in patients with recurrent symptomatic saphenous reflux. Methods: This was a prospective observational study (February 2018 to February 2019) including 21 consecutive patients referred with recurrent symptomatic varicose veins. Standing duplex ultrasound (DUS) with saphenous vein diameter measurement 3 cm from the terminal valve was performed pre-operatively. All the patients were operated on under local anaesthesia. By ultrasound guided puncture a hydrophilic 0.035″ guidewire and 5F Berenstein catheter were inserted through a 5F introducer sheath. Peri-saphenous tumescent anaesthesia (PSTA) was performed under ultrasound guidance. Sclerosant foam was prepared with sodium tetradecyl sulphate 3% or polidocanol 3% using the Tessari method. Concomitant phlebectomies were performed in 52%. Clinical evaluation and DUS were performed pre- and post-operatively at one week, six months, and 12 months. Results: There were 11 men and 10 women (median age 52 years; interquartile range [IQR] 43 – 61). The great saphenous vein was treated in 18 patients. The median vein diameter was 6.8 mm (IQR 4.7 – 8.9). Previous procedures were Cure conservatrice et Hemodynamique de l'Insuffisance Veineuse en Ambulatoire (CHIVA), mechanochemical ablation, thermal ablation, and cyanoacrylate closure. The distribution of the clinical class (Clinical Etiology Anatomy Pathophysiology [CEAP] classification) was 16 C2, three C3, and two C4 limbs. Immediate technical success was 100%. There were no complications in the early post-operative period. The median follow up was eight months (IQR 5 – 10). The occlusion rate demonstrated by DUS was 100% (21/21) at one week, 100% (21/21) at six months, and 86% (18/21) at 12 months. The median post-procedural vein diameter at one week, six months, and 12 months was 4.8 mm (IQR 3.9 – 6), 4.3 mm (IQR 3.5 – 5.5), and 4 mm (IQR 3 – 4.9), respectively. Conclusion: Combination CDFS with PSTA achieves good short and medium term venous occlusion rates, associated with few complications in patients with recurrent symptomatic saphenous reflux.