BGC - THE COMPLETE STORY !!!!

FEBRUARY 2001

ABSTRACT AND COMMENTARY BY:
Attilio Cavezzi, MD
San Benedetto Del Tronto (AP), Italy

Treatment of Varicose Long Saphenous Veins with Sclerosant in Microfoam Form: Long-Term Outcomes
Cabrera J, etc

Sclerotherapy has always been an effective way to treat varicose veins but several studies have shown a high percentage of recanalization on long-term followup. The authors report their experience with sclerosant microfoam treatment of varicose veins as well as their long-term outcomes.

From 1993 to 1996, limbs with varicose veins caused by greater saphenous vein (GSV) incompetence (diameter at the junction of 9 to 32 mm) were treated with a proprietary, patented microfoam of 1 to 3% Lauromacrogol 400. Patients were studied pre- and post-treatment by physical examination and color-flow duplex scanning. They were treated by duplex-guided sclerotherapy with compressive bandages and elastic stockings in the post-treatment period.

The sclerosing foam used in the authors' experience is a microbubble foam of the detergent drug Lauromacrogol 400 coupled with carbon dioxide. This new form of sclerosant permits a greater expansion of the active surface area of the sclerosing drug which is much larger than the active surface of the normal liquid sclerosant. The microfoam was injected through a 20G catheter under duplex guidance and with the patient supine. Generally, 15 to 30 ml of foam was injected into the GSV. Spasm of the treated vessel was the final endpoint.

Results of treatment in 500 GSVs can be summarized as follows: 86% of veins required only one session to achieve immediate sclerosis, 10.5% required a second session, and 3.5% required three sessions. Further injections were necessary during followup to sclerose varicose tributaries. Duplex followup at three or more years revealed fibrosis in 81% of GSVs, a patent GSV without reflux in 5%, and recurrence of reflux in 14%. Disappearance of tributary varicose veins was achieved in 96.5% of limbs. No major complications were reported. Segmental varicophlebitis occurred but it was uncommon.

The authors consider duplex-guided sclerotherapy of the GSV by microfoam to be very effective, even at long-term