Catheter-directed foam sclerotherapy, an alternative to ultrasound-guided foam sclerotherapy for varicose vein treatment: A systematic review and meta-analysis

Abstract

Purpose Catheter-directed foam sclerotherapy is a new addition to the treatment modalities available for varicose veins. As a modification of ultrasound-guided foam sclerotherapy, catheter-directed foam sclerotherapy has been purported to offer higher complete ablation rates and an improved safety profile. The aim of this study is to appraise the current literature on the outcomes of catheter-directed foam sclerotherapy compared to ultrasound-guided foam sclerotherapy in chronic venous insufficiency. Methods The review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data from studies that reported the outcomes of catheter-directed foam sclerotherapy and ultrasound-guided foam sclerotherapy were extracted, to determine the pooled proportion of complete ablation rates, using a random effect meta-analysis model. Results A total of 62 studies, involving 3689 patients, were included in the systematic review. Higher rates of complete ablation were reported in catheter-directed foam sclerotherapy compared to ultrasound-guided foam sclerotherapy during the short- and medium-term follow-ups (Relative Risk = 1.06, Relative Risk = 1.15, Relative Risk = 1.19, p < 0.05). Fewer major and minor complications were also reported in patients who underwent catheter-directed foam sclerotherapy (Relative Risk = 0.23, Relative Risk= 0.43–0.76, p < 0.05). Conclusion Catheter-directed foam sclerotherapy has been demonstrated to have many advantages over ultrasound-guided foam sclerotherapy, offering superior complete ablation rates in the short-, medium- and long-term follow-ups. It also has a better safety profile, conferring a lower risk of major and minor complications. The conclusions should however be viewed in the context of significant limitations imposed by limited study data.

Medicine and Phlebolymphology: Time to Change?

“…The relatively young foam sclerotherapy has progressively gained more validation, also in view of the appealing results recently achieved with catheter foam sclerotherapy (CFS), in combination with tumescence and vein irrigation (96.5% reflux-free great saphenous veins at 3 years) [45]. A recent systematic review and meta-analysis detailed literature data concerning CFS, showing potential benefits from this variant of foam sclerotherapy [46]. The favorable cost/benefit ratio is the acknowledged best feature of foam sclerotherapy, a versatile and widely practiced technique [47].…”

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

“…For the treatment of primary varicose veins, this procedure has already demonstrated many advantages over UGFS, such as high occlusion rates at short, medium, and long term follow up a with lower risk of major complications. 9 …”

Current Best Practice in the Management of Varicose Veins

“…UGFS is more successful if given by catheter rather than injected up the vein from a single point, 97 and with tumescence injected around the vein, increasing the sclerosant dwell time. 98 However, this reduces the simplicity of the procedure and makes the process similar to EVTA – but with inferior results.…”