The frequency and clinical significance of nontarget superficial and deep vein occlusion after physician compounded foam sclerotherapy of varicose tributaries

Abstract

Objective To evaluate the incidence and clinical relevance of silent nontarget occlusion (NTO) of superficial and deep veins occurring after ultrasound-guided foam sclerotherapy (UGFS) that can be detected by serial duplex ultrasound scan (DUS). Methods This retrospective analysis evaluated the medical records of patients treated with UGFS at a private clinic in Moscow, Russia from 2015 to 2017. All patients underwent serial DUS at 1 to 2 weeks and 1, 3, 6, and 12 months after UGFS. Results During the observation period, 268 patients were treated with UGFS, using physician compounded polidocanol foam 257 lower limbs of 196 patients (73%) with varicose veins who underwent DUS at 1 to 2 weeks after the last session of UGFS (inclusion time-point): 139 women and 57 men (mean age: 44.2 ± 12.2 years) with the following CEAP clinical class distribution: C2, 74.0%; C3, 20.0%; C4, 4.5%; and C5, 1.5%. NTO at the inclusion time-point occurred in 60 limbs (23.3%) of 57 patients (28.5%) and was symptomatic only in three limbs (1.2%). Most occlusions were localized in the untreated great saphenous vein trunk ( n = 28) and the calf muscle veins ( n = 23). Overall, 72%, 44%, 29%, and 10% of all limbs and 77%, 45%, 28%, and 12% of limbs with NTO were followed up by DUS at 1, 3, 6, and 12 months, respectively. There were no cases of thrombus progression or symptomatic venous thromboembolism (VTE). At six months, no deep vein occlusions persisted. Conclusions The frequency of nontarget vein occlusion after UGFS revealed by serial DUS may be as high as 23.3%. These occlusions tend to resolve within six months and are not associated with symptomatic VTE.

Factors influencing superficial and deep vein thrombosis after foam sclerotherapy in varicose veins

“…Such a phenomenon had already been diagnosed by Parsi et al., who differentiated local occlusion with low D‐dimer levels that did not require treatment from deep vein thrombosis with increased risk of embolism, high D‐dimer levels and a need for anticoagulation [17]. At the same time, similar requests for the differentiation of spontaneous deep vein thrombosis from sclerotherapy‐related deep thrombosis were made by the workgroup led by Lobastov [12]. This group suggested considering the “endovenous foam‐induced thrombosis (EFIT)” defined by Kulkarni as a modification of the already available classification of “endovenous heat‐induced thrombosis (EHIT)” [13, 26].…”

“…There is no uniform therapeutic procedure for muscle vein thrombosis after foam sclerotherapy. A wide variety of therapeutic approaches are presented in the current scientific literature [7,[9][10][11][12]18]. In the German guideline "sclerotherapy of varicose veins", asymptomatic muscle vein thrombosis is regarded as a benign complication [1].…”

“…It is likely that the prevalence of muscle vein thrombosis after sclerotherapy is underestimated in the literature [6]. While both symptomatic [5] and asymptomatic courses are observed in deep leg vein thrombosis after sclerotherapy, the latter have been reported significantly more often [10][11][12][13].…”

Standards and regulations of a self-regulating organization "The National College of Phlebology (Russia)"

“…благодаря этому Лобастовым К.В. et al был введен правомерный термин «нецелевая окклюзия», отражающий особенности данной патологии [9]. учитывая приведенную выше выдержку из клинических рекомендаций, опубликованных на сайте Минздрава (от 2017 г.…”

“…8 Лечение термоиндуцированных тромбозов 3. 9 Нецелевые окклюзии после склеротерапии 3. 10 Целесообразность уЗИ вен таза перед процедурой склеротерапии 3.…”