Tumescent-assisted echosclerotherapy (TAES) in the treatment of great saphenous vein incompetence

Abstract

Objectives: Despite encouraging results of saphenous vein sclerotherapy this method is not free of potential complications and does not guarantee a 100% rate of occlusion. In this paper, the author's own experiences with catheter-directed, tumescent solution-supported echo-guided foam sclerotherapy of the saphenous vein are presented. Material and methods: Thirty-four incompetent great saphenous veins were treated with foam sclerotherapy involving the use of long catheters and perivenous tumescent solution injection prior to foam administration. The mean length of incompetent saphenous veins was 25.5cm (range 14-39 cm). The diameters of the proximal part of the saphenous veins ranged from 5.0 to 15.0 mm. In 25 patients (71.4%), primary varicose veins were diagnosed, and in other patients either post-surgical (recurrent) or post-thrombotic saphenous veins were treated. Results: At 30-day follow up total occlusion of the entire segment of treated vein was achieved in 79.4% of cases. In one case the vein was not occluded, and in 6 patients (17.6%) a partial occlusion was revealed. In the group of 6 patients with partial vein occlusion, a repeated sclerotherapy with the use of a short catheter and ultrasound guided puncture was performed. 6 and 12 months after the procedure, 32 out of 34 obliterated veins (94.1%) remained fully occluded. The mean foam volume used for saphenous vein obliteration was 2.6 ml. No serious adverse events were reported. Conclusions: Tumescent-assisted echo-guided foam sclerotherapy is a safe and clinically effective method of saphenous vein obliteration, particularly for veins with no history of a previous thrombosis or surgical treatment.