الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
Foam sclerotherapy is often presented as a new method for the management of varicose veins. However, several reports established most of its principles approximately 50 years ago. Minor modifications in the way foam is produced, as well as the use of ultrasound to guide it to all of the sites of venous reflux, have resulted in a renewed interest in this technique.
This study was conducted at Sohag University hospitals aiming to evaluate the efficacy, safety, and patient satisfaction following foam sclerotherapy for varicose veins.
We included a total of 60 cases with lower limb varicosities whose mean age was 33.72 years (range, 20 – 52). Females represented 62% of cases, while the remaining cases were males.
As regard the duration of varicosities in our study, it had a mean of 6.03 years (range, 1 – 12). The right leg was affected in 52% of cases, while the other cases had the left side affected.
All cases were subjected to complete history taking, thorough physical examination, and routine laboratory investigations. Besides, Doppler scanning was also ordered to identify sites of superficial venous reflux and incompetent perforators and to exclude possible DVT or phlebitis. All cases were managed by US guided foam sclerotherapy. The target vein was cannulated under ultrasound guidance with intravenous cannula or butterfly needle. Foam was generated using Tessari method. Great saphenous veins were treated with 3% Aethoxysclerol. Accessory great saphenous and short saphenous veins were treated with 2% Aethoxysclerol. Reticular veins and telangiectasia treated with 1% Aethoxysclerol.
The number of sessions ranged between 1 and 3 sessions (mean = 1.67). The mean volume of injected foam was 11.33 ml. Patients were followed for up to 6 months after the procedure.
The cosmetic appearance showed a significant improvement (p < 0.001) after our intervention. All cases reported bad cosmesis before intervention, which decreased down to 58, 17, 7, and 10% at 1-week, 1-, 3-, 6-month follow up visits respectively. Although there was a small rise at 6-month visit, but it was also significantly better than the basal value.
Pain was experienced by 87% of cases before intervention. However, it was only reported by 37 and 3% of cases one week and one month after sclerotherapy (p < 0.00). After 3 months, there was still 3% of cases complaining of pain, and this percent was doubled at the last follow up. All follow up values were significantly better than the preprocedural findings (p < 0.001).
Regarding the sensation of heaviness in the current study, it showed significant improvement like pain through the follow up period (p < 0.001). Only 25% of cases reported that sensation after 1 week, and that percent decreased down to 3, 3, and 7% during the subsequent visits respectively.
Moreover, edema showed significant improvement 1 month after intervention, and that improvement was also noticed through the following visits. Unlike the previous complaints, it did not show significant change after 1 week (p = 0.06). This could be explained by occurrence of post procedural inflammation and tissue response which may delay the resolution of the preexisting edema.
As regard venous reflux in the short saphenous vein, it was present in 13% of cases before intervention, and it was not detected in any of the included cases after intervention (0% - p < 0.001). Furthermore, large saphenous reflux was present in 48% of cases before intervention, and its incidence decreased down to 10% after 1 week. The following visits also showed a significant decrease down to 3, 3, and 7% respectively (p < 0.001).
Saphenofemoral reflux was present in 48% of cases before intervention, and it decreased down to 7, 3, 3, and 7% of cases at the scheduled follow up visits respectively (p < 0.001). On the other hand, although saphenopopliteal reflux disappeared after intervention, that improvement was statistically insignificant (p = 0.008).
In the current study, AASV reflux did not show significant changes after intervention although it decreased compared to the baseline value (p > 0.05). Besides, APSV showed a significant decrease after one week (p = 0.031), while this significance faded through the follow up visits (p = 0.008).
As regard venous ulcer improvement, it did not show a significant change in the current study (p > 0.05). Nevertheless, it was present in 5% of cases before intervention, while it was absent after 3 months.
Regarding great saphenous vein diameter, it decreased from 6.22 mm before intervention, down to 5.35, 4.45, and 3.93 mm 1-, 3-, and 6-month visits respectively (p < 0.001). Moreover, incompetent perforators showed a significant decrease after intervention (p < 0.001). It was absent in 97% after intervention.
When it comes to complications encountered in our study, it was reported by 28% of cases. Skin hyperpigmentation was the commonest complication (13 cases – 22%), followed by visual disturbances (5 cases – 8%), and thrombophlebitis (4 cases – 7%).
Conclusion
Ultrasound-guided foam sclerotherapy appeared to be a safe and effective procedure for the treatment of chronic venous insufficiency in the selected group of patients. The observed complications were minimal and most of the patients reported satisfaction with the treatment outcomes.