6. Sclerotherapy
Catheter-directed foam with tumescence.
A. Cavezzi
Using foam sclerotherapy on larger saphenous diameters results in a higher recanalization rate. Larger veins require higher doses, which increases the deep vein thrombosis rate and the risk of cerebral complications. Moreover, stagnating and inflowing blood within veins neutralizes foam in a few seconds. To reduce the diameter of the vein and the blood inflow, the author describes a new foam sclerotherapy approach using a perisaphenous tumescence infiltration with an intrasaphenous flushing with saline solution through a long catheter. After using this technique for refluxing great saphenous veins (GSV) with concomitant phlebectomies on varicose tributaries in a prospective study, the author concludes that this technique is an effective, extremely cheap, and safe treatment for overall GSV reflux. Larger diameters can also be treated with good efficacy and safety.
The difference in wall penetration between STS and polidocanol.
M. Cough
A 3% sodium tetradecyl sulphate (STS) and polidocanol foam are widely used for treating incompetent truncal veins. However, few data are available concerning the halflife of the products as well on the damages inflicted upon the vein wall. No comparison between STS and polidocanol, in vivo, on human veins has been published and we do not know precisely why there are relatively high recanalization rates following foam sclerotherapy. Polidocanol foam exhibits superior stability to STS, but endothelial cell loss and medial injury were significantly greater with STS.
It seems that permanent venous ablation probably requires complete endothelial denudation and collagen denaturation. The greater injury inflicted by STS should make it a more potent sclerosant. The persistent islands of endothelial cells combined with a minimal media injury may explain the high recanalization rates after foam sclerotherapy.
Sclerosant selection.
P. Coleridge-Smith
For the author, not all foams are the same, and it is impossible to compare clinical results unless characteristics of the patients and foam are known and are reproducible. Air foams have good performance, but they have associated risks with some persistent bubbles in the circulation. The small bubbles and narrow bubble distribution, along with a slow drainage and separation times improves foam performance by enhancing stability of the foam.
Debate: Air is the best gas for making foam
For the motion.
K. Darvall
Against the motion.
A. Cavezzi
Air is free and readily available. Air-based foam seems to be more stable and easier to use. There is no evidence that air-based foam is less safe or less effective and the minor side effects are unaffected by the gas used. We do not need to use a large volume of foam to improve efficacy and there is no huge difference in efficacy according to the gas used.
The vote was for the motion.
