Retrograde administration of ultrasound-guided endovenous microfoam chemical ablation for the treatment of superficial venous insufficiency.

Abstract

OBJECTIVE:

This study measured patient outcomes among symptomatic patients with superficial chronic venous insufficiency who were treated with retrograde ultrasound-guided polidocanol microfoam 1% in a community setting.

METHODS:

Between March 2015 and June 2017, 250 symptomatic patients with C2-C6 chronic venous insufficiency received polidocanol microfoam 1% and were followed for 16 ± 7 months. Sixteen of the 250 patients (6.4%) had skin ulcers, and 56 (22.4%) were treated previously with thermal or surgical interventions. All patients underwent a duplex ultrasound venous incompetence study to map perforators and veins to be treated. Incompetent veins were accessed with a micropuncture needle distal to the midthigh perforator, approximately 10 cm above the knee fold. The leg was then elevated 45°. Under ultrasound guidance, the incompetent greater saphenous vein was closed with polidocanol microfoam 1%. A second injection was administered through the same catheter directing the microfoam to flow in a retrograde fashion through the incompetent venous valves to the ankle.

RESULTS:

All patients completed the initial treatment; 55 (22.0%) required planned secondary treatment during the follow-up period for residual venous reflux in the below-knee greater saphenous vein. Complete elimination of venous valvular reflux and symptom improvement was documented in 236 patients (94.4%). Minor adverse events included asymptomatic deep vein thrombi (n = 2), common femoral vein thrombus extension (n = 1), and superficial venous thrombi (n = 4). Of the 16 patients with skin ulcers, 10 were C6 patients and 80% experienced wound closure within 4 weeks of treatment.

CONCLUSIONS:

Retrograde administration of polidocanol microfoam 1% is a safe and effective treatment with important clinical benefit for superficial venous insufficiency in community practice.

• Authors: Steven T Deak
• Journal: Journal of vascular surgery. Venous and lymphatic disorders (J Vasc Surg Venous Lymphat Disord) Vol. 6 Issue 4 Pg. 477-484 (07 2018) ISSN: 2213-3348 [Electronic] United States
• PMID: 29909854 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Chemical References

• Sclerosing Solutions
• Polidocanol
• Polyethylene Glycols

Topics

• Adult
• Aged
• Aged, 80 and over
• Chronic Disease
• Endovascular Procedures (adverse effects, methods)
• Female
• Humans
• Leg Ulcer (diagnostic imaging, physiopathology, therapy)
• Male
• Middle Aged
• Patient Satisfaction
• Polidocanol
• Polyethylene Glycols (administration & dosage, adverse effects)
• Recovery of Function
• Retreatment
• Retrospective Studies
• Sclerosing Solutions (administration & dosage, adverse effects)
• Sclerotherapy (adverse effects)
• Time Factors
• Treatment Outcome
• Ultrasonography, Interventional
• Venous Insufficiency (diagnostic imaging, physiopathology, therapy)
• Wound Healing