Novosti
Khirurgii
This journal is
indexed in Scopus









Year 2017 Vol. 25 No 1

GENERAL & SPECIAL SURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2017.1.38   |  

V.A. KHODOS

SIDE EFFECTS AND COMPLICATIONS OF MICROFOAM STEM SCLEROOBLITERATION IN VARICOSITY; MEASURES TO PREVENT AND TO ELIMINATE

National Medical Academy of Post-Graduate Education Named After P.L. Shupyk,
Kiev,
Ukraine

Objectives. To study side effects and complications of microfoam stem scleroobliteration and to determine measures of their prevention and elimination.
Methods. The results of microfoam stem scleroobliteration in 603 patients (658 lower limbs) including men and women with the lower limb varicosity (from 2009 to 2015) were analyzed. Reflux along the great saphenous vein (GSV) was found in 607 (92,25%) lower limbs, and along the small saphenous vein (SSV) – in 51 (7,75%) lower limbs. A specificity of microfoam sclerotherapy catheter stem scleroobliteration was its combination of hydrocompression around stem performance and phased application of microfoam. The generalized and local side effects and complications were analyzed during the assessment of medical treatment results. Based on the data received after ultrasonic duplex scanning (3-24 months) after the microfoam scleroobliteration, the presence of GSV/SSV recanalization was registered.
Results. Visual disturbances were registered in 8 (1,33%) out of 603 patients, the transient neurologic symptoms – in 6 (0,99%), a vasovagal reaction – in 1 (0,17%) patient. Among local complications, occurrence of GSV thrombophlebitis (femoral segment) was revealed in 4 (0,61%) cases (658 lower limbs), venous thrombosis – in 2 cases (0,30%). Re-canalization of different length was detected in 62 (9,42%) stem veins within 3-12 months. In 32 cases the repeated microfoam scleroobliteration was involved within those terms. During 12-24 months the repeated microfoam scleroobliteration was carried 19 cases and in 3 cases it was performed for the third time. Re-canalization had no hemodynamic significance in the remaining 11 cases.
Conclusion. The analysis of conducted studies showed that the application of the microfoam sclerotherapy catheter stem scleroobliteration in combination with the hydrocompression around stem and stepwise administration of the microfoam minimizes the occurrence frequency of generalized and local side effects and complications, and leads to reduction of recanalization amount, provides appropriate safety in application of this method.

Keywords: varicosity, thrombophlebitis, reflux, microfoam sclerotic obliteration, sclerotic therapy complications, recanalization, hydrocompression
p. 38-43 of the original issue
References
  1. Davies HO, Popplewell M, Darvall K, Bate G, Bradbury AW. A review of randomised controlled trials comparing ultrasound-guided foam sclerotherapy with endothermal ablation for the treatment of great saphenous varicose veins. Phlebology. 2016 May;31(4):234-40. doi: 10.1177/0268355515595194.
  2. Kurdal AT, Yildirim F, Ozbakkaloglu A, Iskesen I, Tetik O. Ultrasound-guided catheter-directed foam sclerotherapy for great saphenous vein. Minerva Chir. 2015 Feb;70(1):33-6.
  3. Williamsson C, Danielsson P, Smith. L. Catheter-directed foam sclerotherapy for chronic venous leg ulcers. Phlebology. 2014 Dec;29(10):688-93. doi: 10.1177/0268355513505506.
  4. Shadid N, Ceulen R, Nelemans P, Dirksen C, Veraart J, Schurink GW, van Neer P, vd Kley J, de Haan E, Sommer A. Randomized clinical trial of ultrasound-guided foam sclerotherapy versus surgery for the incompetent great saphenous vein. Br J Surg. 2012 Aug;99(8):1062-70. doi: 10.1002/bjs.8781.
  5. Baeshko AA, Shestak NG, Koryt'ko SS, Kovalevich KM, Vartanian V.F. Rezul'taty ul'trazvuk-kontroliruemoi pennoi skleroterapii bol'shoi podkozhnoi veny po usovershenstvovannoi metodike [The results of ultrasound-controlled foam sclerotherapy of the great saphenous vein according the improved method]. Angiologiia i Sosud Khirurgiia. 2015;21(4):127-133.
  6. Cavezzi A1, Parsi K. Complications of foam sclerotherapy. Phlebology. 2012 Mar;27 Suppl 1:46-51. doi: 10.1258/phleb.2012.012S09.
  7. Bergan J, Pascarella L, Mekenas L. Venous disorders: treatment with sclerosant foam. J Cardiovasc Surg (Torino). 2006 Feb;47(1):9-18.
  8. Sarvananthan T, Shepherd AC, Willenberg T, Davies AH. Neurological complications of sclerotherapy for varicose veins. J Vasc Surg. 2012 Jan;55(1):243-51. doi: 10.1016/j.jvs.2011.05.093.
  9. Hill DA. Neurological and chest symptoms following sclerotherapy: a single centre experience. Phlebology. 2014 Oct;29(9):619-27. doi: 10.1177/0268355513499017.
  10. Maurya AK, Singh S, Sachdeva V, Nath B, Verma SC, Gupta PK. Outcome of Ultrasound Guided Foam Sclerotherapy Treatment for Varicose Veins: Procedure is Standard and Need No Further Study. Indian J Vasc Endovasc Surg. 2015;2(3): 96-100.doi: 10.4103/0972-0820.166933.
  11. Bradbury AW, Bate G, Pang K, Darvall KA, Adam DJ. Ultrasound-guided foam sclerotherapy is a safe and clinically effective treatment for superficial venous reflux. J Vasc Surg. 2010 Oct;52(4):939-45. doi: 10.1016/j.jvs.2010.04.077.
  12. Gillet JL, Guedes JM, Guex JJ, Hamel-Desnos C, Schadeck M, Lauseker M, Allaert FA. Side-effects and complications of foam sclerotherapy of the great and small saphenous veins: a controlled multicentre prospective study including 1,025 patients. Phlebology. 2009 Jun;24(3):131-8. doi: 10.1258/phleb.2008.008063.
  13. Darvall KA, Bate GR, Bradbury AW. Patient-reported outcomes 5-8?years after ultrasound-guided foam sclerotherapy for varicose veins. Br J Surg. 2014 Aug;101(9):1098-104. doi: 10.1002/bjs.9581
  14. Chapman-Smith P, Browne A. Prospective five-year study of ultrasound-guided foam sclerotherapy in the treatment of great saphenous vein reflux. Phlebology. 2009 Aug;24(4):183-8. doi: 10.1258/phleb.2009.008080.
  15. Frullini A, Felice F, Burchielli S, Di Stefano R. High production of endothelin after foam sclerotherapy: a new pathogenetic hypothesis for neurological and visual disturbances after sclerotherapy. Phlebology. 2011 Aug;26(5):203-8. doi: 10.1258/phleb.2010.010029.
Address for correspondence:
04112, Ukraine, Kiev,
Dorogozhytskaya str., 9,
National Medical Academy of Postgraduate Education named after PL Shupyk,
Department of surgery and vascular surgery.
Tel.: +38 050 469-56-15
E-mail: vkhodos@ukr.net
Valentin A. Hodos
Information about the authors:
Khodos V.A. MD, Ass. Professor of the surgery and vascular surgery department, National Medical Academy of Postgraduate Education Named After P.L. Shupyk.
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