Efficacy of foam sclerotherapy for recurrent varicose veins at the sapheno-femoral junction

BACKGROUND: Recurrent varices after treatment (REVAT) is an important finding in phlebology practice. REVAT can occur regardless of the treatment method used. The current study primarily aimed to examine the efficacy of foam sclerotherapy for REVAT at the sapheno-femoral junction (SFJ) in the treatment of varicose vein disease. Further, it secondarily aimed to evaluate the complication rate and pain intensity of REVAT. The predefined hypothesis was that repeated REVAT increases the occlusion rate, and that the type and size of REVAT affects therapeutic success.METHODS: This study included 104 patients with 123 REVATs at the SFJ over a period of 12 months. REVAT was classified as either neoangiogenesis (NEO) or saphenous stump recurrence (SSR). Ultrasound-guided foam sclerotherapy with 2% or 3% Aethoxysklerol® (with polidocanol as the active ingredient) was performed on all REVATs. The patients were allowed to undergo 1-3 treatment sessions.RESULTS: Three months after the initial treatment, 78% of the patients exhibited complete occlusion. REVATs that were completely occluded after 3 months were re-examined 12 months after the initial treatment. Approximately 85% of the cases achieved complete occlusion. The occlusion rates between NEO and SSR differed. After 3 months, 64% of the SSR and 90.7% of the NEO were occluded. Patients with REVATs of smaller diameters at the SFJ had high occlusion rates. None of the patients experienced major side effects during the study period, and the patients rated the mean treatment-related pain intensity as extremely low.CONCLUSIONS: Foam sclerotherapy is a very effective and safe method for treating REVATs with small diameters at the SFJ. Thus, this treatment can be repeated as often as required and is considered a minimally painful and well-tolerated treatment.