John J. Bergan

Foam sclerotherapy offers a treatment strategy with great potential. Recently, general and vascular surgery have become less invasive; so too, has the treatment of venous disorders. Sclerosants cause irreversible damage to the vascular endothelium by disrupting cell membranes resulting in sustained vasospasm and denudation of the venous monolayer. Prospective randomized outcome data support the hypothesis that foam sclerotherapy is superior to liquid sclerotherapy. All published reports of varicose vein treatment with foam describe efficacy in terms of immediate and primary venous occlusion of better than 80%. Severe complications of foam sclerotherapy are rare. Recurrent varices are in the 10% to 20% range. Use of foam sclerotherapy in our experience has proven to be effective, essentially pain-free, and durable in the short term. The treatment is quick, efficient, and cheap.

Venous malformations may occur either as localized or segmental lesions. Radiologic imaging defines the extent of involvement but magnetic resonance imaging is the best modality: it gives a bright hypersignal on T2-weighted spin-echo sequences. During a 30-month period, 1427 patients were investigated for venous disorders and 1% were found to have venous angiomata (9 women and 5 men). The age range was 15 to 76 years (mean 30.8+/-18.6 years). Foam was produced by the Tessari technique using 1% or 2% concentration of polidocanol. The duplex Doppler was used for ultrasound guidance to insure intravenous flow of foam and to monitor effects of treatment. A goal of pain-free healing of ulcers or cosmetic improvement was set for each patient. The mean number of treatments was 3.6+/-2.8 (range 1-10). Pain-free healing was achieved in patients with non-healing ulcerations and cosmetically, all of the patients were improved. Sclerosant foam is useful in treating low-flow venous malformations.

Treatment of venous insufficiency with liquid sclerotherapy is considered by some to be an unfulfilled promise. It was heralded in the first half of the last century to be a replacement for surgery, but as recurrences of varicose veins appeared in limbs treated with injection techniques, surgery reappeared and was dominant in the last half of the century. Just as saphenous stripping was proved to be superior to proximal ligation, both were replaced by use of electromagnetic energy, such as radiofrequency and laser venous ablation, as a means of taking the saphenous veins out of the circulation. Now reports of recurrent varices in 20 to 50% of operated cases are making some physicians look to alternatives in treating varicose veins. Foam sclerotherapy must be looked upon as an entirely new method of treatment. It is useful in all types of varices and is proven to be safe, simple, cheap, reliable, and repeatable.