Ultrasound-guided foam sclerotherapy is becoming more widely used in the UK, but the National Institute for Health and Clinical Excellence has concluded that “current evidence of long-term efficacy is limited”. The aim of this study was to report clinical outcomes five years after treatment.
During 2003, Coleridge Smith treated 167 patients using foam sclerotherapy for truncal saphenous incompetence, recurrent following previous surgery in 30% of cases. A total of 230 saphenous trunks were treated (184 great and 46 small saphenous veins). In all patients treatments were given at intervals of two weeks until duplex ultrasonography showed that all saphenous trunks and varices had been successfully obliterated. For great saphenous veins, the investigators used median of 10ml foam, and for small saphenous veins, 6ml. An average of 2.1 sessions of treatment were required per patient. Patients were invited to return after six months to check on completion of treatment, but only 68 came back an average of 11 months following the initial course of treatment. Re-treatment for recurrent varices or recanalisation of saphenous trunks was carried out in 9% of patients.
Five years following treatment all patients were invited for a further assessment. Only half of patients returned. Reasons for not attending included: patient was not interested, had moved away, or was not contactable. Patients who came for examination were studied by clinical examination and by duplex ultrasonography. Clinical outcome was assessed as successful if no or few varices were present, and failure where moderate or severe recurrence was present according to the method of Hobbs (1984). Duplex ultrasonography was undertaken to assess the extent of saphenous incompetence.
After five years, a successful clinical outcome was observed in 88 out of 101 limbs (88%). Recurrent saphenous reflux was observed in 11 of 81 great saphenous veins and three of 41 small saphenous veins. Primary reflux in previously normal great saphenous veins arose in four limbs.
Clinical recurrence five years after foam sclerotherapy was 12%. This is comparable to, or better than, that reported after surgical intervention (20–45%). Coleridge Smith concluded that “it is safe to say that long-term recurrence following ultrasound guided foam sclerotherapy no more frequent than following surgery”.
