• Endovenous chemical ablation is a technique for treatment of great saphenous vein insufficiency and this has been performed with foam under ultrasound guidance. Dr. Hill and colleagues have reported the safety and efficacy of foam sclerotherapy of the great saphenous vein using different maneuvers on the lower extremity – that is to reduce the likelihood of foam and bubbles from embolizing to the lungs, and in one of their patients, with a patent foramen ovale, from embolizing across two chambers of the heart and traveling to the microcirculation of the brain.

• Three groups of patients were studied and the authors demonstrated that foam sclerotherapy of the great saphenous vein was safest when the leg was elevated and without applied compression on the deep veins in the groin. 

• The authors concluded from this retrospective study that “ultrasound-guided sclerotherapy of the great saphenous vein using foam sclerosants is best performed with the leg elevated and no occlusive pressure at the saphenofemoral junction in order to reduce the risk of gas embolization to the central nervous system. [They stated further] that “study is needed to assess the midterm success of this technique and to confirm the effect of using foam produced from physiologic gases”.

Dr. Karamanoukian’s comment – ultrasound guided foam sclerotherapy is still in evolution and long term outcome is still pending when compared to endovenous obliteration of the great saphenous vein with laser or radiofrequency. It is less expensive that VNUS Closure and EVLT but is associated with gas embolization to the brain with potential TIA and stroke.

picture below from www.veinsweb.com accessed August 25, 2008