Association of great saphenous vein diameter and clinical severity score after treatment of severe chronic venous insufficiency with foam sclerotherapy

Main Article Content

Melissa Andreia de Moraes Silva
https://orcid.org/0000-0001-8773-3095
Luiz Henrique Silva de Sordi
https://orcid.org/0000-0003-3349-6025
Lara Camargo Rezende Grillo
Elisa de Paula Garcia
Luisa Resende Silva
https://orcid.org/0000-0002-0668-3805
Thyago Silva Grigório
Rodolfo Souza Cardoso

Abstract

Objectives: to evaluate the association of the greater saphenous vein (GSV) diameter in the treatment of patients with severe chronic venous insufficiency (C6 CEAP classification) with ultrasound-guided polidocanol foam sclerotherapy (UGFS).  Methods: A prospective, descriptive and analytical study of 28 patients (30 limbs) that underwent UGFS. Patients were divided into 2 subgroups by GSV diameter (< 8 mm and ≥ 8 mm). Variables analyzed were ulcer healing, clinical intercurrences, clinical CEAP classification, Venous Clinical Severity Score (VCSS), diameter of the treated vein and presence of occlusion or recanalization by Doppler ultrasound. Patients were analyzed at the 1st, 3rd, and 6th months post-treatment. Results: The average age was 68.7 ± 10.5 years, 23 (82,1%) were women, and the average body mass index was 29.2 kg/m2. Although an improvement in VCSS score was observed during follow-up, no significant intergroup difference was noted. Seventeen (56%) limbs presented occlusion of the treated vein at the 1st month, 11 (36%) at the 3rd month, and 9 (30%) at the 6th month of follow-up. The ulcer healing rate was 56,6%. The average ulcer healing time was 90 days. Three (10%) patients presented with ulcer recurrence at the 6th month.  Survival analysis showed no significant difference in ulcer healing rate between subgroups after one year of follow-up (log-rank, p = 0,178). Conclusion: There was no difference between the subgroups of large and small VSM diameter in terms of symptom severity. However, significant reduction of VCSS and pain relief was observed after foam sclerotherapy.



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1.
de Moraes Silva MA, Sordi LHS de, Grillo LCR, Garcia E de P, Silva LR, Grigório TS, et al. Association of great saphenous vein diameter and clinical severity score after treatment of severe chronic venous insufficiency with foam sclerotherapy. HSJ [Internet]. 2021 Dec. 28 [cited 2024 Nov. 21];11(4):102-7. Available from: https://portalrcs.hcitajuba.org.br/index.php/rcsfmit_zero/article/view/1222
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ORIGINAL ARTICLE
Author Biographies

Melissa Andreia de Moraes Silva, Itajubá Clinics Hospital

Doctor and Master in Sciences from the Federal University of São Paulo (Unifesp/EPM). Vascular Surgeon and Vascular Ultrasonographer by CNRM/MS and SBACV/AMB. Professor at the Faculty of Medicine of Itajubá. Effective Member of the Brazilian Society of Angiology and Vascular Surgery.

Luiz Henrique Silva de Sordi, Faculty of Medicine of Itajubá

Sixth-year student at the Faculty of Medicine of Itajubá.

Elisa de Paula Garcia, Itajubá Clinics Hospital

Specialist in Vascular Surgery at the Itajubá Clinics Hospital.

Luisa Resende Silva, Itajubá Clinics Hospital

Specialist in Vascular Surgery at the Itajubá Clinics Hospital.

Thyago Silva Grigório, Hospital de Clínicas de Itajubá

Vascular Surgeon at the Itajubá Clinics Hospital.

Rodolfo Souza Cardoso, Itajubá Clinics Hospital

Vascular Surgeon and Interventional Radiologist at the Itajubá Clinics Hospital.

References

Mansilha A, Sousa J. Pathophysiological mechanisms of chronic venous disease and implications for venoactive drug therapy. Int J Mol Sci. 2018;19(6):1669. https://doi.org/10.3390/ijms19061669

Bergan JJ, Schmid-Schönbein GW, Smith PD, Nicolaides AN, Boisseau MR, Eklof B. Chronic venous disease. N Engl J Med. 2006;355(5):488-98. https://doi.org/10.1056/NEJMra055289

Raffetto J, Eberhardt RT. Chronic venous disorders: general considerations. In: Cronenwett JL, Johnston KW, eds. Rutheford's Textbook of Vascular Surgery, 7th Edition. Philadelphia, PA: Saunders-Elsevier; 2010. p. 831-843

Kaplan RM, Criqui MH, Denenberg JO, Bergan J, Fronek A. Quality of life in patients with chronic venous disease: San Diego population study. J Vasc Surg. 2003;37(5):1047-53. https://doi.org/10.1067/mva.2003.168

Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. 2014;130(4):333-46. https://doi.org/10.1161/CIRCULATIONAHA.113.006898

Alder G, Lees T. Foam sclerotherapy. Phlebology. 2015;30(2 Suppl):18-23. https://doi.org/10.1177/0268355515589536

Silva MAM, Araujo ÁZP, do Amaral JF, Jesus-Silva SG, Cardoso RS, Miranda F Jr. Impacto da escleroterapia com espuma de polidocanol guiada por ultrassom em pacientes com úlcera venosa. J Vasc Bras. 2017;16(3):239-43. https://doi.org/10.1590/1677-5449.002717

Shadid N, Ceulen R, Nelemans P, et al. Randomized clinical trial of ultrasound-guided foam sclerotherapy versus surgery for the incompetent great saphenous vein. Br J Surg. 2012;99(8):1062-70. https://doi.org/10.1002/bjs.8781

Jia X, Mowatt G, Burr JM, Cassar K, Cook J, Fraser C. Systematic review of foam sclerotherapy for varicose veins. Br J Surg. 2007;94(8):925-36 https://doi.org/10.1002/bjs.5891

Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg. 2001;27(1):58-60. https://doi.org/10.1097/00042728-200101000-00017

Yamaki T, Hamahata A, Soejima K, Kono T, Nozaki M, Sakurai H. Prospective randomised comparative study of visual foam sclerotherapy alone or in combination with ultrasound-guided foam sclerotherapy for treatment of superficial venous insufficiency: preliminary report. Eur J Vasc Endovasc Surg. 2012;43(3):343-7. https://doi.org/10.1016/j.ejvs.2011.07.029

Silva MAM, Burihan MC, Barros OC, Nasser F, Ingrund JC, Neser A. Resultados do tratamento da Insuficiência Venosa Crônica grave com espuma de polidocanol guiada por ultrassom. J Vasc Bras. 2012;11(3):206-11. https://doi.org/10.1590/S1677-54492012000300007

Star P, Connor DE, Parsi K. Novel developments in foam sclerotherapy: Focus on Varithena® (polidocanol endovenous microfoam) in the management of varicose veins. Phlebology. 2018;33(3):150-62. https://doi.org/10.1177/0268355516687864

Carugo D, Ankrett DN, Zhao X, et al. Benefits of polidocanol endovenous microfoam (Varithena®) compared with physician-compounded foams. Phlebology. 2016;31(4):283-95. https://doi.org/10.1177/0268355515589063

Lawaetz M, Serup J, Lawaetz B, et al. Comparison of endovenous ablation techniques, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Extended 5-year follow-up of a RCT. Int Angiol. 2017;36(3):281-8. https://doi.org/10.23736/S0392-9590.17.03827-5

Venermo M, Saarinen J, Eskelinen E, et al. Randomized clinical trial comparing surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy for the treatment of great saphenous varicose veins. Br J Surg. 2016;103(11):1438-44. https://doi.org/10.1002/bjs.10260

Campos W Jr, Torres IO, da Silva ES, Casella IB, Puech-Leão P. A prospective randomized study comparing polidocanol foam sclerotherapy with surgical treatment of patients with primary chronic venous insufficiency and ulcer. Ann Vasc Surg. 2015;29(6):1128-35. https://doi.org/10.1016/j.avsg.2015.01.031

Rasmussen LH, Lawaetz M, Bjoern L, Vennits B, Blemings A, Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011;98(8):1079-87. https://doi.org/10.1002/bjs.7555

Myers KA, Jolley D, Clough A, et al. Outcome of ultrasound-guided sclerotherapy for varicose veins: mediumterm results assessed by ultrasound surveillance. Eur J Vasc Endovasc Surg 2007; 33:116-21. https://doi.org/10.1016/j.ejvs.2006.09.005

Shadid N, Nelemans P, Lawson J, Sommer A. Predictors of recurrence of great saphenous vein reflux following treatment with ultrasound-guided foam sclerotherapy. Phlebology. 2015;30(3):194-9. https://doi.org/10.1177/0268355514521183

Hamel-Desnos CM, De Maeseneer M, Josnin M, Gillet JL, Allaert FA; DIAGRAVES Study Group. Great Saphenous Vein Diameters in Phlebological Practice in France: A Report of the DIAGRAVES Study by the French Society of Phlebology. Eur J Vasc Endovasc Surg. 2019;58(1):96-103. https://doi.org/10.1016/j.ejvs.2018.09.011

Shaidakov EV, Grigoryan AG, Ilyukhin EA, Bulatov VL, Rosukhovskiy DA. Radiofrequency ablation or stripping of large-diameter incompetent great saphenous varicose veins with C2 or C3 disease. J Vasc Surg Venous Lymphat Disord. 2016;4(1):45-50. https://doi.org/10.1016/j.jvsv.2015.07.007

Woo HY, Kim SM, Kim D, Chung JK, Jung IM. Outcome of ClosureFAST radiofrequency ablation for large-diameter incompetent great saphenous vein. Ann Surg Treat Res. 2019;96(6):313-8. https://doi.org/10.4174/astr.2019.96.6.313

Eklöf B, Rutherford RB, Bergan JJ, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg. 2004;40(6):1248-52. https://doi.org/10.1016/j.jvs.2004.09.027

Rutherford RB, Padberg FT Jr, Comerota AJ, Kistner RL, Meissner MH, Moneta GL. Venous severity scoring: An adjunct to venous outcome assessment. J Vasc Surg. 2000;31(6):1307-12. https://doi.org/10.1067/mva.2000.107094

Cabrera J, Redondo P, Becerra A, et al. Ultrasound-guided injection of polidocanol microfoam in the management of venous leg ulcers. Arch Dermatol. 2004;140(6):667-73. https://doi.org/10.1001/archderm.140.6.667

Attaran RR, Bhalla A, Mena-Hurtado CI, Ochoa Chaar CII. Correlation between great saphenous length of treatment zone and diameter with improvement in symptoms post-ablation. J Vasc Surg Venous Lymphat Disord. 2021;S2213-333X(21)00099-8. https://doi.org/10.1016/j.jvsv.2021.02.013

Abreu GCG, Camargo Jr. O, Abreu MFM, Aquino JLB. Ultrasound-guided foam sclerotherapy for chronic venous disease with ulcer. A prospective multiple outcome cohort study. J Vasc Bras. 2020;19:e20180108. https://doi.org/10.1590/1677-5449.180108

Coelho Neto F, Araújo GR, Kessler IM. Evaluation of quality of life and photoplethysmography in patients with chronic venous insufficiency treated with foam sclerotherapy. J Vasc Bras. 2015;14(2):145-52. https://doi.org/10.1590/1677-5449.8314

Howard JK, Slim FJ, Wakely MC, et al. Recanalisation and ulcer recurrence rates following ultrasound-guided foam sclerotherapy. Phlebology. 2016;31(7):506-13. https://doi.org/10.1177/0268355515598450

Scotton MF, Miot HA, Abbade LPF. Factors that influence healing of chronic venous leg ulcers: a retrospective cohort. An Bras Dermatol. 2014;89(3):414-22. https://doi.org/10.1590/abd1806-4841.20142687

Milic DJ, Zivic SS, Bogdanovic DC, Karanovic ND, Golubovic ZV. Risk factors related to the failure of venous leg ulcers to heal with compression treatment. J Vasc Surg. 2009;49(5):1242-7. https://doi.org/10.1016/j.jvs.2008.11.069

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