Elastic compression after ultrasound-guided foam sclerotherapy in overweight patients does not improve primary venous hemodynamics outcomes

Objective: Lower extremity varicose veins have a high prevalence and can be associated with significant morbidity in their more advanced presentations; overweight patients tend to present with more severe clinical symptoms and conventional surgical treatment remains challenging. Although the advent of ultrasound-guided foam sclerotherapy (UGFS) increased the treatment options for these patients, the need for elastic compression after UGFS remains controversial. Methods: Overweight patients with lower extremity varicose veins secondary to great saphenous vein reflux were treated with UGFS and then randomized to use or no use of a 3-week treatment of elastic compression stockings. Follow-up was performed by clinical evaluation and duplex ultrasound examination. The primary outcomemeasure was the absence of venous reflux in the great saphenous vein. Results: One hundred thirty-five lower limbs were treated; 72 limbs were randomized to elastic compression and 63 limbs to the control group. There were no statistically significant differences in the number of procedures (P =.64) or the mean foam volume per procedure (P =.27) between groups. There was no difference in the reflux rate at either 3 weeks (26% vs 35%; P =.16) or 3 months (25% vs 21%; P = 85). Major complications were venous deep thrombosis (n = 2), neurologic event (n = 1), and ischemic ulceration (n = 1); the overall rate was 3% in both groups-2 of 62 in control patients and 2 of 69 in compression patients (P =.45). Venous diameter reduction was noted in both groups during treatment (P <.05) but with greater decrease in greater saphenous vein diameter in patients treated with compression. Conclusions: Elastic compression stockings for 3 consecutive weeks after UGFS in overweight patients did not decrease great saphenous vein reflux, need for repeat procedures, or the volume of foam injected. However, UGFS was associated with a greater and uniform reduction in saphenous vein diameter at all times after the procedure.