Saphenofemoral incompetence treated by ultrasound-guided sclerotherapy

BACKGROUND. Published long-term recurrence rates are higher after sclerotherapy than after surgery for the treatment of varicose veins involving greater saphenous tributaries associated with saphenofemoral incompetence (SFI). Duplex ultrasound has recently become the gold standard for the diagnosis of venous disorders, and over the past 5 years, has been utilized during sclerotherapy to guide injections more precisely. OBJECTIVE. To determine greater saphenous vein recanalization and recurrence rates of varicose veins associated with SFI after duplex ultrasound-guided outpatient sclerotherapy. METHODS. Ambulatory patients with varicose veins deriving from greater saphenous vein reflux associated with SFI documented by duplex ultrasound from two private practices were treated by duplex ultrasound-guided compression sclerotherapy using 3% sodium tetradecyl sulphate. Patients were followed by clinical and duplex examinations annually. RESULTS. Forth-eight of 202 (23.8%) limbs were found to have recanalized by duplex ultrasound at 1 year, and 0/28 (0%) at 2 years (48/202, 23.8% cumulative rate). Clinical recurrences (visible varicosity or symptoms occurred in 46/202 (22.8%) of limbs at 1 year, and 10/28 (35.7%) at 2 years (56/202, 27.2% cumulative rate). There were no intra-arterial injections or other complications. CONCLUSION. Duplex ultrasound enhances the precision and, therefore, both the efficacy and safety of saphenous vein sclerotherapy when performed by experienced practitioners. While awaiting long-term follow-up to document the progressive recurrence rate over time, our results at 2 years are superior to those after conventional sclerotherapy, and compare favorably with those after surgical interruption.