Ultrasound-Guided Foam Sclerotherapy for the Treatment of Chronic Venous Ulceration: A Preliminary Study

Objectives: When compared to compression therapy atone, surgical correction of superficial venous reflux (SVR) reduces recurrence but does not appear to increase heating of chronic venous ulceration (CVU). The role of ultrasound-guided foam sclerotherapy (UGFS) of SVR as part of the treatment of CVU remains uncertain. The aim of this study is to describe CVU heating and recurrence rates after UGFS and to relate these outcomes to patterns of pre- and post-intervention venous reflux. Methods: A prospective study of 27 consecutive patients (28 legs) of median age 69 (interquartile range 54-79) years undergoing UGFS for SVR in addition to compression for treatment of CVU of median duration 12 (IQR 6-23) months. Prior to and 1, 6, and 12 months after treatment patients underwent clinical and duplex assessment. Results: 8 limbs (29%) had deep and superficial venous reflux, and 20 limbs had SVR atone. There was a history of DVT in 4 limbs, and 4 patients were on warfarin. No limbs had significant arterial disease and all received post-UGFS compression. Median volume of (3% STD) foam used was 8 (range 2-14) ml. 1, 3 and 6 months after UGFS, 22 (79%), 27 (96%) and 27 (96%) CVU had heated. At 12 months, 25 ulcers remained heated, 2 ulcers had recurred; one patient had died from carcinomatosis. Discussion: Following UGFS as an adjunct to compression, 96% of CVU heated within 3 months and only 2 heated ulcers (7%) had recurred at 12 months. UGFS appears to be an attractive minimally-invasive alternative to surgery to treat SVR in patients with CVU, especially the elderly and frail. (C) 2009 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.