Air versus physiological gas for ultrasound guided foam sclerotherapy treatment of varicose veins

Abstract

Objectives: We have used ultrasound guided foam sclerotherapy (UGFS) to treat varicose veins in 2029 limbs since 2006. In 2009 we introduced physiological gas (30% O₂ and 70% CO₂) for making foam with sodium tetradecyl sulphate (Fibrovein, STD Pharmaceutical Products Ltd, Hereford UK) instead of air. The aim of this study was to compare our early experience of UFGS using CO₂/O₂ with our prior experience using air.

Methods: Data were collected in a prospectively maintained database. In this series 470 limbs were treated with UGFS and followed up at 6 weeks with clinical and duplex ultrasound assessment. The 235 consecutive limbs undergoing UGFS immediately before and the 235 after the introduction of CO₂/O₂ were selected for comparison.

Results: The age, gender and CEAP classifications for the two groups were not significantly different. 73% were primary veins and 70% great saphenous, with no differences between the groups. Transient neurological events are rare in our experience (0.7%) with only one visual disturbance occurring in this series. There was a significant reduction in the incidence of skin staining in the CO₂/O₂ (7.2% vs 3.3%, p = 0.02, χ² test) as compared to the air treated group, but no difference in the incidence of thrombophlebitis. The total volume of foam injected was similar in both groups but use of CO₂/O₂ foam was associated with a significant improvement in the truncal occlusion rate, from 86% to 91% (p < 0.05, χ² test).

Conclusion: UGFS with CO₂/O₂ instead of air was associated with a slightly increased saphenous truncal occlusion rate and reduced the incidence of skin staining without increasing thrombophlebitis in this clinical series. We observed only one transient neurological event in this series so could not evaluate the effect of CO₂/O₂ foam in reducing these events.