SAN DIEGO Foam sclerotherapy will soon be considered the standard of care for treating varicose veins, if it isn't already, Dr. John Bergan predicted at the annual meeting of the American Venous Forum.
"We have reached the point where foam has taken over," said Dr. Bergan, professor of surgery at the University of California, San Diego. "Put your laser on eBay because you are not going to be told this, but foam can do everything."
Insurance companies still generally consider foam sclerotherapy an investigational technique. But over the last 10 years, there have been at least 50 articles dedicated to some aspect of, or experience with, the technique, Dr. Bergan said.
Those publications indicate efficacy of immediate and primary venous occlusion of better than 80%, and that foam is 10 times stronger than liquid. They suggest that repeating the procedure when it fails the first or second time produces a success rate approaching 95%, and recurrence occurs only about 20% of the time, at 5 years.
In at least 70% of cases with saphenous vein reflux, there is no need to treat or strip the saphenous vein, because treating the varicose veins with foam will resolve the reflux or cause the saphenous vein to occlude.
Moreover, severe complications are extremely rare and allergic reactions to polidocanol just do not occur, he added.
A couple of years ago, his group was planning to buy a laser, but their experience with foam changed their minds, Dr. Bergan said.
Since January 2002, his group has treated 869 patients with foam sclerotherapy, and the vein-closure success rate at 1 year, with one or two treatments, has been 90%. And that group of patients has included 66 patients with active leg ulcers, unstable healed ulcers, or disabling lipodermatosclerosis.
There have been 13 adverse events total, of which 4 were ocular symptoms (which resolved), 3 were cases of dry cough, 2 were cases of migraine, 2 were cases of chest pain, and 2 were myoclonus and giddiness. In addition, there were three cases of deep vein thrombosis (two gastrocnemius thrombi, one posterior tibial thrombosis). Since last year, the group has instituted a policy of keeping the treated legs elevated at 45 degrees for 10 minutes after injection, and in 134 patients, there have been no adverse events.
Foam is as effective as laser or radiofrequency ablation, he said. The big difference is cost, with the generator for laser or radiofrequency costing about $30,000 and foam costing about $10.
"The literature is here," he said. "If your insurance company gives you a hard time, call me. I'll give you 50 references, or you can find them yourself on PubMed."