Servier – Phlebolymphology

Seromas are rare complications after varicose vein surgery; they manifest clinically as palpable masses or swelling at the site of the wound. Aethoxysclerol is an approved sclerosing agent for varicose veins in several countries in Europe. The aim of our case was to show the therapeutic effect and the safety of use of ultrasound-guided aethoxysclerol foam sclerotherapy in a small postoperative seroma after endovenous laser ablation (EVLA) with phlebotomies.

Figure 1. Left) Seroma at ultrasound. Right) Ultrasound-guided foam sclerotherapy.

87-year-old female, CEAP 4 (by clinical-etiological anatomical-pathophysiological classification). Medical history: diabetes mellitus type 2, arterial hypertension, hypercholesterolemia, thyroidopathy, pacemaker, under insulin and antiplatelet treatment. We treated a postoperative seroma after EVLA that was refractory to conventional treatments including compression dressings, repeated needle aspiration, and manual lymph drainage. Ultrasound-guided drainage was carried out with 21G needle and foam sclerotherapy towards fascia gap.

Table I. At the patient’s first 3 visits, at 2, 2.5, and 3 months accordingly, 6 mL of serum was aspirated from the seroma, while no foam sclerotherapy was injected. Compression stockings were applied during the 5 month period. The volume of foam injected during the next 4 visits did not reduce.

Although seromas after phlebotomy are a rare complication, they can cause a significant impairment of the patients’ quality of life. Since no sclerotherapy agent has yet been approved in the treatment of seromas, those treatments can only be offered as off-label therapy.