2.4 Sclerotherapy
Sclerotherapy treatment of telangiectasies by ultrasound guidance.
C. Hamel Desnos
The author started by stressing the importance of a right initial mapping to ensure the success of the treatment. To perform this mapping, according to the author, an adequate clinical examination with careful observation (frequently using cold light) and ultrasound imaging are necessary. In fact, insufficient or no treatment of the underlying reflux is the cause, in many cases, of matting. Even if it can be difficult to perform sclerotherapy treatment of small and very superficial veins under ultrasound imaging guidance, the use of an adequate technique can be the key for success. For these purposes, the equipment to be used should have a high frequency probe (13 to 16 MHz). Assessment is carried out with the patient in the standing position, then with the patient in the lying position. Sclerotherapy is always performed with the patient in the lying position. In conclusion, as for any sclerotherapy treatment, the success of sclerotherapy for reticular varices and telangiectases is achieved through careful initial examination, making it possible to establish which sources of the disorder may be involved. The author finished her talk stating that, in sclerotherapy treatment, it is important to know exactly how to inject, but just as important to know exactly where to inject.
LAFOS: a mix between laser and foam sclerotherapy without tumescent anesthesia. Short-term follow-up results.
A. Frullini
In order to enhance the treatment of insufficient saphenous veins with sclerosing foam, the author presented a new technique called LAFOS (Laser Assisted Foam Sclerotherapy) in which a new specifically designed Holmium:YAG laser has been used to reduce the vein diameter immediately before foam sclerotherapy. This laser pretreatment is capable of shrinking the vein lumen by converging on the type III collagen fibers of the tunica media, resulting in a reduction in the foam volume needed without affecting the intima, which is essential for an effective sclerosis. As such, the author stated that this technique allows the ablation of the vein with lower chances of complications (no risk of perivenous damage, no pain). This method can be performed as an office-based procedure as anesthesia is not required. The technique consists of gaining access to the vein with a simple cannula (17 g) or with a sheath, placing the laser fiber, retrieving the fiber while the vein diameter is reduced, and immediate foam injection in the same cannula.
Subsequently, the author presented the short-term results of the first 50 cases treated by LAFOS. The laser system used had a 5W max average power with a maximum of 500 mJ/pulse. The treatment was performed on 38 patients with an insufficient greater saphenous vein (GSV) and on 12 patients with lesser saphenous vein (LSV) insufficiency. The mean maximum diameter of the GSV was 9.17 and 7.91 for the LSV. Two GSVs were previously treated twice unsuccessfully with two sessions of echo-guided foam sclerotherapy. Vein shrinkage was easily achieved and the internal lumen diameter was reduced in association with thickening of the vein wall. Complete occlusion was always observed at one month, even in the two cases resistant to conventional treatment with sclerosing foam. No complications due to foam sclerotherapy were observed with the exception of minor bruising that resolved uneventfully. As a result, the author concluded that this new technique is less expensive than surgery or thermal ablation, can be performed in an office setting with no anesthesia and no pain, is a faster procedure with immediate return to family activities and work, makes sclerotherapy more technologically advanced, and uses a lower volume of foam. He added that the media pretreatment could possibly result in a better late outcome and that the vein shrinkage permits larger vein treatment (>2 cm).
