Optimal indications for foam sclerotherapy

Breu F. X., Rottach Egern/Tegernsee , f.x.breu@t-online.de

Transparenzerklärung Dr. F. X. Breu

- Bayer Vital

- Kreussler Pharma

- Leo Pharma

- Sigvaris

- OmniaMed

Hiermit lege ich offen, dass ich von folgenden Firmen Honorare erhalten habe, die sich auf Vorträge und Moderationen, die Teilnahme an Advisory Boards und allgemeine Beratung beziehen:

European Guidelines for Sclerotherapy in Chronic Venous Disorders

Rabe E, Breu FX, Cavezzi A, Coleridge Smith P, Frullini A, Gillet JL, Guex JJ, Hamel-Desnos C, Partsch B, Ramelet AA, Tessari L, Pannier F for the Guideline Group

Phlebology 2013

Guideliene Conference, Mainz 07.-10.06.2012

Guideliene Conference, Mainz 07.-10.06.2012

22 European Phlebological Societies

Antignani, P.L. Italian Society of Angiology and Vascular Medicine

Bihari, I. Hungarian Venous Forum

Böhler, K. Austrian Society of Phlebologyand Dermatologic Angiology

Breu, F. X. German Society of Phlebology

Cavezzi, A. Italian College of Phlebology

Ceulen, R. Benelux Society of Phlebology

Coleridge Smith, P. Venous Forum of the Royal Society of Medicine

Fernandez, F. Spanish Chapter of Phlebology

Frullini, A. Italian Phlebological Association

Gillet, J.L. French Society of Phlebology

Goranova, E. Bulgarian Society of Phlebology

Guex, J.J. French Society of Phlebology

Guggenbichler, S. German Society of Phlebology

Hamel-Desnos, C. French Society of Phlebology

Islamogu, F. Turkish Society of Phlebology

Kern, P. Swiss Society of Phlebology

Kuzman, G. Bulgarian Society of Phlebology

Larin, S. Russian Phlebological Association

Maurins, U. Baltic Society of Phlebology

Milic, D. Serbian Society of Phlebology, Balcan Venous Forum

Pannier, F. German Society of Phlebology

Partsch, B. Austrian Society of Phlebologyand Dermatologic Angiology

Rabe, E. German Society of Phlebology

Radu, D. Romanian Society of Phlebology

Ramelet, A.-A. Swiss Society of Phlebology

Rasmussen, L. Scandinavian Venous Forum

Schuller-Petrovic, S. Austrian Society of Phlebology and Dermatologic Angiology

Sommer, A. Benelux Society of Phlebology

Strejcek, J. Czech Society of Phlebology

Stücker, M. German Society of Phlebology

Tessari, L. Italian College of Phlebology

Tüzün, H. Turkish Society of Phlebology

Urbanek, T. Polish Society of Phlebology

Indications

We recommend sclerotherapy for all

types of veins, in particular:

Incompetent saphenous veins

(GRADE 1A)

Tributary varicose veins (GRADE 1B)

Incompetent perforating veins

(GRADE 1B)

Reticular varicose veins (GRADE 1A)

Telangiectasias (spider veins) (GRADE 1A)

Indications

Residual and recurrent varicose veins

after previous interventions (GRADE 1B)

Varicose veins of pelvic origin

(GRADE 1B)

Varicose veins (refluxing veins) in

proximity of leg ulcers (GRADE 1B)

Venous malformations (GRADE 1B)

Specific (optimal) indications forfoam sclerotherapy

Isolated incompetent side branches (e.g. v. saph. access. ant.), reticular veins, “refractory” and/or large-diameter spider veins, telangiectasias, central veins of spider veins

Partial incompetence of the GSV (max diameter 8 mm) and SSV of the side branch or perforans type

incompetence of opening type with working valve on the outer pelvic level (iliac veins) or in the common femoral vein (prox. the SFJ)

Recurrent varicosis (REVAT)

varix rupture, spontaneous varix bleeding

SFJ= saphenous junction

SSV = suprasaphenous valve

TV = terminal valve

PTV = preterminal valve

M.Stücker: Vasomed 2011 Congress edition: in 48% TV sufficient and

PTV insufficient = good indication for endoluminal procedure

f.x.breu@t-online.de10

72y. pat. with recurrent varicous bleeding,

AF, anticoagulation, rec. ulcers

After 4 times sclerotherapy

Control after 12 weeks

Recurrences

47 y old female after 3 times surgery right and 2 times surg. left leg

Specific indications for foam sclerotherapy

Isolated branch varicosis (e.g. v. saph. access. ant.), reticular veins, “refractory” and/or large-calibre spider veins, telangiectasias, central veins of spider veins

Partial incompetence of the GSV and SSV of the side branch or perforans type (max. diameter 8 mm)

GSV insufficiency of opening type with working valve on the outer pelvic level or in the common femoral vein

Recurrent varicosis (REVAT)

varix rupture, spontaneous varix bleeding

Obesity

Periulcerous varicosities (aged patient)

The tangle of dilated venules under

the ulcer are the target of treatment

in foam sclerotherapy

Healing and Recurrence Rates Following Ultrasound-

guided Foam Sclerotherapy of Superficial Venous Reflux in

Patients with Chronic Venous Ulceration

130 Pat., 132 Beine. CEAP: 49 C5 + 83 C6, mittleres Alter: 70y,

mittlere Ulkusdauer: 8m, mittleres Schaumvolumen: 8 ml

Med. follow up: 16m (12-32m)

Heilungsrate (C6): 81% nach 6m

Rezidive: 5% nach 2y (ESCHAR 2007: ca. 40% nur

Kompr., ca. 20% OP+Kompr.!)

--> Keine Thrombose, Sehstörung oder neurolog. Ereignis

Pang K H et al; Birmingham, UK; Eur J Vasc Endovasc Surg 2010; 39

Specific indications for foam sclerotherapy

Isolated branch varicosis (e.g. v. saph. access. ant.), reticular veins, “refractory” and/or large-diameter spider veins, telangiectasias, central veins of spider veins Partial insufficiency of the Vsm and Vsp of the side branch or perforans typeMagna insufficiency of opening type, possibly better results with functioning valve on the outer pelvic level or in the v. fem comm. Recurrent varicosis (REVAS)Varix rupture, spontaneous varix bleedingObesityPeriulcerous varicosities (old patient)Patient who refuses surgery or other procedureLymphedemaRel. contraindications for surgery (eg OAK) Patients at increased risk during heparin bridging (eg. artificial heart valves)Venous malformations such as KTSVulvar varicosis

Varix convolutes and highly tortuous varicose veins (not suitable for laser and VNUS)Bone-perforators

Sek. lymphedema

with varicose veins

Vulvar varices of pelvic origin

Knochenperforatoren mit Seitenästen

• We sometimes see side branches with their origin

in bone perforators

Thanks to A.Ramelet Phlebology 2016

Thank you for your attention

f.x.breu@t-online.de