1. Ultrasound guided foam sclerotherapy of varicose veins
Anton Krnić, MD, PhD
Poliklinika Sinteza, Zagreb
KB Sveti Duh, Zagreb

2. E-medicine / Medscape
It is most effective for veins less than 6-7 mm in diameter but can be effective for veins of almost any diameter
…if excellent technique is employed

3. E-medicine / Medscape
Sclerotherapy produces minimal procedural and postprocedural pain
It is easier to perform than most alternative strategies.

4. Clinical practice guidelines
We suggest foam sclerotherapy as an option for the treatment of the incompetent saphenous veins
We recommend sclerotherapy to treat varicose tributaries
The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg May;53(5 Suppl):2S-48S.

5. Authorities’ opinion
John Bergan: “A Truly Minimally Invasive Techinque”
Phillp Colleridge Smith: “Can be used to treat truncal saphenous incompetence and recurrent varicose veins”

6. Technique Patient: woman, 44 years
Clinical presentation: varicose veins, CEAP 2
Duplex ultrasound: great saphenous vein insuffitiency, with insufficient varicose tributaries

7. Technique

8. Technique

9. Technique

10. Technique

11. Technique

12. Technique

13. Technique Compression stockings ccl 2 are applied
The patient is asked to ambulate for ½ hour after leaving the clinic

14. Before

15. 2 weeks after

16. Before - after

17. Our Results Duplex scanning within a month – short term follow up
315 treated limbs with insuffitient GSV/ SSV/ AASV/ Giacomini Vein or recurrent varicose veins in 2,5 years in Zagreb and Sarajevo
Duplex scanning within a month – short term follow up
Primary success rate: 100%

18. E-medicine/Medscape EVLA - 94% RFA - 84% UGFS - 77% Stripping - 78%
Success rate after 3 years / meta-analysis of 118 studies
EVLA - 94%
RFA - 84%
UGFS - 77%
Stripping - 78%
van den Bos R, et al. Endovenous therapies of lower extremity varicosities: a meta-analysis. J Vasc Surg. Jan 2009;49(1):230-9.

19. Side Effects – Our Results
Skin staining – common, fades with time
Hard, tender lumps – common, withdraw with time
DVT – none
Pulmoary embolism – none
Allergy to sclerosing agent - none

20. Conclusion
Ultrasound gudieded foam sclerotherapy is an outstanding technique for varicose veins treatment
It is least invasive
It is highly efficent
Easy to perform treatment and retreatment

21. Thank you for your attention.