Sealing foam in the therapy of truncal varicose veins?
Sealing microfoam is a further development of the microfoam generally used for sclerotherapy. With the success of sealing varicose vein, the idea was close to further develop the microfoam. The sealing of veins has already been carried out in many German hospitals in the 1930s.
The well – known technical and chemical possibilities, combined with the microfoam therapy practiced for 20 years almost inevitably lead to a combination of these techniques. Sealing microfoam is one of the possible variations.
Microfoam therapy for 80 years
The microfoam for the treatment of varicose veins has been known since 1938. It was established in the 90s as a solid therapy of varicose veins and spider veins. The treatment management of the varicose disease was clearly facilitated and the therapy was gentle.
And nothing new had to be looked for, and there were already clinical experiences from the 1950s.
Microfoam: Gold standard for treatment of reticular veins and spider veins
Since 2010, the United States Food and Drug Administration (FDA) has also approved micro foam therapy with the use of an aethoxyclerol foam to treat varicose veins and declared it the „gold standard“ for spider veins and retinal vein therapy. In Germany, the first guideline on sclerotherapy was published in 2001. It has been updated in the years 2003, 2007 and 2012 especially with regard to the micro foam therapy.
In microfoam therapy, the drug ethoxysklerol is foamed with sterile air fine bubbles and injected by means of a fine catheter into the vein. Depending on the therapist, there are ticks and tricks for refining the microfoam. Also, various additives are now added to the microfoam.
This further increases the effectiveness on the one hand. On the other hand, we want to prevent the dreaded pigmentation (ecchymosis).
Greater saphenous vein after sealing with Sealing foam
Sealing foam of GSV r. ( diameter of the GSV 0,9 cm )
Our Results about 27 month sealing foam of truncal varicose veins
Since December 2006, we have successfully completed 12761 microfoam sessions.
In the last 27 months (5/2016 – 8/2018) – after the entry of the micro foam specialist Dr. med. Martell in our practice – performed at Saphenion 3341 microfoam treatments. In 191 cases, truncal varicose veins were treated. These were GSV in 73 cases, SSV in 66 patients, and VSAA in 50 cases.
In addition, the giacomini – / femoro popliteal vein was ablated in 41 cases.
The average age of patients in this therapy group was 44 years (19-78 years).
It was 1% – 3% Ethoxisklerol used and foamed with a long – standing in medical use adhesive sterile liquid. The treatment duration was on average 12 min. (5 – 21 min), anesthesia was not necessary in any case.
Simultaneous therapy on both legs or side branches and spider veins may be possible if the maximum values recorded in the guidelines for micro – foam therapy are not exceeded. The preoperative diameter of the varicose veins was 4.8 mm (2.7 mm – 10.5 mm). The diameter of the treated veins 6 months after sealing foam was 2.4 mm (0.8 mm – 7.2 mm).
Therapy access after Sealing Foam
Sealing foam – therapy was 100% successful in incomplete truncal varicose veins of GSV and SSV. All veins were closed after 27 months. Nearly the same applies to the complete SSV. Again, the occlusion rate was 95% (63 SSV). Therapy of the complete GSV showed a closure rate of 91,8% (67 GSV)
Side Effects after Sealing Foam
Side effects were extremely rare. In about 3% of all cases we saw a brown discoloration (ecchymosis) over a long time. In one case multiple puncture ulcers developed after external wound treatment with ointments and gel. In 3 cases we found a post – therapeutic phlebitis after 3-5 weeks treatment in this summer. There was not to be found deep venous thrombosis (thrombosis prophylaxis only once intra operatively).
Also, the neurological complications known from the radical stripping or thermal procedures were not reported by our patients.
Also of the neurological complications – known in the thermal procedures when used on the lower leg – was not reported by our patients.
Only indurations of treated veins and hardened vein cord feeling along the treated vein were frequently described, also muscle aching similar appearances were called frequently.
Although the Sealing Foam is also suitable for varicose veins of larger diameters (truncal varicose veins), however, in our experience a very good therapeutic effect up to a vein diameter of 6 mm is safe. For all larger diameters, the use of sealing microfoam is also possible and effective, but the use of venous glue VenaSeal, laser or radio wave is currently considered safer.
Compared to the thermal processes often used today, the side effect rate of the sealing foam is lower, and anesthesia is not necessary. Compression stockings are recommended by us for 7 – 10 days.
Compared to VenaSeal, the only approved venous adhesive, a significant cost advantage stands out. However, the VenaSeal guarantees a treatability of all truncal varicose veins simultaneously in one session. This is not fully achievable with the Sealing Foam, since the amount used per session is limited. On the other hand, however, a simultaneous therapy of side branches and spider varices is simultaneously possible.
Here, however, the next months will bring a further boost in experience, since we clearly push ahead with the use of Sealing Foam.
Bier,Braun Kümmel: Chirurgische Operationslehre, begründet. von F. Sauerbruch; Johann Ambrosius Barth, Leipzig; 1958