Sealing foam in varicose veins – our 29 month experiences

Sealing microfoam for varicose veins?

Sealing microfoam is a further development of the microfoam used for sclerotherapy. With the success of the vein super glue, the idea came up to further develop the microfoam. The bonding of veins has been carried out since the mid-20`s in many German hospitals. The known technical and chemical possibilities, combined with the micro-foam therapy practiced since the mid-90s, almost inevitably lead to a combination of these techniques. Adhesive microfoam (Sealing Foam) is one of the possible variations.

Microfoam known for 80 years.

The microfoam for the treatment of varicose veins has been known since 1938. He has established himself 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. In addition to finding an adhesive component, nothing new had to be sought. There were already clinical experiences from the 20s of the last century for the adhesion of varicose veins.

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 over 29 months

Since December 2006, we have successfully completed 12,907 micro foam sessions. In the last 29 months (5/2016 – 10/2018), Saphenion has undergone 3487 microfoam treatments following the entry of microfoam specialist Ms. Lillie Martel. In 218 cases, trunk varicose veins were treated. These cases included a SSV in 76 cases, 81 patients with a GSV varicose, in 61 cases a VSAL – varicosis. In addition, the giacominivene / femoropopliteal vein on thighs and lower legs was treated in 47 cases.

The average age of patients in this therapy group was 47 years (19 – 82 years).

It was 0.5% – 3% Ethoxisklerol used and foamed with a – since the mid-20s also used in trunk veins – intense adhesive sterile liquid. The treatment duration was on average 14 minutes. (5 – 35 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 amount of microsurgery used in the guidelines for microfoam therapy is 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 2.6 mm (0.8 mm – 7.3 mm).

Therapy success after adhesive microfoam

Adhesive microfoam therapy was 100% successful in incomplete stock varices of GSV and SSV. All venules were closed after 29 months. The results for sealing SSV are similarly good. This showed a closure rate of 96.1% (73 veins). Therapy of complete GSV showed a closure rate of 88.9% (72 GSV)

Side Effects after Sealing Foam

Side effects were extremely rare. In about 5% of all cases we saw a brown discoloration (ecchymosis) over a long time. In two cases multiple puncture ulcers developed. 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 once intra operatively).

Also, the neurological complications – known from the radical stripping or thermal procedures – were 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.

 

Our discussion

Sealing microfoam therapy is also very well suited for the treatment of stem varicosis of narrow – caliber truncal varicose veins. We are currently using Sealing Foam for truncal varicose veins if the diameter of the vein in the ultrasound examination does not exceed 5 – 6 mm. The effectiveness of microfoam in the case of varicosis had already been established by the European Society of Vascular Surgery (ESVS) in its 2015 guidelines.

Compared to radical surgical therapy and the many thermal methods used today, the side effect rate of sealing foam is lower. This is especially true for the therapy on the lower leg. Anesthesia is not necessary. Compression stockings are recommended by us for 7 -10 days. Compared to VenaSeal, the only approved and very effective venous glue, a significant cost advantage stands out.

However, the venous glue VenaSeal allows for the treatment of all venous veins requiring treatment simultaneously in one session. This is not fully achievable with the sealing microfoam, since the amount used per session is limited. In addition, the effectiveness of the microfoam in the treatment of the trunk varicose veins in comparison to the venous adhesive is very dependent on the vein diameter and the pressure conditions in the truncal varicose veins. On the other hand, however, a therapy of side branches and reticular and spider varices is simultaneously possible.

Our experiences

Sealing microfoam can also be used for varicose veins of larger diameters, but in our experience a very good therapeutic effect up to a vein diameter of 5 – 6 mm is quite safe. Sealing microfoam can also be used with all larger diameters, but the use of venous adhesive VenaSeal, laser or radio wave results – ignoring the possible side effects of thermal processes – but a higher closure efficiency. The use of Sealing micro foam will be continued consistently by us – due to the really good post operative results.

With the further increase in experience, the indication profile will be further enhanced. Thus, in addition to the VenaSeal vein adhesive and the radio frequency therapy, we have a third minimally invasive, effective and gentle endovenous procedure available.

 

 

links:

http://www.ejves.com/article/S1078-5884(15)00097-0/abstract

http://www.ejves.com/article/S1078-5884(15)00097-0/abstract

http://www.der-niedergelassene-arzt.de/fileadmin/user_upload/zeitschriften/vasomed/Artikel_PDF/2017/01-2017/Murena.pdf

http://www.ncbi.nlm.nih.gov/pubmed/26557230

http://www.phlebology.de/leitlinien-der-dgp-mainmenu/280-leitlinie-zur-diagnostik-und-therapie-der-krampfadererkrankung

http://gesundheitsnews.imedo.de/news/1017861-krampfadern-minimalinvasive-therapien-auf-dem-vormarsch

http://van den Bos R. et al. : Metaanalyse randomisierter klinischer Studien und Fallserien, J. Vasc. Surg., 2008, Aug.8

https://www.ncbi.nlm.nih.gov/pubmed/28892412

https://www.ncbi.nlm.nih.gov/pubmed/29629358

Bier,Braun Kümmel: Chirurgische Operationslehre, begründet. von F. Sauerbruch; Johann Ambrosius Barth, Leipzig; 1958

 

 

 

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