Foam Sclerotherapy for Chronic Venous Disease

Over the past 20 years, foam sclerotherapy has become a permanent tool-kit for the treatment of CVI. It is classified as a non-thermal and non-tumescent technique even if in the literature some authors have switched its use with the use of tumescent anesthesia (catheter directed) to treat large diameter veins. However, there are some guidelines and consensus statements noting that the role of this technique is still controversial because most practitioners develop their own methods and individual approaches based on a combination of common sense, intuition, and dogma. Safety and efficacy for the ablation of great and small saphenous veins has been proven through RCTs but long-term results at 3-year follow-up evidenced inferiority when compared with thermal and tumescent techniques. The reported incidence of complications of sclerotherapy is quite variable in the literature and the older publications mostly refer to liquid sclerosants. Significant complications include anaphylaxis, thromboembolism, cerebrovascular events, tissue necrosis, nerve damage, and oedema. Other minor complications can be classified as cosmetic and include telangiectatic matting and pigmentation. However, foam sclerotherapy should be considered the gold standard for ablation of small and cosmetic veins and reticular varicosities and should be considered a complementary technique to treat complex cases, recurrences, and tortuous veins, and can be used whenever it is not possible to perform endovenous thermal techniques.