European Consensus Statement Offered on Foam Sclerotherapy

SAN DIEGO — European experts in foam sclerotherapy have updated their recommendations regarding how to perform foam sclerotherapy. Those recommendations include one that foam as viscous as possible should be used, and that only a 2%-3% mixture of polidocanol is needed for the greater saphenous vein, Dr. Nick Morrison said at the annual meeting of the American Venous Forum.

At the second European Consensus Meeting on Foam Sclerotherapy in April 2006, 26 European experts and 1 American expert were surveyed about their practices, and the survey was used to update recommendations originally made in 2003, said Dr. Morrison, president-elect of the American College of Phlebology and a surgeon who practices in Scottsdale, Ariz.

Dr. Morrison said the document that emerged from that survey included consensus statements on the following:

▸ Access material. The majority of experts use direct puncture to access the great saphenous vein, and for the great and small saphenous vein, most use a needle or a short catheter for access, though some use larger needles or a long catheter for larger veins.

▸ Access location. For the great saphenous vein accessed by direct puncture, the preferred access location of most experts is the proximal thigh. When a long catheter is used, however, access below the knee is preferred. For the small saphenous vein, access is preferred at the proximal or middle part of the calf.

▸ Foam. Foam should be made as viscous as possible, and the amount of foam used should be small and limited, even if that means a second procedure, the experts concurred. The average amount of foam used by the experts per puncture was up to 6 mL, and the maximum volume was up to 8 mL. Eighty-five percent of the experts used less than 10 mL per session. The consensus was that 10 mL was the maximum amount of foam that should be used per leg and per session. Most experts use 2%-3% polidocanol, and most use liquid rather than foam for telangiectasias.

▸ Foam preparation. For the preparation of foam, the Tessari and the DSS/Tessari methods are recommended in all indications. Most experts are using a 4:1 liquid:gas ratio, with air being the most commonly used gas component, though CO2 and O2 can also be used.

▸ Safety. Most of the experts do not use a catheter with a balloon to control the flow of foam; in fact, some believe it is better to have some minor seep rather than a large bolus released at once when the balloon is deflated. A slight majority of the experts uses a limited amount of foam per puncture and per session to increase safety.

Most advise that the puncture site be a minimal distance of 8–10 cm from the saphenofemoral and saphenopopliteal junctions. Immediate compression over the puncture site should be avoided, and most experts use echographic control of foam location.

▸ Contraindications. A relative contraindication is a patent foramen ovale. Patients with a known, asymptomatic foramen ovale should rest in a supine position longer, from 8 to 30 minutes.

▸ Compression. The great majority of experts see a need for compression after treatment of a saphenous vein, its tributaries, perforating veins, and vascular malformations. About half of the experts use compression for treated reticular veins and telangiectasias.

SAN DIEGO — European experts in foam sclerotherapy have updated their recommendations regarding how to perform foam sclerotherapy. Those recommendations include one that foam as viscous as possible should be used, and that only a 2%-3% mixture of polidocanol is needed for the greater saphenous vein, Dr. Nick Morrison said at the annual meeting of the American Venous Forum.

At the second European Consensus Meeting on Foam Sclerotherapy in April 2006, 26 European experts and 1 American expert were surveyed about their practices, and the survey was used to update recommendations originally made in 2003, said Dr. Morrison, president-elect of the American College of Phlebology and a surgeon who practices in Scottsdale, Ariz.

Dr. Morrison said the document that emerged from that survey included consensus statements on the following:

▸ Access material. The majority of experts use direct puncture to access the great saphenous vein, and for the great and small saphenous vein, most use a needle or a short catheter for access, though some use larger needles or a long catheter for larger veins.

▸ Access location. For the great saphenous vein accessed by direct puncture, the preferred access location of most experts is the proximal thigh. When a long catheter is used, however, access below the knee is preferred. For the small saphenous vein, access is preferred at the proximal or middle part of the calf.

▸ Foam. Foam should be made as viscous as possible, and the amount of foam used should be small and limited, even if that means a second procedure, the experts concurred. The average amount of foam used by the experts per puncture was up to 6 mL, and the maximum volume was up to 8 mL. Eighty-five percent of the experts used less than 10 mL per session. The consensus was that 10 mL was the maximum amount of foam that should be used per leg and per session. Most experts use 2%-3% polidocanol, and most use liquid rather than foam for telangiectasias.

▸ Foam preparation. For the preparation of foam, the Tessari and the DSS/Tessari methods are recommended in all indications. Most experts are using a 4:1 liquid:gas ratio, with air being the most commonly used gas component, though CO2 and O2 can also be used.

▸ Safety. Most of the experts do not use a catheter with a balloon to control the flow of foam; in fact, some believe it is better to have some minor seep rather than a large bolus released at once when the balloon is deflated. A slight majority of the experts uses a limited amount of foam per puncture and per session to increase safety.

Most advise that the puncture site be a minimal distance of 8–10 cm from the saphenofemoral and saphenopopliteal junctions. Immediate compression over the puncture site should be avoided, and most experts use echographic control of foam location.

▸ Contraindications. A relative contraindication is a patent foramen ovale. Patients with a known, asymptomatic foramen ovale should rest in a supine position longer, from 8 to 30 minutes.

▸ Compression. The great majority of experts see a need for compression after treatment of a saphenous vein, its tributaries, perforating veins, and vascular malformations. About half of the experts use compression for treated reticular veins and telangiectasias.

SAN DIEGO — European experts in foam sclerotherapy have updated their recommendations regarding how to perform foam sclerotherapy. Those recommendations include one that foam as viscous as possible should be used, and that only a 2%-3% mixture of polidocanol is needed for the greater saphenous vein, Dr. Nick Morrison said at the annual meeting of the American Venous Forum.

At the second European Consensus Meeting on Foam Sclerotherapy in April 2006, 26 European experts and 1 American expert were surveyed about their practices, and the survey was used to update recommendations originally made in 2003, said Dr. Morrison, president-elect of the American College of Phlebology and a surgeon who practices in Scottsdale, Ariz.

Dr. Morrison said the document that emerged from that survey included consensus statements on the following:

▸ Access material. The majority of experts use direct puncture to access the great saphenous vein, and for the great and small saphenous vein, most use a needle or a short catheter for access, though some use larger needles or a long catheter for larger veins.

▸ Access location. For the great saphenous vein accessed by direct puncture, the preferred access location of most experts is the proximal thigh. When a long catheter is used, however, access below the knee is preferred. For the small saphenous vein, access is preferred at the proximal or middle part of the calf.

▸ Foam. Foam should be made as viscous as possible, and the amount of foam used should be small and limited, even if that means a second procedure, the experts concurred. The average amount of foam used by the experts per puncture was up to 6 mL, and the maximum volume was up to 8 mL. Eighty-five percent of the experts used less than 10 mL per session. The consensus was that 10 mL was the maximum amount of foam that should be used per leg and per session. Most experts use 2%-3% polidocanol, and most use liquid rather than foam for telangiectasias.

▸ Foam preparation. For the preparation of foam, the Tessari and the DSS/Tessari methods are recommended in all indications. Most experts are using a 4:1 liquid:gas ratio, with air being the most commonly used gas component, though CO2 and O2 can also be used.

▸ Safety. Most of the experts do not use a catheter with a balloon to control the flow of foam; in fact, some believe it is better to have some minor seep rather than a large bolus released at once when the balloon is deflated. A slight majority of the experts uses a limited amount of foam per puncture and per session to increase safety.

Most advise that the puncture site be a minimal distance of 8–10 cm from the saphenofemoral and saphenopopliteal junctions. Immediate compression over the puncture site should be avoided, and most experts use echographic control of foam location.

▸ Contraindications. A relative contraindication is a patent foramen ovale. Patients with a known, asymptomatic foramen ovale should rest in a supine position longer, from 8 to 30 minutes.

▸ Compression. The great majority of experts see a need for compression after treatment of a saphenous vein, its tributaries, perforating veins, and vascular malformations. About half of the experts use compression for treated reticular veins and telangiectasias.