Document Detail

Blocking the saphenofemoral junction during ultrasound-guided foam sclerotherapy-- assessment of a presumed safety-measure procedure.
MedLine Citation:
PMID:  20926321     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Ultrasound-guided foam sclerotherapy (UGFS) is a technique in which a mixture of sclerosing drug and gas is used to treat varicose veins. Several authors have demonstrated transient systemic effects after UGFS. These effects are not well understood but probably originate from a systemic distribution of the sclerosing foam. Therefore, safety measures have been developed to prevent foam from flowing into the deep venous system. The aim of the study is to evaluate whether blockage of the saphenofemoral (SF) junction by either manual compression or surgical ligation prevents microbubbles from leaking into the deep venous circulation.
METHODS: To detect the distribution of microbubbles, radioactive pertechnetate (99mTcO4-) was added to the foam solution. Initially, in vitro trials were performed in the laboratory to investigate the effect of 99mTc on foam stability. The time taken for foam to liquefy was measured for foam alone and for the mixture with 99mTc. In subsequent research, eight varicose great saphenous veins (GSVs) were treated by UGFS. In three patients, this treatment was preceded by surgical ligation of the SF junction. In three patients, the groin was manually compressed during UGFS. In two patients, UGFS was performed without compression of the groin.
RESULTS: In vitro, 99mTc did not influence foam stability; after 2.6 min all foam had reduced to liquid, regardless of whether 99mTc had been added or not. In vivo trials showed that all patients showed a decrease in the cumulative amount of 99mTc detected in the GSV following polidocanol-99mTc mixture injection. However, the decrease of radioactivity was slightly reduced when compression or ligation of the SF junction was performed.
CONCLUSIONS: Blocking the SF junction during UGFS using either manual compression or ligation does not prevent, but may reduce the flow of foam into the femoral vein.
R P M Ceulen; E A Jagtman; A Sommer; G J J Teule; G W H Schurink; G J Kemerink
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery     Volume:  40     ISSN:  1532-2165     ISO Abbreviation:  Eur J Vasc Endovasc Surg     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-29     Completed Date:  2011-01-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9512728     Medline TA:  Eur J Vasc Endovasc Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  772-6     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
Department of Dermatology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
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MeSH Terms
Femoral Vein / radionuclide imaging,  surgery*,  ultrasonography
Middle Aged
Radiopharmaceuticals / diagnostic use
Saphenous Vein / radionuclide imaging,  surgery*,  ultrasonography
Sclerosing Solutions / adverse effects,  therapeutic use*
Sclerotherapy* / adverse effects
Sodium Pertechnetate Tc 99m / diagnostic use
Treatment Outcome
Ultrasonography, Doppler, Duplex*
Ultrasonography, Interventional*
Varicose Veins / physiopathology,  radionuclide imaging,  therapy*,  ultrasonography
Reg. No./Substance:
0/Radiopharmaceuticals; 0/Sclerosing Solutions; 23288-60-0/Sodium Pertechnetate Tc 99m

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