Thrombus extension into the deep venous system following superficial vein chemical ablation with Varithena ® polidocanol microfoam has been reported. The objective of this study was to assess the effect of intraoperative improved techniques during treatment for patients with symptomatic varicose veins and their impact on extension of thrombus into deep veins.
A retrospective review of a prospectively maintained database was performed. All patients who underwent endovenous chemical ablation with polidocanol microfoam (Varithena, Boston Scientific, Marlborough, MA, USA) for symptomatic superficial axial and tributary vein reflux were identified. Patients had postoperative duplex (48-72 hours) scanning post procedure; those who did not adhere to the recommended follow-up were excluded. Demographic data, CEAP Classification, Venous Clinical Severity Score (VCSS), procedure details, and follow up data were abstracted.
Between April 2018 and August 2020, 157 limbs in 122 patients were treated with Varithena® microfoam; 129 limbs in 99 patients met inclusion criteria. Veins treated included: great saphenous vein (n=89), anterior accessory saphenous vein (n=15), small saphenous vein (n=14), and tributary veins (n=56). Adjunctive techniques during treatment included: intraoperative elevation of the limb to greater than 45 degrees, ultrasound mapping and digital occlusion of large perforator veins, limitation of foam volume per session, injection of sterile saline prior to treatment and compression of the limb in the elevated position. The preoperative VCSS was 11.4 and decreased after treatment to 9.7. The immediate closure rate was 95% with 81% overall symptomatic relief at last follow up. Mean follow up was 113.5 days for the entire cohort; two limbs (1.5%) required postoperative anticoagulation for thrombus extension into the deep venous system (common femoral vein n=1, popliteal vein n=1) postoperatively for a mean of 22 days. Both resolved with anticoagulation. One asymptomatic limb developed a femoral vein deep venous thrombosis (DVT) and one symptomatic late DVT was noted four-months post-procedure. Postoperative pain and phlebitis were reported in 15.6% and 14.8% of patients, respectively and all resolved at last follow up. No pulmonary emboli were noted and no neurologic or visual adverse events recorded.
Adjunctive techniques during microfoam ablation decreased thrombotic complications in our series compared with those reported in earlier Phase III clinical trials. Excellent early closure and symptomatic improvement were also noted. Endovenous microfoam ablation with Varithena ® is a safe and effective non-tumescent, non-thermal alternative to laser and radiofrequency ablation.

Copyright © 2020. Published by Elsevier Inc.