Ultrasound-guided foam sclerotherapy is safe and effective in the management of superficial venous insufficiency of the lower extremity.

BACKGROUND: Superficial venous disease of the lower extremity has a significant impact on quality of life. Both truncal and tributary vein reflux contribute to this disease process. Endovenous foam sclerotherapy is a widely used technique throughout the world for the management of superficial venous reflux and ultrasound guidance improves its safety and efficacy. METHODS: A PubMed search for ultrasound-guided foam sclerotherapy (UGFS) was conducted and all abstracts were reviewed to identify clinical trials and systematic reviews for a full-text analysis. Additional articles were also identified through searching the references of the selected studies. RESULTS: The production of foam for sclerotherapy in a 1:3 or 1:4 ratio of air to sclerosant is optimal in a low silicone, low-volume syringe system. Physiologic gas may decrease any side effects, with the trade-off of decreased foam stability. Proper technique with appropriate sterility and cleansing protocols are paramount for safe and effective treatment. The technical success of UGFS for great saphenous vein disease is inferior to endothermal and surgical modalities and retreatment is more common. However, the clinical improvement in patient-reported quality of life is similar between these three modalities. When used for tributary veins in combination with endothermal approaches of the truncal veins, UGFS has high rates of success with excellent patient satisfaction. UGFS has demonstrated an excellent safety profile comparable with or superior to other modalities. CONCLUSIONS: With proper technique, UGFS is safe and effective for the management of superficial venous disease.

The need for participation in the development and critical review of recommendations for infection control policies involving vascular ultrasound.

Recently reported guidelines from the Society of Diagnostic Medical Sonography regarding disinfection of ultrasound probes and infection control policies for ultrasound procedures conflict with accepted clinical norms in vein practices and recommendations from the American Institute for Ultrasound in Medicine. We have provided a review of these conflicting policy recommendations and new proposed practice recommendations and a call for physicians who perform ultrasound-guided procedures to be involved in the process of development and critical review of societal recommendations.

Venous angioplasty and stenting improve pelvic congestion syndrome caused by venous outflow obstruction.

OBJECTIVE: Pelvic congestion syndrome (PCS) is widely thought to be due to ovarian or internal iliac vein reflux. This report of a retrospective review of treatment of nonthrombotic common iliac vein (CIV) or inferior vena cava (IVC) obstruction with relief of symptoms demonstrates an often overlooked pathologic process. Stent placement is evaluated as an effective treatment of PCS due to venous obstruction even if observed left ovarian vein (OV) reflux is left untreated. METHODS: Records from two institutions were reviewed for patients with nonthrombotic venous outflow obstruction and symptoms of PCS severely affecting quality of life. The patients were evaluated with ultrasound, computed tomography (CT), and intravascular ultrasound before stent placement. From January 2008 through May 2013, 19 patients were treated with stents for severe venous outflow obstruction. Although seven patients also were found to have OV reflux, only one of these was treated with left OV coil occlusion. RESULTS: Whereas 10 of the 19 patients presented with a chief complaint of lower extremity pain, edema, or varicose veins, all patients described their pelvic symptoms as their dominant complaint. Ultrasound and CT suggested moderate to severe compression of the left CIV in 18 patients and a high-grade stenosis of the suprarenal IVC in one patient. Venography showed outflow obstruction with pelvic collaterals, and intravascular ultrasound confirmed focal severe stenosis of the involved vein. Follow-up of 1 to 59 months (median, 11 months) revealed complete resolution of pelvic pain in 15 of 19 patients and of dyspareunia in 14 of 17 sexually active patients. Of the 15 patients who experienced left lower extremity pain or edema before treatment, 13 experienced complete resolution after treatment. Imaging follow-up by ultrasound or CT showed 16 of the stents to be widely patent, with 3 minor asymptomatic stenoses. CONCLUSIONS: Nonthrombotic obstruction of the left CIV or IVC is an underappreciated cause of PCS. Venous angioplasty and stenting provide excellent short-term results for such patients, with resolution of chronic pelvic pain and dyspareunia. Venous obstruction should be considered and carefully evaluated in patients presenting with pelvic congestion, and treatment of obstruction alone may solve the patient's symptoms.