Sclerofoam assisted laser therapy for saphenous refluxes: an innovative tumescence-free technique

Endovenous laser (EL) and radiofrequency devices have continuously increased their appealing in the last decade. Even if miniinvasive, such procedure still requires multiple high volume injections of tumescent anesthesia: a medical act that is not totally complications- free. Aim of the present investigation is to evaluate the feasibility of a hybrid technique (so called sclerofoam assisted laser therapy, SFALT) combining foam sclerotherapy (FS) and EL in a tumescence free approach. Fourty primary chronic venous disease patients (8 males, 32 females, C2-4EpAsPr) presenting a sapheno-femoral reflux both at the Valsalva and compression/relaxation maneuver underwent a SFALT procedure. Diameters were measured at mid-thigh in supine. It consists in a EL fiber introduction into the great saphenous vein (GSV), shrinking it for a single cm at 200 J/cm. After a shrunk plug is created, keeping the fiber stuck in it, 5 cc of foam sclerotherapy [Tessari method, 1% polidocanol (POL) or 1% sodium tetradecyl sulfate (STS)] are injected through the same 6 Fr EL introducer. The consequent spasm allows a following EL mediated shrinkage by means of a significantly reduced fluence. Clinical and sonographic follow up were performed at one and three weeks. At 3 weeks follow up all the 40 cases presented a shrunk GSV, without recanalization signs. Neither major nor minor complications were reported. At the mid-thigh the standing GSV caliber decreased from a preoperative mean value of 0.6±0.2 cm to a post FS injection 0.3±0.1 cm value (P<0.05), showing no statistical difference among STS and POL. SFALT approach is feasible, safe and with potentially interesting outcomes. More investigations are needed in order to define the proper fluence parameters and the chance of eliminating the even mild sedation. This technique offers the chance of a possible tumescence free GSV treatment, even in case of major calibers vessels.