Sclerotherapy of great saphenous vein: a state-of-the-art review and new perspectives

Sclerotherapy remains a cornerstone minimally invasive treatment for venous insufficiency. Injection of a sclerosing agent into a vein damages the venous endothelium, transforming the vessels into fibrous cords, a process known as sclerosis.

The introduction of detergent sclerosants and Sclerosing Foam (SF) has significantly improved this technique, particularly for large varicose veins and Great Saphenous Vein (GSV) ablation.

Ultrasound-Guided Foam Sclerotherapy (UGFS) is the recommended approach for injecting SF into the GSV. However, despite over 25 years of use, significant heterogeneity persists in SF production and injection materials, highlighting the need for improved standardisation.

The emergence of Endovenous Thermal Ablation (EVTA) techniques has shifted the treatment preference for GSV incompetence, primarily due to superior ablation rates. However, a crucial limitation of most studies is the overemphasis on ablation rates while neglecting the crucial clinical recurrence rates. Notably, randomised clinical trials have demonstrated comparable improvements in patients’ quality of life with both EVTA and UGFS, highlighting the complex interplay between ablation success and long-term clinical outcomes.

Recently, innovative hybrid techniques and medical devices have been introduced to address some of the limitations of UGFS, enhancing outcomes and promoting standardisation.

This paper reviews the latest advancements in GSV sclerotherapy and emphasises the critical need for a new perspective in comparing UGFS with EVTA techniques, prioritising patient-reported outcomes over ablation rates. Further research is crucial to assess new endpoints for evaluating different procedures during follow-up, ultimately leading to improved personalised patient care.

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