Female Care

Philip Coleridge Smith DM FRCS Reader in Surgery, UCL Medical School, The Middlesex Hospital, Mortimer Street, London, W1N 8AA, UK.

The concept of foam sclerotherapy was originally introduced by Orbach in 1944 who described the use of a froth made by shaking a syringe of sclerosant with air. He found that this was 10% more effective than the sclerosant used alone.

Little was heard of this technique until Cabrera published an article in 1997 describing his experience in 261 limbs with long saphenous varices and 8 patients with vascular malformations. Some of the varicose veins reached 20 mm in diameter. He considered that foam greatly extended the range of vein sizes which could be managed by ultrasound guided sclerotherapy. He felt that the increased efficacy of foam was attributable to it displacing blood from the treated vein and increasing the contact time between the sclerosant and the vein. He used a ‘microfoam’, that is a foam made of very small bubbles. His method of preparing this foam was not published.

Subsequently a series of authors has described methods of preparing ‘home-made’ foam which may be used for ultrasound guided sclerotherapy. Monfreux described a method necessitating a glass syringe which produced small quantities of polidocanol foam which he used in a series of patients with truncal varicose veins. Sadoun described a method of preparing foam using a plastic syringe avoiding the need for reusable glass syringes.

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Evan Lipsitz, MD

Trends in the treatment of venous disease have mirrored those of arterial pathology with the development and advancement of minimally invasive technologies.

Patients with venous ulcerations or painful varicosities whose only option had previously been only traditional saphenous vein ligation and/or stripping or open perforator ligation can now be treated with a variety of endoluminal approaches. These procedures may also be combined with microphlebectomy. The goal of open and endovenous therapy is to obliterate the affected veins, thereby eliminating reflux, reducing pain, and preventing recurrence of venous ulcers

The decision as to which therapy is appropriate for any given patient depends on the patients clinical presentation, anatomy, medical co-morbidities, and treatment goals. Patients with large, tortuous varicosities and extensive reflux are best served with an open ligation and stripping. Patients with less challenging anatomy are candidates for endovenous intervention.

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What Are Varicose Veins?

Varicose veins usually announce themselves as bulging, bluish cords running just beneath the surface of your skin. They can appear anywhere in the body but most often affect legs and feet. Visible swollen and twisted veins — sometimes surrounded by patches of flooded capillaries known as spider-burst veins – are considered superficial varicose veins. Although they can be painful and disfiguring, they are usually harmless. When inflamed, they become tender to the touch and can hinder circulation to the point of causing swollen ankles, itchy skin and aching in the affected limb.

Besides a surface network of veins, your legs have an interior, or deep, venous network. On rare occasions, an interior leg vein becomes varicose. Such deep varicose veins are usually not visible, but they can cause swelling or aching throughout the leg and may be sites where blood clots can form.

Varicose veins are a relatively common condition, and for many people they are a family trait. Women are at least twice as likely as men to develop them. In the United States alone, they affect up to 60% of all Americans.

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