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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