Introduction:Cutaneous necrosis followed by ulceration and formation of abscess is not a rare complication of foam sclerotherapy. As sclerotherapy reduces the surgery burden and time consuming; it became popular for destroying varicose veins. Sometimes this complication may make the post operative period unpleasant. Material & Methods:Forty three patients with varicose vein who had undergone surgery at three centers during a period of six months by same surgical team were included in the study. Intra-lesional injection of sodium tetradecyl sulphate (STS) was used for varicosities during surgery in seventeen patients of flush ligation and eight patients of EVLA (endovenous laser ablation). Foam was applied in another eleven patients of flush ligation and seven patients of EVLA one month after surgery during follow up visit. All patients were followed up for two months. Result:Among 50 patients 6 were (12%) female and 44 were (88%) male. Of the total patients, 16 (38%) were between 20 and 30 years of age, 15 (34%) were between 30 and 40 years, 8 (18%) were between 40 and 50 years, 3 (8%) were between 50 and 60 years, and only 1 (2%) were >60 years of age. With immediate sclerotherapy after flush ligation and stripping of GSV only one patient developed ulcer. None had ulcer when sclerotherapy practiced after one month of flush ligation with stripping of GSV. With immediate sclerotherapy following EVLA, three patients developed ulcer. Sclerotherapy after one month of EVLA one patient was found developed infected ulcer. In my small study I found infected skin ulceration as a common complication which occurred in both open surgery and EVLA patients. It was more common in EVLA group. It was also common when foam applied along with surgical/ EVLA procedure. Conclusion:Infected skin ulcer presented as the most common complication in cases those who had foam sclerotherapy along with EVLA. In open surgery patients, skin ulceration was also common. In both group of patients, number of skin ulceration was more when foam was applied along with surgical/ EVLA procedure in comparison to those where it was practiced after two months during follow up period. In my observation, skin ulceration was more common in EVLA patients. Further study is required to find any correlation between laser therapy and sodium tetradecyl sulphate. Also, my opinion prefers foam sclerotherapy to be avoided during operative procedure /intervention.

1. Foam sclerotherapy during varicose
vein surgery/ EVLA: should we
avoid to minimize skin infection?
SHANTONU KUMAR GHOSH
Department of Vascular Surgery
NICVD, Dhaka, Bangladesh
shantonukumarghosh@gmail.com
+8801715405567

2. Disclosure
Nothing to disclose

3. Introduction
Cutaneous necrosis followed by ulceration and
formation of abscess is not a rare complication
of foam sclerotherapy. As sclerotherapy reduces
the surgery burden and time consuming; it
became popular for destroying varicose veins.
Sometimes this complication may make the post
operative period unpleasant.

4. Material & Methods
• Forty three patients with varicose vein who had
undergone surgery at three centers during a
period of six months by same surgical team were
included in the study.
• Intra-lesional injection of sodium tetradecyl
sulphate (STS) was used for varicosities during
surgery in seventeen patients of flush ligation and
eight patients of EVLA (endovenous laser
ablation).

5. • Foam was applied in another eleven patients
of flush ligation and seven patients of EVLA
one month after surgery during follow up visit.
• All patients were followed up for two months.

6. Flush ligation of GSV at SFJ

7. EVLA Procedure

8. Result
Among 50 patients 6 were (12%) female and 44
were (88%) male.
Of the total patients, 16 (38%) were between 20
and 30 years of age, 15 (34%) were between 30
and 40 years, 8 (18%) were between 40 and 50
years, 3 (8%) were between 50 and 60 years,
and only 1 (2%) were >60 years of age.

9. With immediate sclerotherapy after flush ligation
and stripping of GSV only one patient developed
ulcer.
None had ulcer when sclerotherapy practiced
after one month of flush ligation with stripping
of GSV.

10. With immediate sclerotherapy following EVLA,
three patients developed ulcer.
Sclerotherapy after one month of EVLA one
patient was found developed infected ulcer.

11. In my small study I found infected skin
ulceration as a common complication which
occurred in both open surgery and EVLA
patients. It was more common in EVLA group. It
was also common when foam applied along
with surgical/ EVLA procedure.

12. Number of patients
Flush ligation
65%
ELVA
35%

13. Distribution of patients for foam sclerotherapy
Foam
Sclerotherapy
Flush Ligation ELVA
Immediate 17 (39.53%) 8 (18.60%)
After one
month
11 (25.58%) 7 (16.27%)

14. Number of skin ulceration
0 5 10 15 20
Flush Ligation Immediate
Flush Ligation One Month
ELVA Immediate
ELVA One Month
Varicose Vein
Ulceration

15. Infected skin ulcer presented as the most common
complication in cases those who had foam sclerotherapy
along with EVLA.
In open surgery patients, skin ulceration was also
common.
In both group of patients, number of skin ulceration was
more when foam was applied along with surgical/ EVLA
procedure in comparison to those where it was practiced
after two months during follow up period.
Conclusion

16. In my observation, skin ulceration was more
common in EVLA patients. Further study is
required to find any correlation between laser
therapy and sodium tetradecyl sulphate.
Also, my opinion prefers foam sclerotherapy to
be avoided during operative procedure
/intervention.
Conclusion

17. References
1. Smith PC. Foam and liquid sclerotherapy for varicose veins.
Phlebology 2009; 24 Suppl 1: 62-72.
2. Nael R, Rathbun S. Effectiveness of foam sclerotherapy for the
treatment of varicose veins. Vasc Med 2010 Feb; 15(1): 27-32.
3. Cavezzi A, Parsi K. Complications of foam sclerotherapy.
Phlebology 2012 Mar; 27 Suppl 1: 46-51.

18. Thank you