Fill and aspirate foam sclerotherapy (FAFS): a new approach for sclerotherapy of large superficial varicosities concomitant to endovenous laser ablation of truncal vein

•Fill and aspirate foam sclerotherapy (FAFS) is a easy and feasible alternative to the ambulatory phlebectomy for the treatment of large superficial varicose veins.•By using FAFS, foam can be prevented from passing into the deep veins.•By using FAFS, endothelium-derived biological mediators as well as the bubles are aspirated from the circulation and this may reduce systemic complications.•The DVT risk may also be decreased due to the aspiration of the pro-coagulant bloodfoam mixture.

AimTo define and assess the short-term clinical feasibility of fill and aspirate foam sclerotherapy (FAFS) for treating large superficial varicose veins concomitant to endovenous laser ablation (EVLA).Materials and methodsTwenty-seven patients who refused to have phlebectomies with great saphenous vein reflux and large superficial varicosities were included in the study. Both EVLA and FAFS were performed concomitantly. FAFS is a technique in which all or most of the bubbles and blood–foam mixture are removed from the targeted large varicose veins immediately after the foam has caused sufficient damage to the endothelial cells. Patients were reviewed 1 month and 6 months after the treatment. Improvement in the clinical, aetiological, anatomical, and pathological classification (CEAP), and clinical severity was graded using the revised venous clinical severity score (rVCSS) and cosmetic results were investigated at the 6 month visit.ResultsAblation of GSV was performed in 27 limbs in 27 patients (19 males, 70.3%; mean age 44 years; range 21–69 years). All patients had a technically successful FAFS treatment. The CEAP classification score, the rVCSS values, and the cosmetic results showed prominent improvement 6 months after the treatment. There were no significant complications, such as stroke, skin burns, necrosis, paresthesia, deep-vein thrombosis, or allergic reaction. None of the patients experienced neurological events.ConclusionFAFS is a promising safe and effective technique for treating large superficial varicosities concomitant to EVLA of the truncal veins with excellent clinical results. Randomized prospective studies with larger series are required to compare the FAFS with ambulatory phlebectomy and standard foam sclerotherapy.