Clinical Determinants of Ultrasound-guided Sclerotherapy Outcome

BACKGROUND: Ablation of the incompetent saphenous vein may be accomplished by either surgical extirpation or ultrasound-guided sclerotherapy (UGS). Clinical guidelines for the selection of suitable candidates for UGS have yet to be established for this relatively new procedure. OBJECTIVE: To assess the effects of age, gender, and vein size on the outcome of UGS. METHODS: UGS was performed on 116 Class C2-6EPASPR limbs with duplex-confirmed saphenofemoral junctional incompetence using 1-mL injectate volumes of 3% sodium tetradecyl sulphate (STS) (15-mL maximum) and Class II compression. Treatment endpoint was persistent vasospasm observed on duplex imaging, with clinical and duplex ultrasound follow-up at 2 weeks, 6 months, and annually for 2 years. RESULTS: Statistical testing showed that only vein size affected recanalization. Age, gender, and vein size all affected the dosage required to achieve vasospasm, but not the clinical recurrence rate. Vein size was larger in males and correlated with age. CONCLUSIONS: Larger doses of STS are required to induce vasospasm in older patients, males, and those with larger veins. Regardless of gender and age, larger veins are more likely to recanalize, but are not necessarily associated with clinical recurrence. Although older patients and males tend to have larger veins, their recanalization rates are similar to younger patients and females when sufficiently higher STS doses are used to induce vasospasm. Ambulatory patients of all ages and either gender may be good candidates for UGS if vasospasm is used as the treatment endpoint. Contrary to prevailing opinion, large vein caliber is not an absolute contraindication for UGS.