Neurological complications of sclerotherapy for varicose veins

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248 Sarvananthan et al Table II. Overview of cohort and randomized studies reporting neurological complications following foam sclerotherapy First Author Year Bergan 35 Bhogal 36 Bradbury 37 Cabrera 38 Cabrera 39 Cavezzi 40 Ceulen 41 Chapman 42 Darke 43 Demagny 19 Frullini 44 Frullini 45 Gillet 46 Gillet 47 Kern 20 Morrison 48 Myers 49 Neuhardt 23 Ouvry 21 Park 50 Raymond- Martimbeau 51 Reich- Schupke 52 Smith 53 Tessari 54 Wright 22 Yamaki 55 Type of study Total patients Type of vein avoiding maneuvers such as bending over to put on shoes or compression stockings and remaining supine following injection of foam 33 for approximately 5 minutes may reduce the risk. In the majority of studies evaluated in this review, details of such activities are infrequently published, making it difficult for the authors to comment as to whether this contributed to any of the side effects reported. Further studies to support this hypothesis are awaited, Foam used Liquid used Technique JOURNAL OF VASCULAR SURGERY January 2012 Volume of foam (cm3) Concentration of sclerosant (%) 2006 PR 293 GSV, P, V 293 0 Tessari 5-10 mL 1-3 2008 PA 112 — 112 0 U 10-17 mL U 2010 PR 977 GSV, SSV, AASV 1252 legs 0 Tessari 4-8 mL 1-3 2004 RR 116 GSV, SSV, P 116 0 U 1-30 mL 0.27-1 2001 RR 783 GSV V 783 0 U 10-20 mL 0.25-3 2002 PR 194 75 V, 15 R, 11 AASV, 33 SSV, 43 GSV, 17 P 194 0 Tessari 2.9 mL 0.2 2008 C 35 U 35 0 U 5 mL 1 2009 PR 146 146 GSV 146 0 Tessari 7.3 mL 3 2006 PR 181 115 GSV, 28 SSV, 77 other 181 0 Tessari 14 mL 1 2002 PRT 254 GVS V 200 veins 200 veins U 2 mL 1.5-3 2002 RR 453 337 large veins 257 196 257 Monfreux U U 116 small varicosities 196 Tessari 2000 RR U GSV, SSV, V 595 veins 0 Frullini U U 2010 PR 20 GSV n 7, SSV 20 0 DSS 5.60 2.77 mL 0.5-3 n 2, AASV Sterivein n 4,Vn 10,Rn 5, Pn 1 device 2009 PR 1025 818 GSV 207 SSV 1025 0 Tessari/DSS 4.5 mL 0.5-3 2004 PRT 150 150 RV SV 51 99 Monfreux 10 mL 100 CRO 0.25 POL 2008 PR 177 GSV, SSV, V 177 0 Tessari 6-57 mL 1 2007 PR 489 453 GSV U Tessari 3-40 mL 0.6-3 foam 174 SSV 3 liquid 2008 PA 75 U 100 0 Tessari 4-35 mL 1-3 2008 PRT 95 95 GSV 47 48 DSS 2-2.5 mL 3 2009 PR 312 437 GSV/SSV 312 0 Tessari 2-13 mL 3 2009 PR 3259 GSV, SSV, V 3259 0 Raymond- Martimbeau 0.5-8 mL 0.5-3 2010 PR 76 V 110 legs 0 Tessari 1-2 mL 0.5 2006 PR 808 1109 GSV 808 0 Tessari 20 mL 1-3 STD SSV 1 POL 2001 PR 77 24 GSV/SSV 30 V 23 RV/SV 77 0 Tessari 1-8 mL 0.1-3 2006 PRT 562 GSV, SSV 552 10 U 30 mL 1 9.8 mL 0.5-3 2009 PRT 107 107 GSV 107 0 Tessari 0.7-4 mL 1-3 AASV, Anterior accessory saphenous vein; ASD, atrial septal defect; C, correspondence; CRO, chromated glycerin; CVA, cerebrovascular accident; GSV, great saphenous vein; mL, milliliters; NA, not applicable; P, perforating vein; PA, published abstract; PFO, patent foramen ovale; POL, polydocanol; PR, prospective cohort study; PRT, prospective randomized trial; R, reticular vein; RR, retrospective cohort study; SSV, small saphenous vein; STS, sodium-tetradecyl sulphate; TIA, transient ischemic attack; U, unknown/unspecified; V, varices/varicosities/tributaries. although it is important to note the contrast between the relatively high prevalence of PFO in general population (up to 25%) 34 and the exceedingly low incidence of neurological complications after foam sclerotherapy. It is, therefore, highly likely that additional factors are involved, and, in view of these data, the authors feel unable to justify the routine investigation of all patients for a cardiac defect prior to sclerotherapy, which would be impractical.
JOURNAL OF VASCULAR SURGERY Volume 55, Number 1 Sarvananthan et al 249 Table II. Continued Ratio of liquid: air Type of gas Sclerosant Neurological symptoms/disturbances Air O 2 CO 2 STS POL CG Migraine Headache Visual Speech TIA CVA 1:4 293 0 0 0 34 0 0 0 3 0 0 0 U U U — U U 0 0 1 0 0 0 U 1:4 977 0 0 977 0 0 0 3 5 0 0 0 U U 0 0 116 0 116 0 0 0 2 0 0 0 U U 783 0 0 Lauromacrogol 400 0 0 8 0 0 0 U 1:4/5 194 0 0 194 0 0 0 0 1 0 0 0 U It has also been suggested that the solubility of the gas used to create the foam may have an effect on the complications observed. The replacement of air mixture, containing high percentages of relatively insoluble nitrogen with carbon dioxide, which is highly soluble, has been shown to reduce side effects such as dizziness and chest tightness, but no statistically significant reduction was noted in the occurrence of visual disturbances or other neurological side effects. 35 Cardiac defect 1:4 35 0 0 0 35 0 1 0 1 0 0 0 7 PFO 1:3 146 0 0 146 0 0 2 0 0 0 0 0 U 1:3 181 0 0 0 181 0 1 0 2 0 0 0 U 1:4 200 — 0 400 0 0 0 0 0 0 5 0 U U 453 0 0 363 90 0 0 0 4 0 0 0 U 1:2 595 U U 387 208 0 0 0 2 0 0 0 U 1:4-1:8 20 0 0 1 19 0 10 10 20 1 0 0 U 1:1-1:5 953 72 0 94 931 0 8 0 7 0 1 0 1 PFO 1:4 150 0 0 0 99 51 0 0 3 0 0 0 U 1:4 49 0 128 0 177 0 0 0 8 0 0 0 U 2:3 489 0 0 Both 0 0 0 3 0 0 0 U U 100 0 0 0 100 0 7% U 0 0 U 1:4 95 0 0 0 95 0 0 1 0 0 0 0 U 1:5 312 0 0 0 437 0 0 2 1 0 0 0 U 1:4 3259 0 0 3259 0 0 4 0 2 0 0 0 5 PFO 1:5 110 0 0 0 110 0 1 1 0 0 0 0 U 1:3 808 0 0 1000 149 0 0 0 14 0 0 0 U 1:4 77 0 0 77 0 0 0 0 2 0 0 0 U U 437 Varisolve, 64 STD, 61 POL 64 498 0 0 62 6 U 0 0 U 0 1:4 107 0 0 0 112 0 2 0 0 0 0 0 2 The true incidence of neurological complications following sclerotherapy remains unknown and is subject to significant reporting bias. The authors also acknowledge that in some of the articles included in this review, important details regarding the nature of treatment provision, the neurological side effects experienced, and cranial or cardiac imaging are omitted from publications, making it difficult to interpret the relationship between neurological side effects and different sclerotherapy regimes.
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Neurological complications of sclerotherapy for varicose veins

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