Systematic review of foam sclerotherapy for varicose veins

Background and method: Foam sclerotherapy is a potential treatment for varicose veins. A systematic review was undertaken to assess its safety and efficacy. Results. Sixty-nine studies were included. The median rates of serious adverse events, including pulmonary embolism and deep vein thrombosis, were less than I per cent. The median rate of visual disturbance was 1.4 per cent, headache 4.2 per cent, thrombophlebitis 4.7 per cent, matting/skin staining/pigmentation 17.8 percent and pain at the site of injection 25.6 percent. The median rate of complete occlusion of treated veins was 87.0 per cent and for recurrence or development of new veins it was 8.1 per cent. Meta-analysis for complete occlusion suggests that foam sclerotherapy is less effective than surgery (relative risk (RR) 0.86 (95 per cent confidence interval (c.i.) 0-67 to 1.10)) but more effective than liquid sclerotherapy (RR 1.39 (95 percent c.i. 0.91 to 2.11)), although there was substantial heterogeneity between studies. Conclusion: Serious adverse events associated with foam sclerotherapy are rare. There is insufficient evidence to allow a meaningfull comparison of the effectiveness of this treatment with that of other minimally invasive therapies or surgery.