Efficacy of absolute alcohol injection compared with band ligation in the eradication of esophageal varices. Re-bleeding is common during the treatment period, before all varices become eradicated. AIM: To compare two techniques of endoscopic esophageal varices eradication: sclerotherapy with absolute alcohol and banding ligation. Patients were included if they had large varices with signs of high bleeding risk. After eradication, all patients were followed up to 1 year to look for re-bleeding episodes and variceal recurrence.
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Sclerotherapy involves introducing an irritating chemical into the endothelium of diseased veins inner wall of the vein which makes contacts with the product and whose function is to seal, collapse or "dry" dilated venous channels, causing, after several sessions, reabsorption and their gradual disappearance.
The injection technique of sclerosing products or sealants to treat varicose veins has several centuries of history. In the last 50 years, we have numerous references of authors who have used different products and techniques to achieve the treatment of varicose veins without reconstruction surgery.
In , Orbach was one of the pioneers to use air injected into the vein to favour the effect of the sclerosing product. Also in , Robert Rowden Foote used a mixture of ethanolammonium oleate mixed with air, that, when agitated, created the first sclerosing foam. In Karl Sigg started to systematically use the mixture to treat large veins which had so far only been used to treat smaller caliber veins. Alongside the development of antibiotics, antisepsis, anaesthesia and the technical advances gave an important boost to the development of surgery, leaving sclerotherapy limited to a secondary role.
However, the birth of ultrasound and its application to the real-time study of venous pathology revolutionized the field of phlebology. It was in when Knight, Vin and Zygmunt were the first phlebologists who used Doppler ultrasound to monitor treatments. Schadeck in presented his experience and showed the usefulness of Doppler ultrasound to monitor the location of vessels to be treated and the direction of the sclerosing foam.
In Juan Cabrera presented the results of the application of the foam that he development with his son Juan Cabrera pharmacist. This foam was characterised by its density and high solubility given its use of a mixture of physiological gases. In Monfreux was frequently in France showing his method of creating foam and many French phlebologists have followed his teachings.
The person who maximized the popularity of using sclerosing foam comes from Lorenzo Tessari, who in published his experience using a foam which was easy to manufacture: The Tessari Method. Obviously, NO. There are many foams that can use different manufacturing methods, elements or products. The most common foam that is often used is manufactured by mixing the liquid polidocanol or sodium tetradecyl sulfate with air.
This foam can form irregular, medium size bubbles and which becomes unstable a few seconds after formation. Also, the utilization of atmospheric gas as a vehicle for the sclerosing product limits the volume of foam that can be applies in each session.
Juan Cabrera pioneered the use of a mixture of physiological gases which gave this foam higher solubility. The patent of his foam was acquired by the BTG-Varithena company and therefore this product is protected by intellectual property laws. Cabrera and his team have repeatedly shown that this is one of the most important features for secure administration.
The manufacture of different types of foam using drugs and common medications results in a high variability of foams. This product is the result of the mixture of polidocanol or sodium tetradecyl sulfate, sclerosing used for over 40 years, with a particular mixture of gases, which generate a foam with very particular physical and chemical characteristics.
It is currently applicable to any type of varicose vein, of any size, and in any location. In Dr Juan Cabrera patented a way to make foam calling it "microfoam".
It takes its name from the characteristics of bubble size which is produced by a undisclosed system which is protected by the patent owned by the British Technology Group. Currently the name Microfoam has become popular implying that the resulting foam maintains a characteristic physical stability. Ultrasound guided foam sclerotherapy is achieving results which show effectiveness and safety that match conventional surgical procedures, even though it requires a more comprehensive post-treatment monitoring.
The great advantage of this treatment compared to other methods is that foam sclerotherapy can be used for all types of varicose veins as it can be adapted to each particular situation, given the many variables that have to be considered. We can choose a certain concentration of product and decide to inject more or less volume, with more or less speed and associate different complementary techniques during the process that will help us have one result or another. Este tratamiento se puede aplicar a any type of varicose vein, of any size or location , on an outpatient basis and without any limitation to daily activities.
This treatment is also applicable to vascular malformations that were previously virtually inoperable. For the treatment to be effective and durable, it should be done in several sessions. The total number of sessions depends on each individual case. To start the treatment no fasting or any specific preparation is required.
Patients who are undergoing treatment with antiplatelet therapy aspirin, clopidogrel or similar or with anticoagulants Sintrom do not need to discontinue their treatment. Any treatment must be preceded by a medical examination which records in the medical record the patient history and all data of interest. A detailed study based on a physical exploration as well as an ultrasound Doppler study should be performed.
During this procces the patient is informed about their situation and which vein or veins are not performing correctly. Afterwards, the appropriate course of treatment is planned. If the patient needs treatment, they are asked to come back again to start the sclerotherapy sessions.
Each session requires a new ultrasound examination to plan each visit's treatment strategy. The foam injection is performed through a single virtually painless injection point. The larger the varicose veins, the less injection points are needed. While performing the injection we control the movement of a foam by means of a monitor, allowing us to direct it to where we want. In the case of spider veins or small varicose veins, given that they are thinner, multiple injection points are needed which is done by means of a small calibre needle.
Sometimes an anaesthetic spray is used to reduce discomfort. At the end of each session a compression stocking is put on and should be used in the following weeks and, depending on each individual case, the length of use could be extended or reduced.
The use of a compression stocking is an important element in obtaining good results. After the procedure, you may return a completely normal life, although vigorous exercise or sport activities is not recommended. Currently there are clinical guidelines endorsed by international scientific committees to ensure that ultrasound guided sclerotherapy with sclerosing foam is a safe technique with minimal side effects and that it has a similar effectiveness to conventional surgery for varicose vein treatment see bibliography Van de Bos.
Currently thousands of sessions of sclerotherapy are performed daily and more and more vascular surgeons are discovering the advantages of this treatment. We hope that all the information we have explained about foam sclerotherapy has resulted interesting. If you have not found what you were wanting or if you are interested in having sclerotherapy as a patient in order to eliminate varicose veins of any size, large or small, please don't hesitate in contacting us with your inquiry. Removing varicose veins with no surgery: Sclerotherapy.
In recent years, many other phlebologists and vascular surgeons have developed different methods for manufacturing foam. Specifically, Nick Morrison has demonstrated the low rate of side effects of foam made with a mixture of oxygen and CO2. These gases are diffuse and are safely dissolved in our body. See bibliography.
Since then many internationally prestigious phlebologists such as Tessari Italy , Nick Morrison USA , Guex France , Pauline Martinbeau Canada , Coleridge-Smith Great Britain , Rabe Germany have widely used sclerotherapy foams, and which have been improved in terms of homogeneity and size to achieve a similar microfoam to the one that Dr.
Cabrera patented. There is international consensus in Germany, France, Holland, Britain which are defining the role of this new therapy See bibliography. Medical visit Any treatment must be preceded by a medical examination which records in the medical record the patient history and all data of interest. Espuma esclerosante, tratamiento de la escloreterapia explicado en 4 pasos.
Value of endoscopic injection sclerotherapy in the treatment of bleeding varices
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