Prolonged Compression Therapy Following Foam Sclerotherapy of Varicose Veins
Overview
- Phase
- Not Applicable
- Intervention
- Graduated Compression Stocking: 1 month using
- Conditions
- Chronic Venous Disorder
- Sponsor
- Pirogov Russian National Research Medical University
- Enrollment
- 140
- Locations
- 1
- Primary Endpoint
- Number of patients with hyperpigmentation at 28 days
- Status
- Active, not recruiting
- Last Updated
- 2 months ago
Overview
Brief Summary
Foam-form sclerotherapy is an effective method for eliminating varicose veins, which can be used alone or in combination with other interventions (laser or radiofrequency ablation, cyanoacrylate glue embolization) in the treatment of chronic venous disease of the lower limbs. Sclerotherapy is utilized to address both primary and recurrent varicose veins, and it is associated with a low rate of complications. Among the adverse effects, the most common is skin hyperpigmentation (darkening of the skin with the formation of stripes of shades of brown directly above the treated veins), with an occurrence rate reaching 6-53% within the first month following the procedure. Still, it resolves independently in 70% of cases within 6 months. An essential component of sclerotherapy is compression therapy through bandages or medical stockings, which helps accelerate the absorption of veins and improve the aesthetic results of treatment. Meanwhile, the optimal duration for wearing compression stockings after performing foam-form sclerotherapy of varicose tributaries has not been established.
Detailed Description
Foam-form sclerotherapy effectively eliminates varicose veins, which can be used independently or combined with trunkal ablation to treat chronic venous disease. Sclerotherapy eliminates both primary and recurrent varicosity and is associated with a low frequency of complications. Among the adverse events, the most common is skin hyperpigmentation, with a 6-53% detection rate during the first month after the procedure. However, it resolves spontaneously in 70% of cases within a follow-up period of up to 6 months. Compression therapy is currently considered a mandatory component of sclerotherapy for telangiectasias and reticular veins. Studies indicate that its use for periods ranging from 3 days to 4 months can reduce the incidence of hyperpigmentation by 1.5 to 5 times. Meanwhile, the role of elastic compression during foam-from sclerotherapy of varicose tributaries has not yet been fully clarified. According to a recent randomized controlled study CONFETTI, wearing medical compression stockings (MCS) with a pressure of 18-24 mm Hg at the ankle continuously for 7 days compared to applying a compression bandage for 24 hours was associated with a reduction in pain intensity. Still, it did not affect the severity of chronic venous disease, quality of life, time to return to normal activity, technical success of the procedure, or the frequency of bruising. However, the risk and severity of hyperpigmentation and other adverse effects were not investigated. Therefore, there is a need to determine the feasibility of prolonged use of MCS after foam-form sclerotherapy for varicose veins.
Investigators
Kirill Lobastov
Professor
Pirogov Russian National Research Medical University
Eligibility Criteria
Inclusion Criteria
- •Age over 18 years;
- •Varicose veins of the lower extremities of clinical class C2 according to CEAP (Clinical, Etiological, Anatomical, Pathophysiological) classification;
- •Scheduled foam-form sclerotherapy of varicose tributaries as an independent intervention or after trunkal ablation;
- •Absence of initial skin pigmentation, including that associated with previously performed trunk ablation;
- •Absence of indications for long-term use of compression therapy, including the clinical class of chronic venous disease C3-C6 and persistence of vein-specific symptoms;
- •Signed informed consent to participate in the study.
Exclusion Criteria
- •History of deep vein thrombosis;
- •Contraindications or restrictions to foam-form sclerotherapy;
- •Contraindications or restrictions to long-term use of compression therapy;
- •Inability or difficulty in independently putting on MCS;
- •Refusal to participate in the study.
Arms & Interventions
Group 1: MCS for 1 month
The patient will be prescribed to use medical compression stockings (MCS of class 2 of "RAL GZ 387" standard with a pressure of 23-32 mm Hf at the ankle) continuously for 7 days between the sessions and after the last session of foam-form sclerotherapy. After that, he should continue wearing the MCS during the day (put it on within 30 minutes after getting out of bed, remove it within 30 minutes before going to sleep, and wear it for at least 12 hours a day) for 28 days.
Intervention: Graduated Compression Stocking: 1 month using
Group 2: MCS for 1 week
The patient will be prescribed to use medical compression stockings (MCS of class 2 of "RAL GZ 387" standard with a pressure of 23-32 mm Hf at the ankle) continuously for 7 days between the sessions and after the last session of foam-form sclerotherapy. After that he will stop using MCS.
Intervention: Graduated Compression Stocking: 1 week using
Outcomes
Primary Outcomes
Number of patients with hyperpigmentation at 28 days
Time Frame: 28 days
Assessed by a blinded expert based on the analysis of photographic images of the legs in 4 projections (front, back, right, and left) as the presence of a linear area of skin in various shades of brown in the projection of sclerosed veins.
Secondary Outcomes
- Intensity of the hyperpigmentation at 28 days(28 days)
- Number of patients with hyperpigmentation at 6 months(6 months)
- Intensity of hyperpigmentation at 6 months(6 months)
- Intensity of spontaneous pain in the sclerosed vein at 28 days(28 days)
- Intensity of spontaneous pain in the sclerosed vein at 6 months(6 months)
- Intensity of stimulated pain in the sclerosed vein at 28 days(28 days)
- Intensity of stimulated pain in the sclerosed vein at 6 months(6 months)
- Number of patients with resorption of sclerosed veins at 6 months(6 months)
- The value of VCSS at 28 days(28 days)
- The value of VCSS at 6 months(6 months)
- The value of CIVIQ-20 score at 28 days(28 days)
- The value of CIVIQ-20 score at 6 months(6 months)
- Level of comfort with the use of MCS at 7 days(7 days)
- Level of comfort with the use of MCS at 28 days(28 days)
- Compliance with the use of MCS(28 days)
- Difference in the interface pressure below the MCS(28 days)
- Number of patients with symptomatic venous thromboembolism(6 months)
- Number of patients with phlebitis of the sclerosed vein(6 months)
- Number of patients with skin lesions(6 months)
- Number of patients with adverse events(6 months)