Venous gas embolism during foam sclerotherapy of saphenous veins despite recommended treatment modifications

Abstract

Objective To investigate the effectiveness of methods proposed to prevent venous gas embolism during foam sclerotherapy. Methods Transthoracic echocardiography was performed concurrent with ultrasound-guided sclerotherapy (UGS) of great or small saphenous veins. A volume of 2.5 mL of 3% sodium tetradecyl sulphate foam was prepared following the Tessari method and injected slowly 5–10 cm away from saphenous junctions. The procedure was repeated with modifications including using a 5 µm filter to generate microfoam, carbon dioxide as the foaming gas, leg elevation before or after the injection and immobility post-treatment. Results Bubbles entered the right heart in less than 60 seconds and continued for up to 50 minutes despite all treatment modifications. None of the patients had a patent foramen ovale and none developed any neurological or cardiac symptoms. Conclusion Bubble emboli entered the heart during foam UGS of saphenous veins despite all treatment modifications and low volumes of foam used.