Foam sclerotherapy (FS) is reported to be associated with thrombosis in 1 – 4% of the cases, and systemic adverse effects occur in up to 35%. A study protocol initiated 2016 for Polidocanol-based microfoam using patient´s active foot movtion and prospective monitoring of irregular foam deposits reduced DVT to 0.11% of cases. In 2022, the protocol underwent practical updates and extension to viscous foams and large targets.

Prospective study including a total of 2780 legs in 1654 patients undergoing ultrasound – guided FS (UGFS) of saphenous veins, perforators and side branch varicosities (basis: Aethoxysklerol (POL) 1 – 3%, foam volumes 6 – 12 ml, target vein diameters 5 – 28.5 mm, mean: 8.8 mm, including primary insufficiency or recurrent varices). The new protocol: 1) All steps of UGFS are ultrasound monitored; 2) whole area scans are performed during foam injection. 3) When foam reaches the fascial level of perforators or saphenous junctions, the patient starts successive extensions and elevations of the foot (f = 12/min) to induce deep vein flow; 4) potential sites of foam accumulation undergo additional scans; 5) detected deposits are immediately flushed by more intense foot movements. 6) Foot motions are continued until end of procedures. Duplex ultrasound and clinical follow-up examinations were performed after 2 and 8 weeks and one year.

Adverse events during procedure/until week 8 were: Deep vein thrombosis (DVT): n=2 (0.07%); muscular vein thrombosis (MVT): n=9 (0.32%); visual disturbance: n=4 (< 20 min, 0.14%); chest tightness/cough: n = 4 (< 20 min., 0.14%); nausea: n=2 (< 10 min, 0.07%), transient global amnesia n=2 (< 2h, 0.07%). Anticoagulants (Apixaban 2,5 mg, 1-2/d, 1 – 5 d) were given in case of resident dystopic foam (n=124, 7.4%). The average duration of procedures remained unchanged. At one year follow-up, all cases showed target segment closure after one (92.8%) or two sessions (7.2%).

The novel protocol of exercise-assisted foam sclerotherapy (EAFS) makes a decisive contribution to a particularly good data situation for effectivity and patient safety. Comparing to the 2016 data, complications were even lower although lesions were larger and more complex. As EAFS requires no additional time or money, even saves money by saving anticoagulants, it may be recommended for use at any level of experience.