Improvement of Venous Clinical Severity Score "VCSS" after Ultrasound Guided Foam Sclerotherapy "UGFS" of Incompetent Great Saphenous Vein "GSV"; 1-Year Study

Background: UGFS is considered an acceptable and widely used method for management of 1ry varicose veins. The infiltration of peri-saphenous Tumescent Local Anaesthesia (TLA) decrease the procedure related pain, and compresses the saphenous vein. The VCSS added up to the CEAP classification and is very beneficial for serial assessment and patients follow up. Aim of the work: To determine the improvement of VCSS in subjects with incompetent GSV after UGFS with the use of tumescent local anesthesia during one year follow up. Patients and methods: Between May 2018 and May 2019, 51 subjects were recruited in this study, which attended to The Vascular Surgery Department of Qena University and Assiut University Hospitals. 58 lower extremities were thoroughly examined to evaluate severity of the venous disease using CEAP classification and VCSS. All subjects were investigated by VCSS at 1,6 months and one year for follow up. Results: At 1 month, the VCSS score mean was 3.05 ± 1.5 ranging between (0-6), while at 6 months the score was 0.03 ± 0.18 ranging between (0-1). Statistically significant difference between the VCSS preoperatively and at 12 months follow up was determined as p value ≤ 0.05. Clinical recurrence was absent at 1 & 6 months post operatively. At 1 year follow up, 10 cases had recurrence with visible varicose veins. No considerable complications were happened except for 1 case of DVT during postoperative week that was treated successfully with catheter directed thrombolysis. Conclusion: UGFS is considered an efficient and reliable procedure in obliterating saphenous trunks. VCSS can be applied as a perfect tool for clinical follow up of UGFS. Adding tumescent anesthesia to increase compression of GSV need further study to show its effect and benefit to improve results of UGFS.s.