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Grey-scale Median (gsm) And Other Predictors Of Successful Sclerothrombus Aspiration Following Foam Sclerotherapy
Natalie Marks, MD, Anil Hingorani, MD, Enrico Ascher, MD.
NYU Lutheran Medical Center, Brooklyn, NY, USA.

Objective(s): Foam sclerotherapy is often associated with the formation of a tender and painful sclerothrombus. Drainage of this thrombus improves overall symptoms but it requires painful needle aspirations. These aspirations can fail to drain the sclerothrombus in up to 50% of the patients even when one awaits the recommended 3-5 weeks post-sclerotherapy. To improve the success rate of needle aspiration we analyzed the role of sclerothrombus GSM and other potential predictors including vein diameter and timing of aspiration.
Methods: Thirthy-five symptomatic patients (27 females; 8 males) with mean age 51.5 years±13.7) underwent 47 duplex guided sclerothrombus aspiration procedures between 13 and 114 days (mean 43 days ±21.5) after foam sclerotherapy over a 5 months period. Using B-mode duplex images, we measured vein diameters (1.6mm to 12 mm, mean 4.6±2 mm) and quantified sclerothrombus GSM (Photoshop®) for 120 target venous segments (13 to 38, mean 25.7±4.8).
Results: Complete aspiration of sclerothrombus occurred in 83 segments (69%, Group I), partial aspiration in 22 cases (18%, Group II) and failed aspiration in 15 cases (13%, Group III).
The mean GSM for Group I was 24.2 ± 4 and it was significantly lower as compared to the one obtained for Group II (29 ± 4.4, p<0.0001) and Group III (29.8 ± 5.9, p<0.0001).
Mean diameter of the drained veins in Group I (4.1 ± 1.7 mm) was significantly smaller as compared to Group II (5.2 ± 2.3 mm, p=0.03) and Group III (6.5 ± 2 mm, p<0.0001).
However, there was no statistically significant difference in the mean interval time from sclerotherapy to needle aspiration among the 3 groups. It was 41.5 ± 21.8 days for Group I as compared to Group II (51.3 ± 19.6 days, p = 0.06) and Group III (42.5 ± 21 days, p=0.87).

Conclusions: These data show that GSM of the sclerothrombus and vein diameter are reliable predictors of successful aspiration. Contrary to previous belief the time interval between foam sclerotherapy and sclerothrombus aspiration was not a significant indicator of successful aspiration.

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