Hemodynamic sclerotherapy in comprehensive management of varicose disease of lower-limb veins in patients with morbid obesity

Introduction. Endovenous laser ablation combined with sclerotherapy are effective treatment options for varicose veins of the lower limb. However, sclerotherapy is associated with an increased risk of side effects in patients with morbid obesity, which makes it challenging.

Aim. To improve efficiency of the varicose veins of the lower limb treatment in patients with morbid obesity by using the aspects of “hemodynamic sclerotherapy”.

Materials and methods. Prospective comparative study included 109 patients with C3–C5 classes of chronic venous diseases and morbid obesity was performed. All patients were treated with endovenous laser ablation combined with sclerotherapy. In the main group (n = 56) sclerotherapy was performed in the Trendelenburg position, in the control group (n = 53) – in the horizontal position.

Results. The diameter reduction of the great saphenous vein by 22.5% in the Trendelenburg position with 15° incline was statically significant (p < 0.001). The perforating veins reflux in the Trendelenburg position with 15° incline was not detected in 72.3% of patients (p < 0.001). The occlusion rates of the varicose tributaries not treated with sclerosant in the main group was 41% (p = 0.032). In the main group only 12.5% of patients were found to have phlebitis (p = 0.029), the Visual Analog Score (p = 0.036) and local temperature (p = 0.049) were also significantly lower. The incomplete occlusion rate of the varicose tributaries in the main group was only 5.3%; however, the difference was not statically significant.

Discussion. The perforating veins reflux in the Trendelenburg position and the incomplete occlusion of the varicose tributaries were only in obese patients with body mass index more than 55 kg/m2 and C4b–C5 classes. Conclusions. Sclerotherapy in the Trendelenburg position with the legs elevated at least 15° incline improves the efficiency of the varicose vein’s occlusion in patients with morbid obesity. Sclerotherapy in obese patients with body mass index more than 55 kg/m² has less effect.

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