A 52-year-old female presented to the clinic with bilateral leg symptoms. She reported that her most severe symptoms were consistently tired legs that felt heavy. She had a history of bleeding varicosities in the past.
As a housekeeper, the prolonged standing for her occupation contributed to a worsening of symptoms and limited her ability to work.
Despite the use of 20-30mmHg prescription compression stockings, she only had partial relief of her symptoms and they did not stay in place during the workday.
Patient Work-up: CEAP Class 3, VCSS 16
- The patient had bilateral pitting edema from her distal thigh to her mid-calf, as well as bulging varicosities on her right anterior distal thigh to mid-calf compartment.
- Reflux on ultrasound measured >1-3 seconds from the mid-thigh through the calf in both legs. Vein diameters ranged from 3.8-6.0mm.
Treatment and Results
Varithena was chosen for this patient because thermal and tumescent options presented a risk of neuropathy, especially in her distal segments.
5cc of Varithena was administered to both the distal right thigh and calf Great Saphenous Vein (GSV) segments.
The patient returned at three and six months post-treatment for follow-ups. Changes in leg circumference reflected reductions in edema and patient symptoms.
|Segment||Initial Presentation||6 Months|
|Distal Thigh||65 cm||54 cm|
|Proximal Calf||51 cm||44 cm|
|Mid-Calf||48 cm||37 cm|
|Distal Calf||27 cm||26 cm|
The patient was not only pleased with the reduction in her symptoms post-treatment, she was able to work a full day with minimal pain and discomfort. She is pleased with the results and its impact on her work and home life.
Figure 1. Patient pre-treatment: Symptomatic, moderate edema in both legs.
Figure 2. Patient six months post-Varithena treatment. Edema had minimized and the leg continued to visually improve over the six months.
* Results from case studies are not necessarily predictive of results in other cases. Results in other cases may vary.
Varithena® (polidocanol injectable foam) is indicated for the treatment of incompetent great saphenous veins, accessory saphenous veins and visible varicosities of the great saphenous vein (GSV) system above and below the knee. Varithena® improves the symptoms of superficial venous incompetence and the appearance of visible varicosities.
Important Safety Information
The use of Varithena® is contraindicated in patients with known allergy to polidocanol and those with acute thromboembolic disease. Severe allergic reactions have been reported following administration of liquid polidocanol, including anaphylactic reactions, some of them fatal. Observe patients for at least 10 minutes following injection and be prepared to treat anaphylaxis appropriately. Intra-arterial injection or extravasation of polidocanol can cause severe necrosis, ischemia or gangrene. Patients with underlying arterial disease may be at increased risk for tissue ischemia. If intra-arterial injection of polidocanol occurs, consult a vascular surgeon immediately.Varithena® can cause venous thrombosis. Follow administration instructions closely and monitor for signs of venous thrombosis after treatment. Patients with reduced mobility, history of deep vein thrombosis or pulmonary embolism, or recent (within 3 months) major surgery, prolonged hospitalization, or pregnancy are at increased risk for developing thrombosis. The most common adverse events observed were pain/discomfort in extremity, retained coagulum, injection site hematoma or pain, common femoral vein thrombus extension, superficial thrombophlebitis, and deep vein thrombosis.Physicians administering Varithena® must be experienced with venous procedures, possess a detailed working knowledge of the use of the duplex ultrasound in venous disease and be trained in the administration of Varithena®.
See Full Prescribing Information for Varithena®