Comment to: One-shot scleroembolization: a new technique for the treatment of varicose veins disease of lower extremities. Preliminary results by Viani MP, Viani GM, Sergenti J. Phlebology 2013, August 9 [Epub ahead of print].

Nine patients with reflux from the groin to the knee due incompetence of terminal and pre-terminal valves of GSV were treated. Caliber of the GSV at the SFJ ranged from 5.6 to 10 mm in standing position (mean 6.4 mm). CEAP classification was C2s, in six patients and C5 in three. An endovascular straight 5-French catheter was inserted at the knee in five patients while in the other four cases the great saphenous vein at the knee was isolated surgically. Under echography control one standard platinum coil (0.03500 Fibered Platinum Coils Boston Scientific), 1 mm wider than the caliber of sapheno-femoral junction was then placed 1 cm below the origin of the epigastric vein, causing the prompt occlusion of the terminal portion of the great saphenous vein. A foam injection with lauromacrogol 2% was successively performed through the catheter under echography control, with foam volumes ranging from 4 to 8 cc. The leg was then compressed with an eccentric elastic bandage and the patient was recommended to stay in bed for 30 min; all patients were discharged after a short medical observation (mean time 5 h), maintaining the compression till the following day and changing to stockings class I for the following 15 days. Occlusion of the great saphenous vein trunk was immediately obtained in all patients; no perioperative complications have been observed. Mean follow-up was three months, occlusion being present in 8 out of 9 patients (one was re treated with foam). No migration of coil or compression of the common femoral vein was registered at three months’ US follow-up. Costs are significantly lower when compared to other endoluminal techniques, (radiofrequency, LASER or other minimally invasive mechanical treatments), the average cost of a coil being 120 US dollars.