Abstract To evaluate the current practice of foam sclerotherapy in the USA a questionnaire was developed and distributed among the participants of the annual meeting of the American College of Phlebology (ACP) 2009. 239 participants completed the questionnaire. Four questionnaires came from non-US residents and 31 were non-users of foam sclerotherapy. According to the results more foam users came from the south-east of the USA and more non-users from the north-east. The majority of the users were surgeons, internal medicine or family doctors. The most frequent indication was recurrent varicose veins but many also reported primary treatment of varicose veins. Foam sclerotherapy in venous ulcers was another frequent indication whereas spider
the US survey of the performance of foam sclerotherapy is well in concordance with the European guidelines for sclerotherapy
veins where reported only in 7% of the foam users as an indication.
For the majority the presence of septal heart defects, patent foramen ovale and other congenital heart defects were contraindications for foam sclerotherapy. The same was true for previous neurological adverse effects. Sodium tetradecyl sulphate and polidocanol were used mainly in low concentrations. A sclerosant-to-gas ratio of 1:4 or 1:3 using the Tessari technique and room air were the most common findings. Fifty-nine percent used a maximum of up to 10 ml of foam per session whereas 41% used higher foam volumes. Echocardiographic screening prior to sclerotherapy is rare but ultrasound guidance is used by the majority during the procedure. The vast majority use compression bandages or stockings after injection with a wide variety of duration.
Commentary This is the largest survey of the use of foam sclerotherapy in the USA. However sclerotherapy of saphenous veins and non-saphenous varicose veins are not differentiated. This is a pity as the performance of saphenous veins may differ from other indications with respect to volume, concentration and ultrasound guidance.
Recently the first European evidence-based guidelines for sclerotherapy has been published and it is worthwhile to compare the recommendations there with the results of the US survey.
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