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Retrograde Microfoam Ablation of Superficial Venous Insufficiency

Steven T Deak, MD, PhD, FACS
Deak Vein NJ Clinic Somerset, NJ
November 15, 2017


Varicose Veins: Indications for Intervention

  • Leg aching/pain
  • Leg heaviness
  • Leg fatigue
  • Leg swelling
  • Leg itching
  • Bleeding
  • Venous ulcer
  • Atrophic blanche
  • Lipodermatosclerosis
  • General appearance
  • Superficial thrombophlebitis


  • Superficial venous disease affects 30% of the population1,2,3
  • ~1% of the population has an active (C6) venous leg ulcer (VLU)
  • Treatment of venous leg ulcers cost $14.3 Billion annually
InterventionBest UseLimitation
Surgical (Stripping, ligation, phlebectomy) Tortuous veinsMultiple incisions, time consuming, not ideal for C5-C6
Thermal AblationStraight veins, above kneeTumescence required, not ideal for tortuous veins or below knee
Non-thermal, Non-tumescent catheter-based Straight veins, above kneeNot ideal for tortuous veins or below knee
Compounded FoamTortuous veins, below kneeNot FDA-approved

Surgical and catheter-based approaches pose risk of injury to nerve, skin or muscle.

Polidocanol Injectable Microfoam 1%

FDA approved November 2013

Symptoms: Heaviness, Achiness, Swelling, Throbbing, Itching

Indications: Incompetent great saphenous veins, accessory saphenous veins, and visible varicosities of the great saphenous vein (GSV) system above and below the knee.

Tortuous, straight and large veins >3mm in diameter above and below the knee

Reflux in GSV at Sapheno-Femoral Junction greater than 500 msec

Diameter of GSV greater than 4.0 mm and up to 25.9 mm


low nitrogen content (<0.5%).*%)
microfoam that has uniform, density, size, and stability


Displaces blood, effectively filling the lumen for circumferential contact.


Residual, low-nitrogen bubbles are highly absorbable in blood and are swept away and absorbed in venous circulation.1


Achieves endothelial destruction with very low polidocanol concentration

The vein contracts, narrowing lumen until vein has almost no volume.


38-year-old with varicose veins and heavy feeling, throbbing, and swelling


GSV Reflux 1,830 msec
GSV Diameter 16.1 mm


Two weeks after treatment with 8 mL polidocanol injectable microfoam 1 %



Review of 250 Cases Varicose Veins

Retrograde administration of polidocanol injectable microfoam 1% March 2015 to June 2017

68% female

Age 30 to 95

15% older than 65

Symptoms included heaviness, aching, swelling, throbbing and itching

Patients were examined with duplex scan immediately post procedure and again 5 to 7 days after treatment.

Elimination of reflux in the GSV was achieved in 94% of patients (236/250)


CEAP Distribution

Vein Diameter (mm)

56 Patients (22%) had previous procedure prior to treatment with polidocanol injectable microfoam 1%

Previous ProcedureNumber of Patients
Surgical Stripping and Ligation. 17
EVLT Endovenous Laser Ablation 36
Venous Closure with Radiofrequency 3

Adverse Events

  • Two asymptomatic DVTs
  • One Common Femoral Vein Thrombus Extension (CFVTE)
  • Four Superficial Venous Thrombi (SVT)
  • 14 Patients (5.6%) technical failure and needed additional therapy

CEAP 6 Patient treated with polidocanol 1%




Three weeks post-treatment

CEAP 6 Ulcer Patients Treated with Polidocanol Injectable Microfoam 1%

16 patients had CEAP 6 ulcers; 6 with spontaneous bleeding and 10 with non healing ulcers. 80% of the ulcers healed in less than 1 month.

Results of 250 Cases Varicose Veins

  • Elimination of reflux in the GSV in 94 % of patients (236/250)
  • Vein diameter 8 mm +/- 2.5 mm
  • Reflux time in GSV 2,240 msec +/- 1,120 msec
  • Polidocanol volume 9.5 mL +/- 2.5 mL
  • 80% of CEAP 6 Ulcers healed in less 30 days
  • A second treatment was required in 55 patients (22%) for residual reflux in the below knee segment of the GSV


Retrograde administration of polidocanol injectable microfoam 1% is an effective treatment for superficial venous insufficiency of GSV and leg ulcers from a single remote access site.

Treatment of Venous Valvular Hypertension and Venous Valvular Reflux in CEAP 6 Ulcers

Retrograde Microfoam Chemical Ablation