Transient ischaemic attacks after sclerotherapy of the small saphenous vein

Summary

We report on the case of a 55-year-old male patient, who had a transient ischaemic attack (TIA), lasting 30 minutes, after foam sclerotherapy of the small saphenous vein. The patient had marked small saphenous varicose veins on both sides as well as varicosities of the anterior accessory saphenous vein in the left leg. CEAP classification was stage 3 on both sides.

The patient had a history of chronic atrial fibrillation with severe sick sinus syndrome and was on therapeutic anticoagulation. He also had dilated cardiomyopathy with an ejection fraction of only 35 %. Following two unremarkable sessions of foam sclerotherapy with 0.5 % foamed polidocanol applied to the anterior accessory saphenous vein, the patient had a transient ischaemic attack shortly after completion of the third session, in which the small saphenous vein was treated, likewise with foam sclero-therapy with 0.5 % foamed polidocanol. He experienced weakness of the left leg, reduced strength in the left hand and numbness in both limbs on the left side. The symptoms resolved completely within 30 minutes. A cardiology work-up prior to the intervention excluded the presence of a patent foramen ovale or intra-cardiac thrombi. Carotid artery stenosis was ruled out as the cause of the TIA by colour duplex ultrasonography. As ECG monitoring after the occurrence of the TIA showed that the heart rhythm remained stable, without any bradycardia or long pauses, we assume that the foam sclerotherapy was the cause of the TIA, even though a cardiac cause cannot be ruled out with absolute certainty.

Keywords

Foamsclerotherapy - transient neurologic deficit - cardiac dysfunction

• Literatur

• 1 Noppeney T, Kluess HG, Breu FX, Ehresmann U, Gerlach HE, Hermanns H-J, Nüllen H, Pannier F, Salzmann G, Schimmelpfennig L, Schmedt C- G. Steckmeier B. Leitlinie zur Diagnostik und Therapie des Krampfaderleidens. Gefäßchirurgie 2010; 15: 523-541.
• 2 Rabe E, Pannier E, Gerlach H, Breu FX, Guggenbichler S, Wollmann JC. Leitlinie zur Sklerosierungsbehandlung der Varikose. Phlebologie 2008; 37: 27-34.
• 3 Breu FX, Guggenbichler S, Wollmann JC. 2nd European Consensus Meeting on Foam Sclerotherapy, 28-30 April 2006,Tegernsee, Germany. Vasa 2008; 37 (Suppl. 71) 1-32.
• 4 Sarvananthan T, Shepherd AC, Willenberg T, Davies AH. Neurological complications of sclerotherapy for varicose veins. J Vasc Surg 2012; 55 (01) 243-251.
• 5 Regan JD, Gilbson KD, Rush JE, Shortell CK, Hirsch SA, Wright DD. Clinical significance of cerebrovascular gas emboli during polidocnol endovenous ultra-low nitrogen microoam ablation an correlation with magnetic resonane in patients with right-to-left shunt. J Vasc Surg 2011; 53 (01) 131-137.