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
