1% polidocanol endovenous microfoam (Varithena) for the treatment of chronic venous disease: A position statement from the American vein and lymphatic society.

BackgroundA variety of minimally invasive thermal and non-thermal techniques to treat superficial truncal vein reflux have been introduced over the past 2 decades. Among these has been polidocanol endovenous microfoam (PEM, VarithenaTM). This position statement reviews the clinical results of the use of PEM in chronic venous disease as well as those situations where PEM may have distinct advantages over other endovenous modalities.MethodAn expert panel of the American Vein and Lymphatic Society reviewed the literature, focusing on the clinical outcomes and unique advantages associated with the use of PEM.ResultIn vitro, ex vivo, and clinical studies have shown PEM to have greater stability and efficacy than physician compounded foam, while other studies have demonstrated saphenous closure rates and clinical outcomes similar to those achieved with thermal ablation. Despite the benefits across the spectrum of chronic venous disease, PEM may have advantages in minimizing the risk of nerve injury associated with treatment of the below knee reflux, treating venous ulcers, and managing recurrent varicose veins and difficult saphenous anatomy due to tortuosity or intraluminal synechia.ConclusionAs the only FDA approved foam sclerosant, PEM provides flexibility in treating patients with standard, variant, and recurrent venous anatomy. The American Vein and Lymphatic Society supports PEM as a safe and effective treatment option for the treatment of C2-C6 disease associated with superficial venous reflux.