From the Guidelines
Fat closing procedure in veins, also known as endovenous chemical ablation, is a minimally invasive technique that is not recommended as the first line of treatment due to its lower occlusion rates and worse outcomes compared to endovenous laser ablation (EVLA) or radiofrequency ablation (RFA) as shown in the most recent study 1.
Overview of Fat Closing Procedure
The procedure involves injecting a solution containing local anesthetic, saline, and sometimes a sclerosing agent into the surrounding fat tissue around the targeted vein. This is typically done under ultrasound guidance to identify the problematic vein. The solution serves multiple purposes: it provides anesthesia, compresses the vein to reduce its diameter, and helps achieve better contact between the vein wall and any sclerosing agent.
Comparison with Other Treatments
Studies have shown that chemical sclerotherapy has lower occlusion rates, ranging from 72% to 89%, compared to EVLA, which has higher success rates at 1-year follow-up 2, 1. Additionally, chemical sclerotherapy has been associated with worse outcomes at 1-, 5-, and 8-year follow-ups, with higher rates of recurrent great saphenous vein reflux and saphenofemoral junction failure compared to conventional open surgery and EVLA.
Recommendations
Based on the most recent and highest quality study 1, endovenous laser ablation (EVLA) or radiofrequency ablation (RFA) is recommended as the first-line treatment for nonpregnant patients with symptomatic varicose veins and documented valvular reflux. These treatments have been shown to have higher success rates and better outcomes compared to chemical sclerotherapy. However, the choice of treatment should be individualized based on patient factors, such as the severity of symptoms, presence of comorbidities, and personal preferences.
Key Points to Consider
- Fat closing procedure in veins is a minimally invasive technique that involves injecting a solution into the surrounding fat tissue around the targeted vein.
- The procedure has lower occlusion rates and worse outcomes compared to EVLA or RFA.
- EVLA or RFA is recommended as the first-line treatment for nonpregnant patients with symptomatic varicose veins and documented valvular reflux.
- The choice of treatment should be individualized based on patient factors.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Fat Closing Procedure in Veins
There is no direct mention of a "fat closing procedure" in the provided studies. However, the studies discuss various treatments for varicose veins, including sclerotherapy, endovenous laser treatment, and radiofrequency ablation.
Sclerotherapy
- Sclerotherapy is a nonsurgical procedure that involves injecting a sclerosant into a vein to cause fibrosis and eventual obliteration of the vein 3.
- The most common sclerosants used in the U.S. include sodium tetradecyl sulfate, polidocanol, 23.4% saline, and a combination of 25% dextrose with 10% saline 3.
- Sclerotherapy can be used to treat both small and large varices of the superficial venous system and perforators 3.
Minimally Invasive Treatments
- Minimally invasive therapies, such as endovenous laser therapy, radiofrequency ablation, and foam sclerotherapy, are as safe and effective as conventional surgery for treating varicose veins 4, 5.
- These treatments have been shown to be effective in improving symptoms and cosmetic appearance, with low to moderate evidence 4.
Comparison of Sclerosants
- Studies have compared the efficacy and safety of different sclerosants, including sodium tetradecyl sulfate and polidocanol, with no significant differences in outcome or complication rates 6, 7.
- However, one study found that sclerotherapy with sodium tetradecyl sulfate led to improved cosmetic appearance compared with polidocanol, although there was no difference in symptoms 6.