Strandness Lecture: Foam Sclerotherapy's Rise and Rise Again

Honoring Doctor Strandness and Professor Bradbury

The American Venous Forum presented its memorial lecture honoring duplex ultrasound pioneer Doctor Eugene Strandness to Professor Andrew Bradbury of Birmingham, recognizing his research building the evidence base for ultrasound guided foam sclerotherapy.

From Skepticism to the English Method

Bradbury described widespread skepticism toward sclerotherapy among 1980s and 1990s vascular surgeons, a 2001 randomized trial of an early foam product, and the English method he developed with Philip Coleridge Smith, achieving high truncal occlusion rates at a median six year follow up.

Safety Evidence: VTE and Neurological Events

Early case reports raised concerns about deep vein thrombosis and rare neurological events from foam entering the cerebral circulation, but a five year safety study of 10,300 treatments found fewer than one permanent neurological event per 10,000 procedures, alongside low venous thromboembolism rates.

Randomized Evidence and Ulcer Healing

Bradbury reviewed Varithena’s FDA approval based on the Vanish trials and the EVRA trial, which found early endovenous ablation, often performed with foam sclerotherapy, significantly reduced venous ulcer recurrence and was cost effective compared with compression therapy alone.