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OBJECTIVE: We compared the effectiveness and safety of polidocanol 1% endovenous microfoam ablation vs endovenous thermal ablation with radiofrequency or laser energy for treatment of venous insufficiency caused by lower extremity truncal vein incompetence via network meta-analysis of published comparative evidence. METHODS: We conducted a systematic literature review following best practices, including a prospective protocol. We screened studies published in English from 2000 to 2023 for randomized and nonrandomized studies reporting direct or indirect comparisons between polidocanol 1% endovenous microfoam and endovenous thermal ablation. Thirteen studies met our eligibility criteria for the network meta-analysis. The co-primary effectiveness outcomes were the closure rate ≥3 months after procedure and the average change in the Venous Clinical Severity Score. For the subgroup of venous ulcer patients, the ulcer healing rate was the primary effectiveness outcome. The secondary outcomes included safety and patient-reported outcomes. Network meta-analyses were conducted on outcomes having sufficient data. Categorical outcomes were summarized using odds ratios (ORs) with 95% confidence intervals (CIs). Sensitivity tests and estimates of network inconsistency were used to investigate the robustness of our meta-analysis. RESULTS: We found that polidocanol 1% endovenous microfoam was not significantly different statistically from endovenous thermal ablation for venous closure (OR, 0.65; 95% CI, 0.36-1.18; P = .16). Although not the primary aim of the study, the network meta-analysis also provided evidence to confirm our supposition that polidocanol 1% endovenous microfoam was significantly differentiated statistically from physician-compounded foam, with higher odds for vein closure (OR, 2.91; 95% CI, 1.58-5.37; P < .01). A sensitivity analysis using the longest available time point for closure in each study, with a minimum of 12 months of follow-up (median, 48 months; range, 12-72 months), showed results similar to those of the main analysis. No association was found between the risk of deep vein thrombosis and the treatment received. The available data were insufficient for a network meta-analysis of Venous Clinical Severity Score improvement and ulcer healing rates. CONCLUSIONS: Polidocanol 1% endovenous microfoam was not significantly different statistically from endovenous thermal ablation for venous closure and deep vein thrombosis risk for chronic venous insufficiency treatment, based on a network meta-analysis of published evidence. Polidocanol 1% endovenous microfoam was significantly differentiated statistically from physician-compounded foam, with higher odds of vein closure. A sensitivity analysis found venous closure findings were robust at follow-up intervals of 12 months or greater and for up to 6 years. New evidence meeting the inclusion criteria for this review will be incorporated at regular intervals into a living network meta-analysis.

Background: The foam's structural longevity, linked to the effectiveness of sclerotherapy, depends on preparation conditions. The factors enhancing the treatment's effectiveness and efficacy are still under discussion. Methods: We conducted an in vitro preclinical research, which included 144 independent trials. A total of 8 combinations involving 18 trials were designed according to settings of +4°C and room temperature (20–22°C), liquid‐to‐air ratios of 1/1 and 1/4, and polidocanol concentrations of 0.5% and 1% using the modified Tessari method. Our study aimed to examine the effect of air ratio, agent temperature, and polidocanol concentration on stability by assessing the foam half‐time (FHT) and defining the optimal preparation conditions. Results: The mean FHT was 117 ± 30.4 s. The longest FHT was in a 1:4 air‐to‐sclerosant ratio at +4°C, regardless of the sclerosant concentration (for %0.5 mean FHT: 146.2 ± 13.9 s, for % 1 mean FHT: 146.9 ± 18 s). There was a significant interaction among the three variables on FHT (p = 0.001). Temperature emerged as the primary factor (F(1, 136) = 124, p < 0.001, ηp2 = 0.477), with lower temperatures markedly enhancing the longevity (p < 0.001). Preparation at a temperature of 4°C resulted in an extended FHT of 32.5 s compared to 22°C (95% CI: 24.06–41.04 s). Conclusion: The temperature, agent concentration, and gas ratio significantly influence the stability of the physician‐compounded foam. The low temperature at +4°C may offer better FHT for sclerotherapy. [ABSTRACT FROM AUTHOR]

Chronic varicose veins disease is widespread worldwide (up to 60% in the adult population), with a significant impact on patients' quality of life and a high cost to society, both due to treatment and the limitation of physical activity imposed by the disease. This article presents a retrospective study on a number of 14 patients treated in Arestetic Clinic in Galati, for a period of one year. The patients included in the study presented reticular and varicose veins up to 6 mm in diameter and under 14 mm on the saphenous vein. Patients completed the Aberdeen Varicose Disease Questionnaire (excluding the first part of the questionnaire) and the Venous Clinical Severity Score was used by the physician. Doppler ultrasound was used for preoperative evaluation and postoperative monitoring. Polidocanol was administered in concentrations of 0.5% and 2%, with the patients being monitored one year after treatment. All patients were declared satisfied with the results and 1 year after treatment no recurrences were found. Polidocanol sclerotherapy is a safe, easy-to-administer, low-cost treatment with no healing time and can be administered multiple times if needed, with minimal risks of complications. Aesthetic results are good, with an important symptom remission rate and high patient satisfaction. Complications were rare and minor (represented by local hyperpigmentation and hardening of the injected path), and the recurrence rate is comparable to surgical treatment.

A comparative analysis of morphological and functional changes in the adrenal glands after embolization of supplying arteries with Lifepearl microspheres (100±25 μm; Terumo) and with a solution of polidocanol (Aethoxysklerol, Kreussler Pharma) was performed in male Vietnamese Lop-Bellied pigs (n=20). The introduction of the microspheres into the arterial bed did not affect the adrenal parenchyma. However, the injection of the liquid sclerosing agent caused foci of productive inflammation leading to the formation of sclerotic tissue and reduction of the volume of glandular tissue. Administration of the sclerosant was accompanied by arterial hypotension, an indirect indication of a decrease in vasoactive hormone production by the adrenal cortex. These findings suggest that polidocanol can be used as an embolization agent for hyperplastic diseases of the adrenal cortex. [ABSTRACT FROM AUTHOR]

Plantar warts are common skin lesions that continue to represent a therapeutic challenge. They are still resistant to therapy and are highly recurrent, despite the diverse number of treatments available. Therapies targeting vasculature, such as pulsed dye laser, have been used successfully in the treatment of plantar warts. Polidocanol, a detergent sclerosant approved for the sclerotherapy of incompetent and dilated saphenous veins, has also been used as an off-label therapy for a wide range of skin conditions with vascular components such as hemangiomas and pyogenic granuloma. The current, open-label, prospective, pilot study aimed to evaluate the safety and efficacy of the intralesional polidocanol 3% in the treatment of plantar warts. Twenty patients (11 females and 9 males), with plantar warts, aged 12–50 years received biweekly sessions of intralesional polidocanol 3% until complete clearance or for a maximum of 6 sessions. Response to treatment was graded as complete (100% clearance), partial (50–99%), and no response (< 50%). At the end of the study, 12 (60%) patients achieved complete clearance of their warts after 1–5 sessions, 5 (25%) patients had only partial response, and 3 (15%) patients did not achieve any clearance of their warts. The procedure was largely tolerable by patients. Pain at the injection site and bruises were reported by 9 (45%) and 2 (10%) patients, respectively. Both side effects resolved spontaneously and completely within a few days. The findings of the current study suggest that intralesional injection of 3% polidocanol in biweekly sessions may be a safe, effective, and tolerable method for the treatment of plantar warts. [ABSTRACT FROM AUTHOR]

Objectives: The catheter-directed foam sclerotherapy (FS) and the suggested perivenous tumescent application for great saphenous vein (GSV) diameter reduction are suggested to improve technical and clinical results; yet, their use is reported rather indiscriminately. Our aim is to introduce an algorithm categorising the use of technical modalities accompanying ultrasound-guided FS of the GSV and present the technical efficacy of FS through a 5 F × 11 cm sheath placed at the knee level. Methods: Representative cases of GSV insufficiency were chosen to describe our methodology. Results: Sole sheath-directed FS can achieve complete GSV occlusion proximally at a level comparable to the catheter-directed technique. We apply perivenous 4°C cold tumescent to GSV >6 mm even in the standing position to ensure diameter reduction of the proximal GSV as close to the saphenofemoral junction. We use long catheters only to overcome large varicosities above the knee level that could otherwise compromise the adequate foam infusion from the sheath tip. When GSV insufficiency extends along the entire limb and severe skin lesions preclude the antegrade distal catheterisation, the sheath-directed FS in the thigh can be concomitantly combined with retrograde FS from catheterisation just below the knee. Conclusions: A topology-oriented methodology with sheath-directed FS is technically feasible and avoids indiscriminate use of more complex modalities. [ABSTRACT FROM AUTHOR]

Chronic varicose veins disease is widespread worldwide (up to 60% in the adult population), with a significant impact on patients' quality of life and a high cost to society, both due to treatment and the limitation of physical activity imposed by the disease. This article presents a retrospective study on a number of 14 patients treated in Arestetic Clinic in Galati, for a period of one year. The patients included in the study presented reticular and varicose veins up to 6 mm in diameter and under 14 mm on the saphenous vein. Patients completed the Aberdeen Varicose Disease Questionnaire (excluding the first part of the questionnaire) and the Venous Clinical Severity Score was used by the physician. Doppler ultrasound was used for preoperative evaluation and postoperative monitoring. Polidocanol was administered in concentrations of 0.5% and 2%, with the patients being monitored one year after treatment. All patients were declared satisfied with the results and 1 year after treatment no recurrences were found. Polidocanol sclerotherapy is a safe, easy-to-administer, low-cost treatment with no healing time and can be administered multiple times if needed, with minimal risks of complications. Aesthetic results are good, with an important symptom remission rate and high patient satisfaction. Complications were rare and minor (represented by local hyperpigmentation and hardening of the injected path), and the recurrence rate is comparable to surgical treatment. [ABSTRACT FROM AUTHOR]

Background: Although sclerotherapy is widely used to treat vascular malformations (VMs), it is associated with several challenges. One significant issue is the insufficient understanding of the influence of various factors on the stability of polidocanol (POL) foam used in sclerotherapy. Objective: This study aimed to explore the effect of the catheter needle caliber on foam stability when using POL with or without hyaluronic acid (HA) for the treatment of VMs. Methods and materials: The Tessari method generated sclerosant foam using POL both with and without HA. We used catheters and syringe needles of various calibers, and the resulting foam was transferred into new syringes to facilitate a comparison of foam stability. Foam half-life (FHT) was utilized as a metric to assess foam stability. Results: The study found that narrower needle calibers produced a more stable foam when POL was used alone; however, no significant effect was observed when HA was added. Furthermore, when the foam was expelled using catheters and syringe needles of the same size, no noticeable changes in the stability were observed. Conclusion: When choosing needles of varying calibers, their effect on foam stability should be carefully considered, particularly when the foam contains HA. [ABSTRACT FROM AUTHOR]

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Background: Percutaneous treatment for primary aneurysmal bone cysts (ABCs) has been widely accepted. The study aimed to evaluate the efficacy of various sclerotherapy agents on patients with primary ABCs. Methods: A meta-analysis of relevant studies. A systematic search was conducted on five databases, resulting in the inclusion of 25 studies with different percutaneous agents. Results: A total of 729 patients with primary ABCs were included. Patients were administered with Ethibloc, doxycycline, embolization, alcohol, polidocanol, and calcitonin with methylprednisolone, respectively. Overall, 542 (74.3%) patients with ABCs had complete healing, 120 (16.4%) had partial healing, 44 (6%) had no-ossification or failure, and 26 (3.5%) had a recurrence. However, there was a total of 45 (6.1%) patients who had surgical curettage after sclerotherapy. Among the sclerotherapy agents, doxycycline showed highly effective results with minimal complications and recurrence, but it required multiple injections per patient. Ethibloc and embolization also proved to be highly effective with fewer injections required but had a higher rate of complications. Absolute alcohol, polidocanol, and calcitonin with methylprednisolone had similar efficacity and favorable success with fewer complications and fewer injections. Conclusion: Percutaneous treatment showed promising results in treating primary ABCs. However, more robust research is needed to establish the best approach for sclerotherapy in clinical practice and to address the limitations of the current literature. [ABSTRACT FROM AUTHOR]

Polidocanol sclerotherapy in the treatment of aneurysmal bone cysts (ABCs) with or without pathological fractures has been a topic of debate. While some studies recommend intralesional curettage as the preferred treatment, others suggest intralesional sclerosants as an effective alternative. This study evaluates the use of polidocanol-based percutaneous sclerosant therapy in 28 patients with ABCs, of which 8 patients had pathological fracture. The patients received injections every four weeks based on clinical and radiological evaluation of the cyst, and the study assessed the results and complications of the treatment. In group A (without pathological fractures), 14 out of 17 (82.4 %) lesions healed without any significant residual lesion. Three out of 17 (17.6 %) patients required further surgical intervention and were treated by curettage and bone grafting, definitively. Minor local inflammatory reaction was observed in 3 patients, which resolved without intervention within 3–4 days. In group B, all the 8 patients (100 %) with pathological fracture in their lesions healed as Grade 1 healing, without any significant residual lesion. One patient developed an episode of anesthesia related complication (delayed recovery) which resolved within an hour, without any residual effect. At final follow up, no recurrence was seen in any patient. The study concludes that polidocanol sclerotherapy is an effective treatment option for patients with ABCs, with or without pathological fractures, and has the potential to become the new treatment of choice for pathological fractures due to its low invasiveness, low morbidity, and affordability. However, further research is needed to confirm the efficacy of polidocanol sclerotherapy in larger patient populations and to compare its effectiveness with other treatment options. [ABSTRACT FROM AUTHOR]

BackgroundAlthough sclerotherapy is widely used to treat vascular malformations (VMs), it is associated with several challenges. One significant issue is the insufficient understanding of the influence of various factors on the stability of polidocanol (POL) foam used in sclerotherapy.ObjectiveThis study aimed to explore the effect of the catheter needle caliber on foam stability when using POL with or without hyaluronic acid (HA) for the treatment of VMs.Methods and materialsThe Tessari method generated sclerosant foam using POL both with and without HA. We used catheters and syringe needles of various calibers, and the resulting foam was transferred into new syringes to facilitate a comparison of foam stability. Foam half-life (FHT) was utilized as a metric to assess foam stability.ResultsThe study found that narrower needle calibers produced a more stable foam when POL was used alone; however, no significant effect was observed when HA was added. Furthermore, when the foam was expelled using catheters and syringe needles of the same size, no noticeable changes in the stability were observed.ConclusionWhen choosing needles of varying calibers, their effect on foam stability should be carefully considered, particularly when the foam contains HA.

The standard treatment for aneurysmal bone cyst is bone curettage and grafting which was associated with high morbidity. Hence sclerotherapy came as alternative therapy, which minimally invasive hence came to popularity. This study aims to find out the radiological outcome of aneurysmal bone cyst with sclerotherapy with polidocanol. Methods: 31 patients who were diagnosed with aneurysmal bone cyst underwent sclerotherapy with polidocanol with follow-up for 2 years. We assessed time to healing and recurrence, pain relief, and radiological outcome using modified Neer's criteria for the radiological healing of the bone cysts. Result: At last follow-up, 100% had achieved complete healing. Complications were injection site necrosis, pain and hypopigmentation, all of which resolved spontaneously. Conclusions: Sclerotherapy by using polidocanol is a safe treatment option which was effective, less cost expense, good cosmetics, reduced morbidity, can do as day care procedure. Local complications due to extravasation which will reduce spontaneously. [ABSTRACT FROM AUTHOR]

Venous malformations are a vascular disorder. Currently, the use of chemical sclerosing agents is a common clinical approach for the treatment of venous malformations. However, the effectiveness of existing sclerosing agents is unsatisfactory and often accompanied by severe side effects. In this study, we have developed a novel cationic surfactant-based sclerosing agent (POL-TA) by conjugating the plasmin inhibitor tranexamic acid (TA) with a nonionic surfactant polidocanol (POL) through an ester bond. POL-TA induces endothelial cell damage, triggering the coagulation cascade and thrombus formation. Moreover, it releases TA in vivo, which inhibits plasmin activity and the activation of matrix metalloproteinase (MMPs), thereby stabilizing the fibrin network of the thrombus and promoting vascular fibrosis. We have established a cell model using venous malformation endothelial cells and assessed the cellular damage and underlying mechanisms of POL-TA. The inhibitory effects of POL-TA on the plasmin-MMPs system were evaluated using MMP-9 activity assay kit. Additionally, the mice tail vein model was employed to investigate the vascular sclerosing effects and mechanisms of POL-TA. • A cationic surfactant-based sclerosing agent (POL-TA) created by conjugating the tranexamic acid (TA) with polidocanol (POL). • POL-TA induces endothelial cell damage, triggering the coagulation cascade. POL-TA releases TA , which inhibits plasmin activity and the activation of MMPs. • The inhibitory effect of TA on the plasmin-MMPs system significantly enhances collagen expression and fibroblast proliferation. [ABSTRACT FROM AUTHOR]

Background: To investigate the difference in the effect of ultrasound-guided puncture injection of polidocanol (PO) and ethanol (ET) in the treatment of renal and hepatic cysts (RHC), and to analyze the factors related to patients' prognosis of disease recurrence. Materials and Methods: A total of 105 patients with RHC admitted to our hospital from August 2020 to August 2021. Among them, 59 patients received ultrasound-guided puncture injection of ET (control group); the rest 46 received ultrasound-guided puncture injection of PO (observation grou). The success rate of one-time puncture and adverse reactions of the two groups were counted, and the levels of C-reactive protein (CRP), Cortisol (Cor), liver and kidney function. Patients were then followed up for a one-year prognosis, and the prognosis of RHC recurrence was recorded. Logistic regression analysis was performed to analyze the factors associated with the recurrence of cysts. Results: Postoperative CRP and Cor were observed to be lower than those in the control group, and hepatic and renal function was better than that in the control group (P<0.05). In addition, the incidence of adverse reactions was lower in the observation group than in group B (P<0.05). Cyst diameter, incomplete cyst aspiration, and post-sclerotic segregation were high-risk independent factors affecting prognostic cyst recurrence (P<0.05). Conclusion: Ultrasound-guided injection of PO puncture sclerosis for RHC has excellent results. At the same time, patients need to be concerned about the diameter of the cyst, incomplete aspiration of the cystic fluid, and whether the cyst is separated after sclerosis. [ABSTRACT FROM AUTHOR]

To assess the safety and efficacy of available interventions in the treatment of lower limb reticular veins and telangiectasias. An electronic search was performed on Scopus, Embase, and Google scholar. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Following data extraction and processing, a Bayesian network meta-analysis and meta-regression was undertaken. The primary endpoint was telangiectasia and reticular vein clearance. Nineteen studies, 16 randomised controlled trials and three prospective case series, including 1 356 patients and 2 051 procedures, were finally incorporated. All interventions, apart from 0.5% sodium tetradecyl sulphate (STS) and 0.25% STS displayed statistically significantly superior telangiectasia and reticular vein clearance compared with normal saline (N/S), Meta-regression analysis employing the type of the venule treated (telangiectasia or reticular vein) as a covariable, revealed a positive correlation between Nd:YAG 1064 nm laser and telangiectasia clearance (β = 1.38, 95% CI 0.56 – 2.14). Further exploration unveiled the superiority of Nd:YAG 1064 nm in the treatment of telangiectasias compared with all included interventions except 72% chromated glycerin (CG). STS 0.25% increased the risk of hyperpigmentation compared with all interventions except 0.5% STS, and 1% polidocanol. CG 72% decreased the risk of matting compared with polidocanol foam (risk ratio [RR] 0.14, 95% CI 0.02 – 0.80) and STS (RR 0.31, 95% CI 0.07 – 0.92). Non-statistically significant differences were identified between interventions regarding pain outcomes. This network meta-analysis has demonstrated a proportional relationship between sclerosant potency and side effect occurrence in the treatment of telangiectasias and reticular veins and the superiority of laser therapy compared with injection sclerotherapy in treating telangiectasias. The transition of telangiectasia and reticular vein treatment from highly potent detergent solutions to equally effective but milder sclerosants could potentially reduce undesirable adverse events. [ABSTRACT FROM AUTHOR]

Background: Vascular malformations are birth defects that happen when different stages of angiogenesis shut down. 44 - 64% of all vascular malformations are venous malformations [VMs]. Sclerotherapy is the first treatment line for VMs. It acts by getting rid of the vascular endothelial cells in the lesion. One of the most common sclerosing agents for VMs is polidocanol, which is a popular counterpart for concentrated ethanol.Aim of the work: This study aims to evaluate the efficacy of Ethanol in comparison to polidocanol foam sclerotherapy in the treatment of venous malformation.Patients and Methods: This prospective interventional study included 20 patients with VM that operated at the department of surgery of Al-Azhar University Hospitals, New Damietta and International Medical Center, Cairo, Egypt from October 2018 to March 2021. Patients were divided into 2 groups. Group A [ethanol] and Group B [Polidocanol].Results: The difference between the 2 groups regarding the demographics, postoperative change of symptoms, degree of satisfaction, and complications, was not significant indicating that polidocanol foam is nearly as effective as ethanol however, it was slightly more tolerated with fewer side effects compared to ethanol.Conclusion: Polidocanol foam is an effective therapeutic option for VM. Although ethanol produces good outcomes with few major side effects, polidocanol has a low chance of damaging adjacent tissue. Polidocanol foam works almost as well as ethanol.

Objective: To evaluate the efficacy of sclerotherapy for congenital vascular malformation (CVM) using a combination of polidocanol foam and bleomycin liquid. Methods: A retrospective review of a prospectively collected data on patients who had sclerotherapy for CVM from May 2015 to July 2022 was performed. Results: A total of 210 patients with a mean age of 24.8 ± 2.0 years were included. Venous malformation (VM) was the most common type of CVM, accounting for 81.9% (172/210) of all patients. At 6 months follow-up, the overall clinical effective rate was 93.3% (196/210), and 50% (105/210) of patients were clinically cured. The clinical effective rates in VM, lymphatic, and arteriovenous malformation group were 94.2%, 100%, and 100%. Conclusion: Sclerotherapy using a combination of polidocanol foam and bleomycin liquid is an effective and safe treatment for venous and lymphatic malformations. It is a promising treatment option with satisfactory clinical outcome in arteriovenous malformations. [ABSTRACT FROM AUTHOR]

Abstract Purpose In this manuscript, we purposed to identify the prognostic factors for treatment of lymphatic malformations in children using polidocanol foam combined with pingyangmycin and to construct nomogram for predicting sclerotherapy response. Methods A retrospective analysis of 77 children having LMs who underwent sclerotherapy using polidocanol foam combined with pingyangmycin under ultrasound display from January 2017 to April 2020 was done. The clinical response was graded as excellent (≥ 90%), good (≥ 50%,

Backgound Pyogenic granuloma would be defined as the benign growth composed of clusters of hyperplastic capillaries divided into lobules by fibromyxoid stroma. The limited therapeutic effect and the high recurrence rates associated with traditional treatment modalities, in addition to large size and occurrence of some lesions in surgically difficult areas necessitate the seek for an alternative therapeutic approach. Sclerotherapy is not routinely reported as an option for treating pyogenic granuloma. Objective To assess the tolerability and efficiency of sclerotherapy (polidocanol solution 3%) in pyogenic granuloma treatment. Methods An open-labeled, interventional therapeutic trial conducted from December 2020 to September 2021. Patients who were diagnosed clinically with PG were enrolled in the study and treated by intralesional injections of polidocanol solution 3%. Results There was significant reduction in the mean of lesion sizes during the second visit when put head-to-head with the first visit, the reduction was also present in the third visit when compared to the first two (P value <0.05). Moreover, nearly 62.5% of patients showed complete resolution during the second visit and the remaining 37.5% resolved completely during the third visit. A significant moderate negative correlation was detected between duration of the lesions and resolution. Other factors, like age, gender, site and sizes of the lesions, didn't have significant impact on response to treatment. Conclusion Sclerotherapy with polidocanol solution 3% is a safe and effective treatment for pyogenic granuloma. [ABSTRACT FROM AUTHOR]

Background: Foam sclerotherapy is considered an acceptable method to treat great saphenous vein (GSV) insufficiency, promoting occlusion of its trunk and eradicating reflux. Various modalities and techniques have been described, varying form foam infusion through multiple short cannulae along the GSV to catheter-directed techniques in order to facilitate complete proximal GSV occlusion and improve technical and clinical success. Purpose: To present a modification of the sclerotherapy tehcnique where the presence of venous ulcers poses an extra challenge to the treatment of GSV treatment. Technique: We describe a technical proposal of single foam perfusion through a 11 cm 5F sheath placed at the knee level combined with simultaneous retrograde infusion below the knee. Perivenous tumescent segmental infiltration with cold normal saline at 4°C is applied initially to reduce the diameter in those GSV >6-7 mm. Conclusions: This combination avoids multiple vein cannulation in the GSV along the thigh as well as the need for antegrade infusion when GSV cannulation at the lower tibia is prohibited by a large ulcer area. [ABSTRACT FROM AUTHOR]