Introduction The development of minimally invasive techniques for the treatment of varicose veins is driven by the aim of achieving results equivalent or superior to surgery whilst minimising complications. Foam sclerotherapy is associated with inferior short-term occlusion rates in comparison to other treatments, suggesting irreversible vein wall injury has not occurred. Further knowledge of the mechanism of action of foam sclerotherapy may facilitate its modification in order to improve clinical efficacy. Methods This study assessed the cellular response to the application of sodium tetradecyl sulphate (STD) foam by analysis of intracellular protein release from cultured human saphenous vein endothelial cells. An ex vivo model using proximal great saphenous vein was developed to quantify the tissue response to the application of foam STD with, and without, initial balloon denudation of vein wall endothelium. Percentage endothelial cell loss (ECL), tunica media injury and collagen structure were assessed. Stability of foam STD was established and modified by surfactant additives. The tissue effects of the modified foam were evaluated. Results All concentrations of foam STD produced equivalent cellular injury. Intra-luminal application of STD foam to great saphenous vein segments was associated with incomplete endothelial destruction and superficial tunica media injury. There was little evidence of collagen disruption. Viscosity enhancing agents were the most effective foam stabilisers. Initial mechanical balloon denudation of endothelium and prolongation of foam stability with surfactants, increased ECL but did not enhance tunica media injury. Conclusions The superficial injury and lack of collagen disruption sustained by veins following exposure to foam STD is likely to explain the capacity for recanalisation following treatment. The increased ECL observed following balloon endothelial denudation and application of modified STD foam may be beneficial in the clinical setting. Further in vivo evaluation of these adjuncts to foam sclerotherapy is required

The development of recurrent varicose veins following primary varicose vein surgery is a significant problem, not only for patients but also for the National Health Service. Varicose vein surgery is one of the commonest elective general surgical operations done in the United Kingdom with over 34,000 operations performed per year. Approximately 20 per cent of procedures are done for recurrent varicose veins. Published recurrence rates range from seven to 70 per cent. Despite these findings, little research has been done into methods of preventing recurrence.

Venous leg ulceration has a high recurrence rate. Patients with healed or frequently recurring venous ulceration are required to perform self-care behaviours to prevent recurrence or promote healing, but many find these difficult to perform. Bandura’s self-efficacy theory is a widely used and robust behaviour change model and underpins many interventions designed to promote self-care in a variety of chronic conditions. By identifying areas where patients may experience difficulty in performing self-care, interventions can be developed to strengthen their self-efficacy beliefs in performing these activities successfully. There are currently a variety of self-efficacy scales available to measure self-efficacy in a variety of conditions; but not a disease-specific scale for use with venous ulcer patients. The aim of this study, therefore, was to develop a disease-specific, patient-focused self-efficacy scale for patients with healed venous leg ulceration. Phase 1 consisted of a qualitative design and used focus group methodology to generate an item pool for potential inclusion into the scale from the patients’ perspective. In phase 2, factor analysis using equamax orthogonal rotation methods was used to reduce the items from 60 to 30, resulting in 5 major domains: general self-care; daily self-care tasks; normal living; developing expertise and avoiding trauma. Preliminary reliability studies indicated that the developed scale, VeLUSET© has good internal consistency, with an overall Cronbach alpha of .929 and a strong test-re-test reliability. Furthermore, correlation with the General Self-Efficacy Scale demonstrated a strong positive relationship between the two scales. These results indicate that the VeLUSET©, although still in the early validation stages, is a reliable instrument to measure venous leg ulcer patients’ self-efficacy in performing self-care tasks within clinical practice. The development of this disease-specific tool has now filled a gap in the research on managing patients with healed venous leg ulceration.