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Sclerotherapy

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Abstract

Sclerotherapy targeted endovenous chemical ablation of veins by injection of liquid or foamed sclerosing agents. Intradermal, subcutaneous, and/or transfascial veins can be treated by this method. The technique could also be used for superficial and deep venous malformations. The sclerosant induces chemical damage to the endothelium and inner media [1, 2]. The long-term effect of sclerotherapy is to transform the treated vein into a fibrous cord, a process known as sclerosis [3–5]. Thrombosis of the vein may occlude it temporarily but is likely to get recanalized in the course of time.

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References

  1. Erkin A, Kosemehmetoglu K, Diler MS, Koksal C. Evaluation of the minimum effective concentration of the sclerosant in an ex-vivo study. Eur J Vasc Endovasc Surg. 2012;44(6):593–7.

    Article  PubMed  CAS  Google Scholar 

  2. Ikpommwosa A, Abbot C, Graham A, et al. The impact of different concentrations of sodium tetradecyl sulphate and initial balloon denudation on endothelial cell loss and tunica media injury in a model of foam sclero therapy. Eur J Vasc Endovasc Surg. 2010;39(3):366–71.

    Article  Google Scholar 

  3. Drake LA, Dinehart SM, Goltz RW, et al. Guidelines of care of sclerotherapy treatment of varicose veins and telangiectatic leg veins. J Am Acad Dermatol. 1996;34:523–8.

    Article  Google Scholar 

  4. Rabe E, Pannier-Fischer F, Gerlach H, et al. Guidelines for sclerotherapy of varicose veins. Dermatol Surg. 2004;30:687–93.

    PubMed  CAS  Google Scholar 

  5. Hamel-Desnos C, Ourvy P, Benigni JP, et al. Comparison of 1 % and 3 % polidocanol foam in ultrasound guided sclerotherapy of great saphenous vein: a randomized double blind trial with two year follow up. The 3/1 study’. Eur J Vasc Endovasc Surg. 2007;34:723–9.

    Article  PubMed  CAS  Google Scholar 

  6. Bergan JJ. History of surgery for somatic veins. In: Bergan JJ, Kistner RL, editors. Atlas of venous surgery. Philadelphia: WB Saunders; 1992.

    Google Scholar 

  7. Garrison FH. Introduction to history of medicine. Philadelphia: WB Saunders; 1929.

    Google Scholar 

  8. Rogers L, Winchester AH. Intravenous sclerosing injections. BMJ. 1930;2:120.

    Article  PubMed Central  Google Scholar 

  9. Biegeleisen HI. Telangiectasias associated with varicose veins. JAMA. 1934;102:2002.

    Google Scholar 

  10. McAusland S. The modern treatment of varicose veins. Med Press Circular. 1939;201:404–10.

    Google Scholar 

  11. Orbach EJ. Sclerotherapy of varicose veins-utilisation of an intra venous air-block. Am J Surg. 1994;LXVI(3):362–6.

    Google Scholar 

  12. Foote RR. The injection treatment. In: Foote RR, editor. Varicose veins, haemorrhoids and other conditions. London: Lewis; 1944. p. 13–4.

    Google Scholar 

  13. Sigg K. Neuere gesichtspunkte zur technik der varizenbehandlung. Ther Umsch. 1949;6:127–34.

    PubMed  CAS  Google Scholar 

  14. Tessari L. Nouvelle technique d’ obtention de la scleromousse. Phlebologie. 2000;53:129.

    Google Scholar 

  15. Cavezzi A, Tessari L, Fullini A. A new sclerosing foam in the treatment of varicose veins. Tessari method. Minerva Cardioangiol. 2000;48(Suppl):248.

    Google Scholar 

  16. Tessari L, Cavezzi A, Fullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg. 2001;27:58–60.

    PubMed  CAS  Google Scholar 

  17. Fegan WG. Varicose veins; compression sclerotherapy. Dublin: Wm Hein Mann Medical Books; 1967.

    Google Scholar 

  18. Goldman MP. Sclerotherapy. St. Louis: Mosby-Year Book; 1991.

    Google Scholar 

  19. Imhoff E, Stemmer R. Classification and mechanism of action of sclerosing agents. Phlebologie. 1969;22:143.

    Google Scholar 

  20. Linden Mayer H, Santeler R. The fibrinolytic activity on the vein wall. Phlebologie. 1997;30:151.

    Google Scholar 

  21. Bergan JJ. Varicose veins: treatment by surgery and sclerotherapy: chapter 147. In: Rutherford RB, editor. Ruther Ford vascular surgery. 5th ed. Philadelphia: WB Saunders; 2000;2:2015–21.

    Google Scholar 

  22. Rabe E, Breu FX, Cavezzi A, et al. European guidelines for sclerotherapy in chronic venous disorders. Phlebology. 2014;29(6):338–54.

    Article  Google Scholar 

  23. Djalali S, Mikulicic F, Berwarth H, et al. Will foam sclerotherapy and endovenous thermal ablation replace varicose vein stripping? Praxis (Bern 1994). 2012;101(20):1297–307.

    Article  CAS  Google Scholar 

  24. Ukritmanoroat T. Comparison of efficacy and safety between foam sclerotherapy and conventional sclerotherapy – a controlled trial. J Med Assoc Thai. 2011;94 Suppl 2:35–40.

    Google Scholar 

  25. Green D. Compression sclerotherapy: techniques. Dermatol Clin. 1989;7(1):137–46.

    PubMed  CAS  Google Scholar 

  26. Bohler-Sommeregger K, Karnel F, et al. Do telangiectasias communicate with deep vein system? J Dermatol Surg Oncol. 1992;18:403.

    Article  PubMed  CAS  Google Scholar 

  27. Kahle B, Leng K. Efficacy of sclerotherapy in varicose veins – a prospective, blinded placebo controlled study. Dermatol Surg. 2004;30:723–8.

    PubMed  Google Scholar 

  28. Rabe E, Schliephake D, Otto J, et al. Sclerotherapy of telangiectasias and reticular veins; a double-blind, randomized, comparative clinical trial of polidocanol, sodium tetradecyl sulfate and isotonic saline (EASI study). Phlebology. 2010;25:124–31.

    Article  PubMed  CAS  Google Scholar 

  29. Peterson JD, Goldman MP, Weiss RA, et al. Treatment of reticular and telangiectatic leg veins: a double blind prospective comparative trial of polidocanol and hypertonic saline. Dermatol Surg. 2012;38:1–9.

    Article  Google Scholar 

  30. Alos J, Carreno P, Lopez JA, et al. Efficacy and safety of sclerotherapy using polidocanol foam: a controlled clinical trial. Eur J Vasc Endovasc Surg. 2006;31:101–7.

    Article  PubMed  CAS  Google Scholar 

  31. Uncu H. Sclerotherapy: a study comparing polidocanol in foam and liquid form. Phlebology. 2010;25:44–9.

    Article  PubMed  CAS  Google Scholar 

  32. Rao J, Witdemove JK, Goldman MP. Double blind prospective comparative trial between foamed and liquid polidocanol and natrium tetradecyl sulfate in treating varicose veins and telangiectatic leg veins. Dermatol Surg. 2005;31:631–5.

    Article  PubMed  CAS  Google Scholar 

  33. Sladen JG. Compression sclerotherapy; preparation, technique, complications and results. Am J Surg. 1983;142(2):228–32.

    Article  Google Scholar 

  34. Yamaki T, Nozaki Mand Sasaki K. Colour duplex-guided sclerotherapy for treatment of venous malformations. Dermatol Surg. 2000;26:323–8.

    Article  PubMed  CAS  Google Scholar 

  35. Kante A, Thibault P. Saphenofemoral incompetence treated by ultrasound-guided sclerotherapy. Dermatol Surg. 1966;22:648–52.

    Google Scholar 

  36. Grondin L, Young R, Wouters L. Sclerotherapie echo-guidee et securite: comparison des techniques. Phlebologie. 1997;50:241–5.

    Google Scholar 

  37. Guex JJ. Ultrasound guided sclerotherapy for perforating veins. Hawaii Med J. 2000;59:261–2.

    PubMed  CAS  Google Scholar 

  38. Des Roos KP, Groen L, Leenders AC. Foam sclerotherapy; investigating the need for sterile air. Dermatol Surg. 2011;37:1119–24.

    Article  Google Scholar 

  39. van Deurzen B, Ceulen RP, Tellings SS, et al. Polidocanol concentration and time affect the properties of foam used for sclerotherapy. Dermatol Surg. 2011;37(10):1448–55.

    Article  Google Scholar 

  40. Jia X, Liu XP, Xiong J, et al. Foam sclerotherapy of great saphenous vein with saphenofemoral ligation compared to standard stripping: a prospective randomized controlled trial (article in Chinese). Zhonghua Wai Ke Za Zhi. 2010;48(22):1731–4.

    PubMed  Google Scholar 

  41. Islamoglu F. An alternative treatment for varicose veins: ligation plus foam sclerotherapy. Dermatol Surg. 2011;37(4):470–9.

    Article  PubMed  CAS  Google Scholar 

  42. Bullens-Goessens YIJM, Mentink LF, Nelemans PJ, et al. Ultrasound guided sclerotherapy of insufficient short saphenous veins. Phlebologie. 2004;33:89–91.

    Google Scholar 

  43. Rasmussen LH, Lawaetz M, Bjoern L, et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011;98(8):1079–87.

    Article  PubMed  CAS  Google Scholar 

  44. Wright D, Gobin JP, Bradburry AW, et al.; Varisolve European Phase III Investigators Group. Varisolve polidocanol microfoam compared with surgery or sclerotherapy in the management of varicose veins in the presence of trunk vein incompetence: European randomized controlled trial. Phlebology. 2006; 21:180–90.

    Google Scholar 

  45. Cavezzi A, Fullini A, Ricci S, Tessari L. Treatment of varicose veins with foam sclerotherapy: two clinical series. Phlebology. 2002;17:13–8.

    Google Scholar 

  46. Hamel-Desnos C, Ouvry P, Desnos P, et al. Scletherpie et thrombophilie: Demarche pour un consensus dons la sclerotherapie chez les thrombophiles. Phlebologie. 2003;56:165–9.

    Google Scholar 

  47. Ferrara F, Ferrara G. Sclerotherapy of varicose veins; my method. Minerva Cardioangiol. 2012;60(2):125–31.

    PubMed  CAS  Google Scholar 

  48. Peterson JD, Goldman MP. An investigation of side effects and efficacy of foam based sclerotherapy with carbondioxide or room air in the treatment of reticular leg veins: a pilot study. Phlebology. 2012;27(2):73–6.

    Article  PubMed  CAS  Google Scholar 

  49. Tan VK, Abidin SZ, Zan SG. Medium term results of ultra sound guided catheter assisted foam sclerotherapy of long saphenous vein for treatment of varicose veins. Singapore Med J. 2012;53(2):91–4.

    PubMed  CAS  Google Scholar 

  50. Relch-Schupke S, Altemeyer P, Stucker M. Tripple lumen balloon catheter for foam sclerotherapy of great saphenous vein: critical review on preliminary results. Phlebology. 2010;25(5):241–5.

    Article  Google Scholar 

  51. Bhogal RH, Moffat CE, Coney P, et al. Can foam sclerotherapy be used safely to treat bilateral varicose veins? Phlebology. 2012;27(1):19–24.

    Article  PubMed  CAS  Google Scholar 

  52. Mayers KA, Roberts S. Evaluation of published reports of foam sclerotherapy: what do we know conclusively? Phlebology. 2009;24(6):275–80.

    Article  Google Scholar 

  53. Shadid N, Ceulen R, Nelemans PJ, et al. Randomised clinical trial of ultrasound guided foam sclerotherapy versus surgery for incompetent great saphenous vein. Br J Surg. 2012;99(8):1062–70.

    Article  PubMed  CAS  Google Scholar 

  54. Darvall KA, Bate GR, Adam DJ, et al. Duplex ultrasound outcomes following ultrasound guided foam sclerotherapy of symptomatic recurrent great saphenous varicose veins. Eur J Vasc Endovasc Surg. 2011;42(1):107–14.

    Article  PubMed  CAS  Google Scholar 

  55. Gillet J, Lausecker M, Sica M, et al. Is treatment of small saphenous vein with foam sclerotherapy at risk of deep vein thrombosis? Phlebology 2014;29(9):600–7.

    Google Scholar 

  56. Rathbun S, Norris A, Stoner J. Efficacy and safety of endovenous foam sclerotherapy: meta-analysis for treatment of venous disorders. Phlebology. 2012;27:105–17.

    Article  PubMed  CAS  Google Scholar 

  57. Bergan JJ, Goldman MP. Complications of sclerotherapy. In: Bernhard VM, Towne JB, editors. Complications of vascular surgery. St. Louis: CV Mosby; 1991.

    Google Scholar 

  58. Guex JJ. Complications of sclerotherapy: an update. Dermatol Surg. 2010;36:1056–63.

    Article  PubMed  CAS  Google Scholar 

  59. Cavezzi A, Parsi K. Complications of foam sclerotherapy. Phlebology. 2012;27 Suppl 1:46–51.

    Article  PubMed  Google Scholar 

  60. Jia X, Mowatt G, Burr JM, Cassar K, et al. Systematic review of foam sclerotherapy for varicose veins. Br J Surg. 2007;94:925–36.

    Article  PubMed  CAS  Google Scholar 

  61. Hamel-Desnos C, Desnos P, Ferre B, Querrec A. In vivo biological effects of foam sclerotherapy. Eur J Vasc Endovasc Surg. 2011;42:238–45.

    Article  PubMed  CAS  Google Scholar 

  62. Fabi SG, Peterson JD, Goldman MP, et al. An investigation of coagulation cascade activation and induction of fibrinolysis using foam sclerotherapy of reticular veins. Dermatol Surg. 2012;38:367–72.

    Article  PubMed  CAS  Google Scholar 

  63. Guex JJ, Allaert FA, Gillet JL. Immediate and midterm complications of sclerotherapy; report of prospective multicentre registry of 12,173 sclerotherapy sessions. Dermatol Surg. 2005;31:123–8.

    Article  PubMed  CAS  Google Scholar 

  64. Gillet JL, Guedes JM, Guex JJ, et al. Side effects and complications of foam sclerotherapy of great and small saphenous veins; a controlled prospective multicentre study including 1025 patients. Phlebology. 2009;24:131–8.

    Article  PubMed  Google Scholar 

  65. Breu FX, Guggenbichler S, Wallmann JC. Second European consensus meeting on foam sclerotherapy, 28–30 April 2006, Tegernsee, Germany. Vasa. 2008;37 Suppl 71:1–32.

    PubMed  Google Scholar 

  66. Forlee MV, Groundern M, Moore DJ, et al. Stroke after varicose vein foam injection sclerotherapy. J Vasc Surg. 2006;43:162–4.

    Article  PubMed  Google Scholar 

  67. Mayers KA, Jolley D. Factors affecting the risk of deep venous occlusion after ultrasound guided sclerotherapy for varicose veins. Eur J Vasc Endovasc Surg. 2008;38:602–5.

    Article  Google Scholar 

  68. Hamel-Densons CM, Gillet J-L, Densons PR, et al. Sclerotherapy of varicose veins in patients with documented thrombophilia: a prospective controlled randomized study of 105 cases. Phlebology. 2009;24:176–82.

    Article  Google Scholar 

  69. Goldman MP, Sadik NS, Weiss RA. Cutaneous necrosis, telangiectatic matting and hyperpigmentation following sclerotherapy. Dermatol Surg. 1995;21:19–29.

    Article  PubMed  CAS  Google Scholar 

  70. Bergan JJ, Weiss RA, Goldman MP. Extensive tissue necrosis following high concentration sclerotherapy for varicose veins. Dermatol Surg. 2000;26:535–42.

    Article  PubMed  CAS  Google Scholar 

  71. Bihari I, Mayyar E. Reasons for ulceration after injection treatment of telangiectasias. Dermatol Surg. 2001;27:132–3.

    Google Scholar 

  72. Geukens J, Rabe E, Bieber T. Embolia cutis medicamentosa of foot after sclerotherapy. Eur J Dermatol. 1999;99:132–3.

    Google Scholar 

  73. Ramelet AA, Parmentier L. Delayed Nicolau’s Levedoid dermatitis after ultrasound guided sclerotherapy. Dermatol Surg. 2010;36:155–8.

    Article  PubMed  CAS  Google Scholar 

  74. Reich-Schupke S, Weyer K, Altmeyer P, Stukcker M. Treatment of varicose tributaries with sclerotherapy with 0.5 % polidocanol foam. Vasa. 2010;4:185–7.

    Google Scholar 

  75. Scultetus AH, Villavicencio JL, Kao TC, et al. Microthrombectomy reduces postsclerotherapy pigmentation: multicenter randomized trial. J Vasc Surg. 2003;38:896–903.

    Article  PubMed  Google Scholar 

  76. Georgiev MJ. Post sclerotherapy hyperpigmentation: a one year follow up. J Dermatol Surg Oncol. 1990;16:608–10.

    Article  PubMed  CAS  Google Scholar 

  77. Oesch A, Stirnemann P, Mahler F. Acute ischemic syndrome of foot after sclerotherapy of varicose veins. Schweiz Med Wochen Schr. 1984;114:1155–8.

    CAS  Google Scholar 

  78. Grommes J, Franzen EL, Binnebosel M, et al. Inadvertent arterial injection using catheter assisted sclerotherapy resulting in amputation. Dermatol Surg. 2010;37:536–8.

    Article  PubMed  Google Scholar 

  79. Hafner F, Froehlich H, Gary T, Broadman M. Intra arterial injections a rare but serious complication of foam sclerotherapy. Phlebology. 2012;28(2):64–73.

    Article  Google Scholar 

  80. Zipper SG. Nervus peronaus-Schadennach varizenklero sierung mit Aethoxyskerol. Versicherung Smedizin. 2000;4:185–7.

    Google Scholar 

  81. Kern P, Ramelet A, Wutschert R, Bounameaux H, Hayoz D. Single blind randomized study comparing chromated glycerin, polidocanol solution and polidocanol foam for treatment of telangiectatic leg veins. Dermatol Surg. 2004;30:367–72.

    PubMed  Google Scholar 

  82. Gillet JL, Donnet A, Lausecker M, Guedes JM, et al. Pathophysiology of visual disturbances occurring after foam sclerotherapy. Phlebology. 2010;25:261–6.

    Article  PubMed  CAS  Google Scholar 

  83. Frullini A, Felice F, Burchielli S, et al. High production of endothelin after foam sclerotherapy: a new pathogenitic hypothesis for neurological and visual disturbances after sclerotherapy. Phlebology. 2011;26:203–8.

    Article  PubMed  CAS  Google Scholar 

  84. Frullini A, Barsotti MC, Santoni T, et al. Significant endothelin release in patients treated with foam sclerotherapy. Dermatol Surg. 2012;38:741–7.

    Article  PubMed  CAS  Google Scholar 

  85. Yamiki T, Nozaki M, Sakurai H, et al. Multiple small doze injections can reduce the passage of sclerosant foam into deep veins during foam sclerotherapy for varicose veins. Eur J Vasc Endovasc Surg. 2008;37:343–8.

    Article  Google Scholar 

  86. Sarvanathan T, Shepherd AC, Willenberg T, Davies AH. Neurological complications of sclerotherapy for varicose veins. J Vasc Surg. 2012;55:243–51.

    Article  Google Scholar 

  87. Parsi K. Paradoxical embolism, stroke and sclerotherapy. Phlebology. 2012;27:147–67.

    Article  PubMed  CAS  Google Scholar 

  88. Busch RG, Derrik Manjoney D. Major neurological events following foam sclerotherapy. Phlebology. 2008;23:189–92.

    Article  Google Scholar 

  89. Gillet JL. Neurological complications of foam sclerotherapy: fears and reality. Phlebology. 2011;26:277–9.

    Article  PubMed  Google Scholar 

  90. Parsi K. Venous gas embolism during foam sclerotherapy of saphenous veins despite recommended treatment modifications. Phlebology. 2011;26:140–7.

    Article  PubMed  CAS  Google Scholar 

  91. Harzheim M, Becher H. Klockgether: brain infarct from a paradoxical embolism following a varices operation. Dtsch Med Wochenschr. 2000;125:794–6.

    Article  PubMed  CAS  Google Scholar 

  92. Caggiati A, Franceschini M. Stroke following endovenous laser treatment of varicose veins. J Vasc Surg. 2010;51:218–20.

    Article  PubMed  Google Scholar 

  93. Vincent JR, Jones GT, van Rij AM. Failure of microvenous valves in small superficial veins is a key to the skin changes of venous insufficiency. J Vasc Surg. 2011;54:62s–9.

    Article  PubMed  Google Scholar 

  94. Greenberg JI, Angle N, Bergan JJ. Foam sclerotherapy. In: Gloviczki P, editor. Handbook of venous disorders. 3rd ed. London: Hodder Arnold; 2009. p. 380–9.

    Google Scholar 

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  1. General Surgery, Government Medical College, Kottayam, Kerala, India

    Binni John

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John, B. (2015). Sclerotherapy. In: Chronic Venous Disorders of the Lower Limbs. Springer, New Delhi. https://doi.org/10.1007/978-81-322-1991-0_9

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