SCLEROTHERAPY

Sclerotherapy is indicated:

-On varicose veins of small diameter, when there is no saphenous veins incontinence: telangiectasias (varicosities), reticular varices, varicose veins withtout any incontinence of the ostium.

-After surgery, in order to treat residual varices.

Sclerotherapy is not appropriate for large varicose veins.

Principle:  A sclerosing agent injected in IV leads to an inflammatory reaction localized to the veins endothelium, which leads to the adhesion of the veins wall, then sclerosis and lastly fibrosis that results in the veins destruction.  The outcome of this technique is quite random, the saphenous veins leak point destruction is not always achieved.

 

Advantages : 

- Simplicity, 

- fast action, 

- ambulatory care, 

- can access small diameter veins like telangiectasias,

- repeatability,

- innocuousness (harmlessness)

 

Technique : 

The patient is laying down, with his head elevated, or with his back at 60° (the sclerosing agent must be injected in an almost empty vein).

Always in an orderly fashion, from up to down, or down to up, never haphazardly.

In the first meeting, the chosen agent’s effectiveness is tested.

IV injection, apply pressure locally.

An ideal sclerosis will collapse the veins walls without forming a thrombus, and without any inflammation.

Works instantly.

 

Product: the most frequently used is Aetoxysclerol (Lauromacrogol) at 0,25%, 0.5%, 2% or 3%. It is used alone or mixed with air bubbles (foam)

 

Usual aftermath of sclerosis :

In the days following the injection, veins may become lumpy and/or hard before resolving, leaving, in most cases, no trace.

 

Sclerotheraphy through echocatheterization : A sclerosis-inducing product is injected, working only on the endothelium (the internal walls of the vessels). There is an existing risk linked to injecting the product, its diffusion through arteries, thrombosis, allergies, etc…

 

Foam sclerotherapy : used for bigger varicoses

 

Disadvantages :

- Side effects

- Pain

- Post-sclerosis inflammatory reaction, redness, pain, swelling. Treatable with NSAIDs (localized or generalized) associated with support hose.

- Veins that are too large in diameter will not be destroyed and will persist as sclerotic veins.Treatment: thrombectomy.

- Extravascular injections.

- Growth of a bunch of new varicosities as a reaction. Rare, it happens chiefly when the sclerosis was too strong.

- Pigmentation

- Allergies

- It is hard to obtain definitive results

 

Contraindications: 

- Kidney failure (formerly called renal insufficiency).

- Major defect

- Diabetes is not a contraindication.