Phlebologie 2020; 49(04): 204-210
DOI: 10.1055/a-1195-4262
Review

Sclerotherapy – How to Achieve a Spectacular Outcome

Sklerotherapie – Wie man spektakuläre Ergebnisse erzielt
Margaret W. Mann
Department of Dermatology at Case Western Reserve University, Cleveland, OH. Innova Dermatology, Hendersonville, TN
› Author Affiliations

Abstract

When performed correctly, sclerotherapy results in fibrous occlusion that is not amenable to recanalization. Paramount to success is adequate contact time of a sclerosant to the endothelial cells to cause sufficient damage to the vein while minimizing side effects. To optimize sclerotherapy results, one needs to choose the right patient and the right vein and then use the proper sclerosing agent and injection techniques. This paper will review current literature on sclerotherapy, as well as tips and tricks to optimize outcome and minimize complications.

Zusammenfassung

Bei korrekter Durchführung erzeugt die Sklerotherapie einen bindegewebigen Verschluss, der nicht rekanalisiert werden kann. Entscheidend für den Erfolg ist eine Kontaktzeit zwischen Sklerosierungsmittel und Endothelzellen, die ausreichend ist, um die Vene mit geringstmöglichen Nebenwirkungen hinreichend zu schädigen. Für optimale Ergebnisse der Sklerotherapie ist es erforderlich, den richtigen Patienten und die richtige Vene auszuwählen und dann geeignete Sklerosierungsmittel und Injektionstechniken anzuwenden. Dieser Artikel gibt einen Überblick über die aktuelle Literatur zur Sklerotherapie und umfasst Tipps und Tricks für eine Optimierung der Ergebnisse und Minimierung der Komplikationen.



Publication History

Article published online:
09 July 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 
  • References

  • 1 Rabe E, Breu FX, Cavezzi A. et al European guidelines for sclerotherapy in chronic venous disorders. Phlebology 2014; 29: 338-354 . doi:10.1177/0268355513483280
  • 2 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: 1079-1087 . doi:10.1002/bjs.7555
  • 3 Weiss MA, Hsu JT, Neuhaus I. et al Consensus for sclerotherapy. Dermatol Surg 2014; 40: 1309-1318 . doi:10.1097/DSS.0000000000000225
  • 4 Santiago FR, Piscoya M, Chi YW. Change in perception of sclerotherapy results after exposure to pre-post intervention photographs. Phlebology 2018; 33: 282-287 . doi:10.1177/0268355517736178
  • 5 Schwartz L, Maxwell H. Sclerotherapy for lower limb telangiectasias. Cochrane Database Syst Rev 2011; DOI: 10.1002/14651858.CD008826.pub2.
  • 6 Tisi PV, Beverley C, Rees A. Injection sclerotherapy for varicose veins. Cochrane Database Syst Rev 2006; DOI: 10.1002/14651858.CD001732.pub2.
  • 7 Mann MW. Sclerotherapy: it is back and better. Clin Plast Surg 2011; 38: 475-487, vii . doi:10.1016/j.cps.2011.02.006
  • 8 Kobayashi S, Crooks S, Eckmann DM. Dose- and time-dependent liquid sclerosant effects on endothelial cell death. Dermatol Surg 2006; 32: 1444-1452 . doi:10.1111/j.1524-4725.2006.32350.x
  • 9 Goldman MP. Treatment of varicose and telangiectatic leg veins: double-blind prospective comparative trial between aethoxyskerol and sotradecol. Dermatol Surg 2002; 28: 52-55 . doi:10.1046/j.1524-4725.2002.01190.x
  • 10 Bush R, Bush P. Evaluation of sodium tetradecyl sulfate and polidocanol as sclerosants for leg telangiectasia based on histological evaluation with clinical correlation. Phlebology 2017; 32: 496-500 . doi:10.1177/0268355516673768
  • 11 Parsi K, Exner T, Connor DE. et al The lytic effects of detergent sclerosants on erythrocytes, platelets, endothelial cells and microparticles are attenuated by albumin and other plasma components in vitro. Eur J Vasc Endovasc Surg 2008; 36: 216-223 . doi:10.1016/j.ejvs.2008.03.001
  • 12 Goldman MP BJ, Guex JJ. Sclerotherapy Treatment of Varicose and Telangiectatic Leg Veins. Fourth Edition. Aufl. Mosby Elsevier Inc; 2007
  • 13 Rathbun S, Norris A, Stoner J. Efficacy and safety of endovenous foam sclerotherapy: meta-analysis for treatment of venous disorders. Phlebology 2012; 27: 105-117 . doi:10.1258/phleb.2011.011111
  • 14 Davies HO, Popplewell M, Darvall K. et al A review of randomised controlled trials comparing ultrasound-guided foam sclerotherapy with endothermal ablation for the treatment of great saphenous varicose veins. Phlebology 2016; 31: 234-240 . doi:10.1177/0268355515595194
  • 15 Carugo D, Ankrett DN, Zhao X. et al Benefits of polidocanol endovenous microfoam (Varithena®) compared with physician-compounded foams. Phlebology 2016; 31: 283-295 . doi:10.1177/0268355515589063
  • 16 Cavezzi A, Tessari L. Foam sclerotherapy techniques: different gases and methods of preparation, catheter versus direct injection. Phlebology 2009; 24: 247-251 . doi:10.1258/phleb.2009.009061
  • 17 Lai SW, Goldman MP. Does the relative silicone content of different syringes affect the stability of foam in sclerotherapy?. J Drugs Dermatol 2008; 7: 399-400
  • 18 Rao J, Goldman MP. Stability of foam in sclerotherapy: differences between sodium tetradecyl sulfate and polidocanol and the type of connector used in the double-syringe system technique. Dermatol Surg 2005; 31: 19-22 . doi:10.1111/j.1524-4725.2005.31008
  • 19 de Roos KP, Groen L, Leenders AC. Foam sclerotherapy: investigating the need for sterile air. Dermatol Surg 2011; 37: 1119-1124 . doi:10.1111/j.1524-4725.2011.02044.x
  • 20 McMaster S. Sodium tetradecyl sulphate foam stability prior to injection: factors affecting liquid reformation. Phlebology 2011; 26: 222-226 . doi:10.1258/phleb.2010.010025
  • 21 Beckitt T, Elstone A, Ashley S. Air versus physiological gas for ultrasound guided foam sclerotherapy treatment of varicose veins. Eur J Vasc Endovasc Surg 2011; 42: 115-119 . doi:10.1016/j.ejvs.2011.04.005
  • 22 Weiss RA, Weiss MA. Doppler ultrasound findings in reticular veins of the thigh subdermic lateral venous system and implications for sclerotherapy. J Dermatol Surg Oncol 1993; 19: 947-951 . doi:10.1111/j.1524-4725.1993.tb00983.x
  • 23 Mann MW. Sclerotherapy: it is back and better. Clin Plast Surg 2011; 38: 475-487, vii . doi:10.1016/j.cps.2011.02.006
  • 24 Tripey V, Monsallier JM, Morello R. et al French sclerotherapy and compression: Practice patterns. Phlebology 2015; 30: 632-640 . doi:10.1177/0268355514554024
  • 25 Weiss RA, Sadick NS, Goldman MP. et al Post-sclerotherapy compression: controlled comparative study of duration of compression and its effects on clinical outcome. Dermatol Surg 1999; 25: 105-108 . doi:10.1046/j.1524-4725.1999.08180.x
  • 26 Raj TB, Makin GS. A random controlled trial of two forms of compression bandaging in outpatient sclerotherapy of varicose veins. J Surg Res 1981; 31: 440-445 . doi:10.1016/0022-4804(81)90084-6
  • 27 Guex JJ. Complications of sclerotherapy: an update. Dermatol Surg 2010; 36 (Suppl. 02) 1056-1063 . doi:10.1111/j.1524-4725.2009.01409.x
  • 28 Goldman MP, Kaplan RP, Duffy DM. Postsclerotherapy hyperpigmentation: a histologic evaluation. J Dermatol Surg Oncol 1987; 13: 547-550 . doi:10.1111/j.1524-4725.1987.tb00940.x
  • 29 Rabe E, Partsch H, Hafner J. et al Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement. Phlebology 2018; 33: 163-184 . doi:10.1177/0268355516689631
  • 30 Schuller-Petrović S, Pavlović MD, Neuhold N. et al Subcutaneous injection of liquid and foamed polidocanol: extravasation is not responsible for skin necrosis during reticular and spider vein sclerotherapy. J Eur Acad Dermatol Venereol 2011; 25: 983-986 . doi:10.1111/j.1468-3083.2010.03873.x
  • 31 Miyake RK, King JT, Kikuchi R. et al Role of injection pressure, flow and sclerosant viscosity in causing cutaneous ulceration during sclerotherapy. Phlebology 2012; 27: 383-389 . doi:10.1258/phleb.2011.011076
  • 32 Willenberg T, Smith PC, Shepherd A. et al Visual disturbance following sclerotherapy for varicose veins, reticular veins and telangiectasias: a systematic literature review. Phlebology 2013; 28: 123-131 . doi:10.1258/phleb.2012.012051
  • 33 Guex JJ, Allaert FA, Gillet JL. et al Immediate and midterm complications of sclerotherapy: report of a prospective multicenter registry of 12,173 sclerotherapy sessions. Dermatol Surg 2005; 31: 123-128 ; discussion 128. doi:10.1111/j.1524-4725.2005.31030
  • 34 Frullini A, Barsotti MC, Santoni T. et al Significant endothelin release in patients treated with foam sclerotherapy. Dermatol Surg 2012; 38: 741-747 . doi:10.1111/j.1524-4725.2012.02390.x
  • 35 Gillet JL. Neurological complications of foam sclerotherapy: fears and reality. Phlebology 2011; 26: 277-279 . doi:10.1258/phleb.2011.011e04
  • 36 Guex JJ. Complications and side-effects of foam sclerotherapy. Phlebology 2009; 24: 270-274 . doi:10.1258/phleb.2009.009049
  • 37 Hill D, Hamilton R, Fung T. Assessment of techniques to reduce sclerosant foam migration during ultrasound-guided sclerotherapy of the great saphenous vein. J Vasc Surg 2008; 48: 934-939 . doi:10.1016/j.jvs.2008.05.077
  • 38 Parsi K. Venous gas embolism during foam sclerotherapy of saphenous veins despite recommended treatment modifications. Phlebology 2011; 26: 140-147 . doi:10.1258/phleb.2010.010030
  • 39 Morrison N, Neuhardt DL, Rogers CR. et al Comparisons of side effects using air and carbon dioxide foam for endovenous chemical ablation. J Vasc Surg 2008; 47: 830-836 . doi:10.1016/j.jvs.2007.11.020