Embolic Agents: Sclerotherapy

History of Sclerosants

The first use of injection sclerotherapy to occlude a vessel was performed by Daniel Zollikofer in 1682. He reportedly injected an acid into a vein to promote thrombosis. This initial attempt led to further development of the procedure and the sclerosing agent. One of the earliest successes in the administration of a sclerosant occurred in 1853 at the Academy of Medicine in Paris where Professors Joseph Pierre Pétrequin and Soquet developed an iodine-tannin solution that produced fewer complications when injected. However, a redefinition of sclerotherapy's goal in 1894 prompted a new direction for sclerosing agents when Delore, a surgeon, proposed to a surgical congress in Lyon that a sclerosant should harden rather than thrombose the vessel. This concept garnered widespread recognition that continued into the 1900s. Paul Linser, a professor of dermatology in Tubingen, used mercury perchlorate solutions to treat varicosities after observing that mercury in syphilis treatments caused sclerosis of arm veins. However, mercurial preparations quickly fell out of favor due to their high toxicity; thus, alternative agents such as iron perchloride, alcohol, and sodium salicylate were explored.[1] Most sclerosants were associated with high toxicity to excessive causticity. A breakthrough occurred in 1946 when Leopold Reiner, a German surgeon, introduced sodium tetradecyl sulfate (STS), a detergent, as a safe and effective sclerosant. Subsequently, another detergent, polidocanol (POL), initially developed as a local anesthetic but abandoned due to its tendency to induce thrombosis, gained renewed purpose as a sclerosant by Otto Henschel, scientific director of Kreussler Pharma in Germany. As the range of sclerosants expanded and their properties were refined, injection sclerotherapy surpassed surgery in popularity for the treatment of diseased veins in the 1960s.[2]

Publication History

Article published online:
14 March 2024

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