What is Sclerotherapy?

From the Guidelines

Sclerotherapy is a viable treatment option for varicose veins, particularly for small to medium-sized veins, and can be performed with minimal side effects and rapid recovery. The procedure involves injecting a sclerosing agent into the affected vein, causing inflammation and eventual occlusion of the vein 1. According to the most recent study from 2023 1, compression sclerotherapy has been used effectively in the treatment of varicose veins, reticular veins, and telangiectasias. The study notes that foamed sclerosant can be used to increase the surface area of the treatment, and that Doppler US has demonstrated occlusion rates of 72% to 89% at 1-year post-treatment.

Key Considerations

• Sclerotherapy is typically used for small (1 to 3 mm) and medium (3 to 5 mm) veins or to treat recurrent varicose veins after surgery 1.
• The procedure can be performed on an outpatient basis, requires no anesthesia, and allows patients to resume normal activities immediately 1.
• Potential side effects include temporary bruising, skin discoloration, and rarely, blood clots 1.
• Compression stockings should be worn for 1-2 weeks after treatment to improve outcomes 1.

Treatment Outcomes

• The study from 2023 1 notes that chemical sclerotherapy has worse outcomes at 1-, 5-, and 8-year follow-ups compared to conventional open surgery and EVLA, with higher rates of recurrent GSV reflux and saphenofemoral junction failure.
• However, the study also reports equivalent improvement in quality of life per the Aberdeen Varicose Vein Severity Score 1.
• Overall, sclerotherapy can be a effective treatment option for varicose veins, but patients should be aware of the potential risks and benefits, and discuss their individual treatment options with their healthcare provider 1.

From the FDA Drug Label

CLINICAL PHARMACOLOGY Sotradecol (sodium tetradecyl sulfate injection) is a sclerosing agent. Intravenous injection causes intima inflammation and thrombus formation. This usually occludes the injected vein. Subsequent formation of fibrous tissue results in partial or complete vein obliteration that may or may not be permanent.

Sclerotherapy with sodium tetradecyl sulfate (SQ) is a treatment that causes intima inflammation and thrombus formation, leading to vein occlusion and potential obliteration.

• The treatment should only be administered by a healthcare professional experienced in venous anatomy and the diagnosis and treatment of conditions affecting the venous system 2.
• Key considerations for sclerotherapy include:
  • Proper injection technique to avoid extravasation and tissue necrosis
  • Preinjection evaluation for valvular competency
  • Slow injections with a small amount of the preparation
  • Post-treatment follow-up to assess for deep vein thrombosis 2

From the Research

Definition and Purpose of Sclerotherapy

• Sclerotherapy is defined as the targeted elimination of small vessels, varicose veins, and vascular anomalies by the injection of a sclerosant 3.
• The aim of sclerotherapy is to damage the vessel wall and transform it into a fibrous cord that cannot be recanalized 3.
• Sclerotherapy is a simple, cost-effective, efficacious, and esthetically acceptable modality for both therapeutic and esthetic purposes 3.

Indications for Sclerotherapy

• Therapeutic indications include varicose veins and vascular malformations 3.
• Esthetic indications include telangiectasias and reticular veins 3.
• Sclerotherapy can be used to treat superficial venous disease, vascular malformations, and other ectatic vascular lesions 4.

Contraindications for Sclerotherapy

• Absolute contraindications include known hypersensitivity to sclerosing agents, acute venous thromboembolism, severe neurological or cardiac adverse events, severe acute systemic illness or infection, and critical limb ischemia 4.
• Relative contraindications include pregnancy, postpartum and breastfeeding, hypercoagulable states, risk of neurological adverse events, risk of cardiac adverse events, and poorly controlled chronic systemic illness 4.

Sclerosing Agents

• Polidocanol and sodium tetradecyl sulfate are the most commonly used sclerosing agents 3, 5.
• Sodium tetradecyl sulfate 0.15% and polidocanol 0.31% are the best sclerosant concentrations for 0.8 mm to 1 mm leg telangiectasia based on histological evaluations and clinical correlation 6.
• Foam sclerotherapy using polidocanol or sodium tetradecyl sulfate is also effective in treating varicose and telangiectatic leg veins 7.

Technique and Safety

• The basic principle of a successful sclerotherapy technique is the use of an optimal volume and concentration of the sclerosant according to the size of the vessel 3.
• Sclerotherapy can be administered by a surgeon or dermatologist who has acquired adequate training in sclerotherapy 3.
• Complications may occur due to inappropriate patient selection or improper injection techniques, and can include hyperpigmentation, matting, local urticaria, cutaneous necrosis, and other adverse events 3, 4.