Absolute Contraindications for Sclerotherapy
Known hypersensitivity to sclerosing agents is an absolute contraindication to sclerotherapy, along with acute venous thromboembolism, severe neurological or cardiac adverse events from previous sclerotherapy, severe acute systemic illness or infection, and critical limb ischemia. 1
Absolute Contraindications
The International Union of Phlebology consensus document clearly defines situations where sclerotherapy should not be performed because the risk of harm outweighs any potential benefits:
Known hypersensitivity or allergy to the specific sclerosing agent being considered (e.g., polidocanol, sodium tetradecyl sulfate) 1, 2
Acute venous thromboembolism (VTE), including deep vein thrombosis or pulmonary embolism 1
Severe neurological or cardiac adverse events that complicated a previous sclerotherapy treatment 1
Severe acute systemic illness or infection requiring immediate medical attention 1, 2
Critical limb ischemia where arterial perfusion is severely compromised 1
Intra-arterial injection is absolutely prohibited (though this is technique-related rather than patient-related) 2
Relative Contraindications
These situations require careful risk-benefit assessment, and sclerotherapy may proceed if benefits outweigh risks with appropriate precautions:
Pregnancy and breastfeeding: While manufacturer labeling lists pregnancy as a contraindication, existing case reports show no increased risk to mother or fetus when sclerotherapy was performed during undetected pregnancy 1, 3. However, varicose veins often regress spontaneously postpartum, making treatment during pregnancy generally unnecessary 3. In exceptional cases (e.g., painful genitoanal varices), sclerotherapy can be performed with thorough informed consent 3.
Hypercoagulable states with increased VTE risk 1
Poorly controlled chronic systemic illness 1
Bed rest or immobility 2
Oral anticoagulation: Not an absolute contraindication if the patient is stable and the underlying condition itself is not contraindicated 2
Important Clinical Considerations
Pregnancy testing: All women of childbearing potential should have pregnancy excluded before sclerotherapy, similar to protocols for other medical procedures 1.
Previous thrombosis history: Patients with prior deep vein thrombosis or known thrombophilia require individual assessment, as these remain under evaluation as potential contraindications 2.
Disulfiram interaction: Concurrent use with chromated glycerin is contraindicated 2.
Chronic renal insufficiency: Chromated glycerin should be avoided in these patients 2.