Skip to main content
SpringerLink
Log in

Sclerotherapy

  • Chapter
  • First Online:
Current Management of Venous Diseases

Abstract

Sclerotherapy has wide application in the treatment of superficial venous insufficiency. It is used in both liquid and foam formulations, with proprietary foam having recently received FDA approval. Several different sclerosing agents are available, and each has unique properties and potential side effects with which treating physicians should become familiar. The size, distribution, and source of the veins being treated are all important considerations when selecting a sclerosing agent, sclerosant concentration, and sclerosing technique. Proper patient workup, assessment for contraindications, and anticipation of potential side effects are all important steps for achieving a successful outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Rabe E, Guex JJ, Puskas A, Scuderi A, Fernandez Quesada F, Coordinators VCP. Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program. Int Angiol. 2012;31:105–15.

    CAS  PubMed  Google Scholar 

  2. Porter JM, Moneta GL. Reporting standards in venous disease: an update. International Consensus Committee on chronic venous disease. J Vasc Surg. 1995;21(4):635–45.

    Article  CAS  PubMed  Google Scholar 

  3. Goldman MP, Guex JJ, Weiss RA. Sclerotherapy. In: Treatment of varicose and telangectatic leg veins. 5th ed. Amsterdam: Saunders/Elsevier; 2011. p. ix–xi.

    Google Scholar 

  4. Rathbun S, Norris A, Morrison N, Gibson K, Hohenwalter E, Lohr J, Raymond-Martimbeau P, Worthington-Kirsch R, Stoner J. Performance of the endovenous foam sclerotherapy in the USA. Phlebology. 2012;27(2):59–66.

    Article  CAS  PubMed  Google Scholar 

  5. Orbach EJ. Sclerotherapy of varicose veins: utilization of an intravenous air block. Am J Surg. 1944;66:362–6.

    Article  Google Scholar 

  6. Cabrera Garrido JR, Cabrera Garcia-Olmedo JR, Garcia-Olmedo Dominguez MA. Elargissement des limites de la schlerotherapie: nouveaux produirs sclerosants. Phlebolgie. 1997;50:181–8.

    Google Scholar 

  7. Monfreux A. Traitement sclerosant des troncs saphenies et leurs collaterals de gros caliber par le methode MUS. Phlebologie. 1997;50:355–60.

    Google Scholar 

  8. Tessari L. Nouvelle technique d’obtention de la sclero-mousse. Phlebologie. 2000;53:129.

    Google Scholar 

  9. Carugo D, Ankrett DN, O’Byrne V, et al. The role of clinically-relevant parameters on the cohesiveness of sclerosing foams in a biomimetic vein model. J Mater Sci Med. 2015;26(11):258.

    Article  Google Scholar 

  10. Varithena (prescribing information) in: https://www.btgplc.com/media/1266/varithena-media-fact-sheet-us-var-2013-0835-3.pdf, Provensis LTD, a BTG International Group Company, December 2013.

  11. Worthington-Kirsch R. Injection sclerotherapy. Semin Intervent Radiol. 2005;22(3):209–17.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Feied CF. Sclerosing solutions. In: Fronek H, editor. The fundamentals of phlebology, venous disease for clinicians. 2nd ed. San Leandro: American College of Phlebology; 2007. p. 23.

    Google Scholar 

  13. Parsi K, Exner T, Connor DE, et al. Lytic effects of detergent sclerosants on erytrocytes, platelets, endothelial cells and microparticles are attenuated by albumin and other plasma components in vitro. Eur J Vasc Endovasc Surg. 2008;36(2):216–32.

    Article  CAS  PubMed  Google Scholar 

  14. Peterson JD, Goldman MP, Weiss RA, et al. Treatment of reticular and telangectatic leg veins: double-blind prospective randomized comparative trial of polidocanol and hypertonic saline. Dermatol Surg. 2012;38(8):1322–30.

    Article  CAS  PubMed  Google Scholar 

  15. Park HS, Do YS, Park KB, et al. Clinical outcome and predictors of treatment response in foam sodium tetradecyl sulfate sclerotherapy of venous malformations. Eur Radiol. 2016;26(5):1301–10.

    Article  PubMed  Google Scholar 

  16. Pieri S, Agresti P, Morucci M, de’ Medici L. Percutaneous treatment of pelvic congestion syndrome. Radiol Med. 2003;105(1–2):76–82.

    PubMed  Google Scholar 

  17. Gibson K, Ferris B, Pepper D. Foam sclerotherapy for the treatment of superficial venous insufficiency. Surg Clin North Am. 2007;87(5):1285–95.

    Article  PubMed  Google Scholar 

  18. Hamel-Desnos C, Desnos P, Wollmann JC, et al. Evaluation of the efficacy of polidocanol in the form of foam compared with liquid form in sclerotherapy of the greater saphenous vein: initial results. Dermatol Surg. 2003;29(12):1170–5.

    PubMed  Google Scholar 

  19. Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg. 2001;27(1):58–60.

    CAS  PubMed  Google Scholar 

  20. Patel SB, Ostler AE, Dos Santos SJ, et al. Effects of environmental and compositional manipulation on the longevity of Tessari-made foam for sclerotherapy. J Vasc Surg Venous Lymphat Disord. 2015;3(3):312–8.

    Article  PubMed  Google Scholar 

  21. Carugo D, Ankrett D, Zhao X, et al. Benefits of Polidocanol endovenous microfoam (Varithena®) compared to physician compounded foams. Phlebology. 2016;31(4):283–95.

    Article  PubMed  Google Scholar 

  22. Bergan J, Pascarella L, Mekenas L. Venous disorders: treatment with sclerosant foam. J Cardiovasc Surg. 2006;47(1):9–18.

    CAS  Google Scholar 

  23. Darke SG, Baker SJ. Ultrasound-guided foam sclerotherapy for the treatment of varicose veins. Br J Surg. 2006;68(2):182–3.

    Google Scholar 

  24. Darvall KA, Bae GR, Adam DJ, et al. Duplex ultrasound outcomes following ultrasound-guided foam sclerotherapy of symptomatic recurrent great saphenous varicose veins. Eur J Vasc Endovasc Surg. 2011;42(1):107–14.

    Article  CAS  PubMed  Google Scholar 

  25. Blaise S, Bosson JL, Diamond JL. Ultrasound-guided sclerotherapy of the great saphenous vein with 1% vs. 3% polidocanol foam: a multicentre double-blind randomised trial with 3-year follow-up. Eur J Vasc Endovasc Surg. 2010;39(6):779–86.

    Article  CAS  PubMed  Google Scholar 

  26. Gonzalez-Zeh R, Armisen R, Barahona S. Endovenous laser and echo-guided foam ablation in great saphenous vein reflux: one-year follow-up results. J Vasc Surg. 2008;48(4):940–6.

    Article  PubMed  Google Scholar 

  27. Rasmussen L, Lawaetz M, Serup J, et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy, and surgical stripping for great saphenous varicose veins with 3-year follow-up. J Vasc Surg Venous Lymphat Disord. 2013;1(4):349–56.

    Article  PubMed  Google Scholar 

  28. van der Velden SK, Biemans AA, De Maeseneer M, et al. Five-year results of a randomized clinical trial of conventional surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy in patients with great saphenous varicose veins. Br J Surg. 2015;102(10):1184–94.

    Article  PubMed  Google Scholar 

  29. Shadid N, Nelemans P, Dirksen C. Randomized clinical trial of ultrasound-guided foam sclerotherapy versus surgery for the incompetent great saphenous vein. Br J Surg. 2012;99(8):1062–70.

    Article  CAS  PubMed  Google Scholar 

  30. Gloviczki P, Comerta AJ, Dalsing MC. The care of patients with varicose veins and associated chronic venous disease: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5 Suppl):2S–48S.

    Article  PubMed  Google Scholar 

  31. Bush RG, Derrick M, Manjoney D. Major Neurological events following foam sclerotherapy. Phlebology. 2008;23(4):189–92.

    Article  CAS  PubMed  Google Scholar 

  32. Forlee MV, Grouden M, Moore DJ, Shanik G. Stroke after varicose vein foam injection sclerotherapy. J Vasc Surg. 2006;43(1):162–4.

    Article  PubMed  Google Scholar 

  33. Hahn M, Schultz T, Jünger M. Vasa. 2010;39(1):108–10.

    Article  CAS  PubMed  Google Scholar 

  34. Leslie-Mazwi TM, Avery LL, Sims JR. Neurocrit Care. 2009;11(2):247–50.

    Article  CAS  PubMed  Google Scholar 

  35. Wong M. Should foam made with physiologic gases be the standard in sclerotherapy? Phlebology. 2015;30(9):580–6.

    Article  CAS  PubMed  Google Scholar 

  36. Morrison N, Neuhardt DL, Rogers CR. Comparisons of side effects using air and carbon dioxide foam for endovenous chemical ablation. J Vasc Surg. 2008;47(4):830–6.

    Article  PubMed  Google Scholar 

  37. Carugo D, Ankrett DN, Zhao X, et al. Benefits of polidocanol endovenous microfoam (Varithena®) compared with physician-compounded foam. Phlebology. 2016;31(4):283–95.

    Article  PubMed  Google Scholar 

  38. Regan JD, Gibson KD, Rush JE, et al. Clinical significance of cerebrovascular gas emboli during polidocanol endovenous ultra-low nitrogen microfoam ablation and correlation with magnetic resonance imaging in patients with right-to-left shunt. J Vasc Surg. 2011;53(1):131–7.

    Article  PubMed  Google Scholar 

  39. Gibson K, Kabnick L. A multicenter randomized, placebo-controlled study to evaluate the efficacy and safety of Varithena® (polidocnaol endovenous microfoam 1%) for symptomatic, varicose veins with saphenofemoral junction incompetence. Phlebology. 2016;32(3):185–93. (epub ahead of print)

    Article  PubMed  PubMed Central  Google Scholar 

  40. U.S. Department of Health and Human Services, FDA, CDER, CBER, CDRH. Guidance for industry – patient-reported oucome measures: use in medical product development to support labeling claims. December 2009.

    Google Scholar 

  41. King JT, O’Byrne M, Vasquez M, Wright D, VANISH-1 Investigator Group. Treatment of truncal incompetence and varicose veins with single administration of a new polidocanol endovenous microfoam preparation improves symptoms and appearance. Eur J Vasc Endovasc Surg. 2015;50(6):784–93.

    Article  CAS  PubMed  Google Scholar 

  42. Todd KL III, Wright DI, VANISH-2 Investigator Group. The VANISH-2 study: a randomized, blinded, multicenter study to evaluate the efficacy and safety of polidocanol endovenous microfoam 0.5% and 1.0% compared with placebo for the treatment of saphenofemoral junction incompetence. Phlebology. 2014;29(9):608–18.

    Article  PubMed  Google Scholar 

  43. Todd KL, Wright D, Orfe E. The durability of polidocanol endovenous microfoam treatment effect on varicose vein symptoms and appearance in patients with saphenofemoral junction incompetence: one-year results from the VANISH-2 study. J Vasc Surg Venous Lymphat Disord. 2014;2(1):112.

    Article  PubMed  Google Scholar 

  44. FDA access data in: http://www.accessdata.fda.gov/drugsatfda_docs/nda/2013/205098Orig1s000SumR.pdf.

  45. Anwar MA, Lane TR, Davies AH, Franklin IJ. Complications of radiofrequency ablation of varicose veins. Phlebology. 2012;27(Suppl 1):34–9.

    Article  PubMed  Google Scholar 

  46. Dexter D, Kabnick L, Berland T, et al. Complications of endovenous lasers. Phlebology. 2012;27(Suppl 1):40–5.

    Article  PubMed  Google Scholar 

  47. Green D. Persistent post-sclerotherapy pigmentation due to minocycline. Three cases and a review of post sclerotherapy pigmentation. J Cosmet Dermatol. 2002;1(4):173–82.

    Article  CAS  PubMed  Google Scholar 

  48. Sarvananthan T, Shepherd AC, Willenberg T, Davies AH. Neurolgoical complication of sclerotherapy for varicose veins. J Vasc Surg. 2012;55(1):243–51.

    Article  PubMed  Google Scholar 

  49. Kern P, Ramelet AA, Wutschert R, Hayoz D. Compression after sclerotherapy for telangiectasias and reticular leg veins: a randomized controlled study. J Vasc Surg. 2007;45(6):1212–6.

    Article  PubMed  Google Scholar 

  50. Kulkarni SR, Slim FJ, Emerson LG, et al. Effect of foam sclerotherapy on healing and long-term recurrence in chronic venous leg ulcers. Phlebology. 2013;28(3):140–6.

    Article  CAS  PubMed  Google Scholar 

  51. Gloviczki P, Comerta A, Dalsing M, et al. The care of patients with varicose veins and associated chronic venous diseases: guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5 Suppl):2S–48S.

    Article  PubMed  Google Scholar 

  52. Masuda EM, Kessler DM, Lurie F, et al. The effect of ultrasound-guided sclerotherapy of incompetent perforator veins on venous clinical severity and disability scores. J Vasc Surg. 2006;43(3):551–6.

    Article  PubMed  Google Scholar 

  53. Whiteley AM, Taylor DC, Dos Santos SJ, Whiteley MS. Pelvic venous reflux is a major contributory cause of recurrent varicose veins in more than a quarter of women. J Vasc Surg Venous Lymphat Disord. 2014;2(4):411–5.

    Article  PubMed  Google Scholar 

  54. Daniels JP, Champaneria R, Shah L, Gupta JK, et al. Effectiveness of embolization or sclerotherapy of pelvic veins for reducing chronic pelvic pain: a systematic review. J Vasc Intervent Radiol. 2016;27(10):1478–86.

    Article  Google Scholar 

  55. Qui Y, Chen H, Lin X, et al. Outcomes and complications of sclerotherapy for venous malformations. Vasc Endovasc Surg. 2013;47(6):454–61.

    Article  Google Scholar 

  56. Varithena® Instructions for use: http://varithena.com/Portals/VarithenaHCP/assets/Varithena_Instructions_for_Use.pdf.

  57. Feied CF, Jackson JJ, Bren TS, et al. Allergic reactions to polidocanol for vein sclerosis. Two case reports. J Dermatol Surg Oncol. 1994;20(7):466–8.

    Article  CAS  PubMed  Google Scholar 

  58. Bzoza Z, Kasperska-Zajac A, Rogala E, Rogala B. Anaphylactoid reaction after the use of sodium tetradecyl sulfate: a case report. Angiology. 2007;58(5):644–6.

    Article  Google Scholar 

  59. Goldman MP, Sadick NS, Weiss RA. Cutaneous necrosis, telangiectatic matting, and hyperpigmentation following sclerotherapy: etiology, prevention, and treatment. Dermatol Surg. 1995;21(1):19–29.

    Article  CAS  PubMed  Google Scholar 

  60. Davis LT, Duffy DM. Determination of incidience and risk factors for postsclerotherapy telangectatic matting of the lower extremity: a retrospective analsyis. J Dermatol Surg Oncol. 1990;16(4):327–30.

    Article  CAS  PubMed  Google Scholar 

  61. Goldman MP, Kaplan RP, Duffy DM. Postsclerotherapy hyperpigmentation: a histologic evaluation. J Dermatol Surg Oncol. 1987;13(5):547–50.

    Article  CAS  PubMed  Google Scholar 

  62. Tafazzoli A, Rostan EF, Goldman MP. Q-switched ruby laser treatment for postsclerotherapy hyperpigmention. Dermatol Surg. 2000;26(7):653–6.

    Article  CAS  PubMed  Google Scholar 

  63. Mlosek RK, Wozniak W, Malinowska S, et al. The removal of post-sclerotherapy pigmentation following sclerotherapy alone or in combination with crossectomy. Eur J Vasc Endovasc Surg. 2012;43(1):100–5.

    Article  CAS  PubMed  Google Scholar 

  64. O’Donnell TF, Eaddy M, Raju A, et al. Assessment of thrombotic adverse events and treatment patterns associated with varicose vein treatment. J Vasc Surg Venous Lymphat Disord. 2015;3(1):27–35.

    Article  PubMed  Google Scholar 

  65. Willenburg T, Smith PC, Shepherd A, Davies AH. Visual disturbance following sclerotherapy for varicose veins, reticular veins and telangiectasias: a systematic literature review. Phlebology. 2013;28(3):123–31.

    Article  Google Scholar 

  66. Frullini A, Felice F, Burchielli S, Di Stefano R. High production of endothelin after foam sclerotherapy: a new pathogenetic hypothesis for neurological and visual disturbances after sclerotherapy. Phlebology. 2011;26(5):203–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Lake Washington Vascular Surgeons, 1135 116th Ave NE, Suite 305, Bellevue, WA, 98004, USA

    Kathleen Gibson MD, FACS

Authors
  1. Kathleen Gibson MD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kathleen Gibson MD, FACS .

Editor information

Editors and Affiliations

  1. Section of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA

    Cassius Iyad Ochoa Chaar

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Gibson, K. (2018). Sclerotherapy. In: Chaar, C. (eds) Current Management of Venous Diseases . Springer, Cham. https://doi.org/10.1007/978-3-319-65226-9_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-65226-9_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-65225-2

  • Online ISBN: 978-3-319-65226-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation