Sclerotherapy for Varicose Vein (Osmotic and Chemical Solutions)
Sclerotherapy is a minimally invasive medical procedure used to treat varicose veins. This non-surgical technique involves the injection of a sclerosant directly into the affected veins. The solution causes endothelial injury and endo-sclerosis on the injected vein. Endothelial destruction is both dose and time -dependent. Following are few examples of osmotic and chemical sclerosant available and their key points. ¹
(Terminology associated with varicose veins, CEAP classification , adverse effect of sclerotherapy and other publications can be seen by clicking on the link.)
| Agent | Vein diameter recommendation (if any) | Keypoints | Adverse Effect |
|---|---|---|---|
| Hypertonic Saline (HS) | 1. Effective Vein diameter = 3-4 mm 2. Modification by addition heparin to reduce thrombosis | 1. Lack of Allergenicity of unadulterated HS 2. Degree of Endothelial damage and RBC extravasation is directly proportional to concentration of HS | 1. Ulceration - spread of HS in extravascular space - avoid by using correct injection technique
2. Muscle cramping and Pain - diffusion of HS to some extent to vessel wall and nerves in adventitia of vein 3. Post treatment Pigmentation - occur due to RBC hemolysis (hyperosmosis) and diffusion of hemosiderin across the damaged endothelium |
| Hypertonic Glucose- Saline | Mainly used for telangiectasias and small-diameter superficial varicosities. | 1. Less pain and RBC extravasation due to decreased concentration of NaCl 2. Avoid drawing back blood to confirm venous location (change is consistency) | 1. Painful (less than HS) 2. Superficial Necrosis (Rare) 3. Post-sclerotherapy Pigmentation 4. Allergic reaction to phenethyl alcohol component (Rare) |
| Glycerin: Chromated and Non-Chromated | 1. Concentration varying from 25-100% 2. Excellent results for treatment of leg veins < 1mm in diameter | 1. Clinical efficacy is dose dependent. 2. Mainly used for telangiectasias 3. Pigmentation and cutaneous necrosis are rare at recommended doses. | 1. High Viscosity and Local Pain 2. CG Component = Allergen and causes hypersensitivity reactions (Rare) 3. Hematuria = associated with ureteral colic (due large dose) 5. Reactive Hypoglycemia (due to glycerin component) - Extremely rare |
| Polyiodinated Iodine | usually mixed with either normal saline or solution of dextrose before injecting. | More pain and high chances for cutaneous necrosis |
2. Sclerotherapy: Treatment of Varicose and Telangiectatic Leg Veins 6th edition