Sclerotherapy for Varicose Vein
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 different categories of sclerosant available, their mechanism of action and 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.)
| Sclerosant Category | Various Agents | Mechanism Of Action | Keypoints |
|---|---|---|---|
| DETERGENT SOLUTIONS | 1. Sodium Morrhuate (SM) 2. Ethanolamine Oleate (EO) 3. Sodium Tetradecyl sulfate (STS) 4. Polidocanol (POL) | 1. Micelles formation - Hydrophobic part stay away from water and hydrophilic part is within water. 2. Destructive action is enhanced in micelle formation rather than monomer form. 3. Immediate Action | 1. Strong detergent has a low safety margin 2. Destructive action is enhanced when they act as aggregates. 3. Aggregate to significant extend at lower temperature. 4. No change in clotting, PT or PTT values except POL (prolong aPTT) 5. Direct toxicity towards granulocytes and RBC. 6. Endosclerosis occur via damage to endothelium and not by WBC/RBC destruction mediated thrombsis. |
| OSMOTIC SOLUTIONS | 1. Sodium Salicylate 40% 2. Sodium Chloride 10%/ Sodium Salicylate 30% 3. Invert Sugar 75% 4. Saccharose 5% 5. Phenol 1% 6. Dextrose 66% 7. Sodium Chloride 20% 8. Sodium Salicylate 30% 9. Glycerin | 1. Dehydration of endothelial cell via osmosis. 2. Action starts after at least 3 mins | 1. Damage starts from 30 minutes to 4 days. 2. Greatest effect at injection site, distal dilution of agent occurs due to serum and blood. 3. Osmotic solution should in enough concentration to diffuse through entire vessel wall for optimal destruction of endothelium 4. Punctate pigmentation at point of Injection. 5. No desquamation of damaged endothelium. |
| CHEMICAL SOLUTIONS | Polyiodinated iodine (PII) 4% | 1. Direct action on endothelium causing endo-sclerosis. 2. Immediate Action | 1. Irreversible destruction of endothelial cells with resultant thrombus formation on sub endothelial layer. 2. Dissolution of intracellular cement after 30 seconds of exposure |
2. Sclerotherapy: Treatment of Varicose and Telangiectatic Leg Veins 6th edition