Skip to Main Content

SCLEROTHERAPY: MANAGEMENT AND TREATMENT OF VARICOSE VEINS

image

SUMMARY

  • Sclerotherapy is a highly effective technique for the treatment of varicose veins.

  • Sclerosants may be divided based on whether they exert osmotic or detergent effects on the vessels.

  • Both liquid and foam sclerotherapy may be used, depending on vessel caliber.

image Beginner Tips

  • Common sclerosants include sodium tetradecyl sulfate (STS), polidocanol, and hypertonic saline.

  • Larger caliber vessels may benefit from foam sclerotherapy, which can be prepared immediately prior to use.

image Expert Tips

  • Vessels should be treated from deep to superficial.

  • Treating with Nd:YAG laser after sclerotherapy may be helpful and lead to markedly increased levels of response.

image Don’t Forget!

  • Maintaining or increasing activity in the postprocedure period is of vital importance.

  • Superficial thrombophlebitis is common after surgery, and localized urticarial reactions may be seen as well.

image Pitfalls and Cautions

  • Microemboli are frequently seen after foam sclerotherapy, and vision changes, while rare, are possible.

  • DVT is a significant risk post treatment, and patients should be warned of this risk.

image Patient Education Points

  • The risk of DVT and vision changes, while unusual, should be discussed at length with all patients.

  • Compression stockings are very helpful in the postoperative period, and ace wraps should be avoided.

image Billing Pearls

  • In the United States, insurance generally does not cover sclerotherapy, even when performed for symptomatic patients. Motivated patients with symptomatic disease may wish to contact their insurer to assess coverage.

INTRODUCTION

Varicose veins are a common problem, and represent a symptom of chronic venous disease that encompasses a wide spectrum of morphologic (venous dilation) and functional (venous reflux) abnormalities.1–3 Vein-related problems may be symptomatic, and range from minimal superficial venous dilation to chronic skin changes with ulceration.

Depending on associated signs and symptoms, chronic venous disease manifestations have been stratified in classes from C0 to C6 based on the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification (Table 72-1). Using this classification, chronic venous insufficiency is generally restricted to disease of greater severity (i.e., classes C4–C6).4 Thus, varicose veins (CEAP category 2) in the absence of skin changes are not indicative of true chronic venous insufficiency. They are dilated, elongated, tortuous, subcutaneous veins 3 mm or greater in diameter that may involve the saphenous veins (great or small), saphenous tributaries, or nonsaphenous superficial leg veins (Fig. 72-1). Varicose veins are present in 10% to 30% of the general population, with increasing rates in older individuals.5,6 Although they are generally thought to be more common in women than men, depending upon the population evaluated, men may have a higher rate of disease.5–7

Table 72-1.CEAP Classification1

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.