Sclerotherapy is a useful adjunct to varicose vein ablation as well as a highly effective primary treatment for telangiectasias and associated reticular veins. Patients with axial varicosities often also have large numbers of small reticular veins and telangiectasias. Sclerotherapy presents a rapid, effective, and cosmetically acceptable treatment that is particularly attractive in patients with very extensive networks of small abnormal veins (Figure 13-1).
Extensive network of protuberant telangiectatic webs, most efficiently treated by sclerotherapy A. Before treatment. B. After two sessions of sclerotherapy with 0.1 percent foamed sotradecol® in the feeder vein and 72 percent glycerin in the telangiectasia.
Isolated small reticular veins and telangiectasias often cause severe symptoms that are worsened by prolonged standing or sitting, and that may be relieved by wearing support hose or by elevation of the legs.1 Vein size alone does not predict the presence of symptoms. Vessels causing symptoms may be as small as 1 mm in diameter or less.2 Besides symptoms of pain, burning, and fatigue, the appearance of the telangiectatic veins may be so disturbing that patients curtail their activities and modify their lifestyles to avoid situations in which their legs may be seen. Sclerotherapy not only offers the possibility of remarkably good cosmetic results but also has been reported to yield an 85 percent reduction in symptoms (Figures 13-2 and 13-3).3
Good cosmetic results and symptomatic improvement after sclerotherapy of painful telangiectasias. A. Before treatment. B. After three sessions using 0.1 percent sodium tetradecyl sulfate in the telangiectasias and 0.2 percent foamed sodium tetradecyl sulfate in the feeding reticular vein. Polidocanol 0.25% liquid for the telangiectasias and polidocanol 0.5% foam for the feeder could have been utilized as well.
Patient with painful residual telangiectasias after greater saphenous vein treatment. A. Before treatment. B. After three sessions with 72 percent glycerin.
A substantial investment of time and effort is required to develop expertise in sclerotherapy of veins of any size. Prior experience with venipuncture helps very little with treatment of larger veins and is completely irrelevant in the treatment of the smallest veins. Many physicians believe that expertise in venipuncture automatically confers expertise in sclerotherapy, which could not be further from the truth. Successful treatment requires the correct technique, diagnosis, and treatment plan for the type and size of vein to be treated. The procedure is mastered by reading written descriptions of proper technique and by observing and emulating the meticulous technique of skilled physicians. Many different techniques have been used in the treatment of small veins, but certain basic principles are universal.4–8