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SCLEROTHERAPY: MANAGEMENT AND TREATMENT OF VARICOSE VEINS
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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.
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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.
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Expert Tips
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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.
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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.
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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.
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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.
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Primary care clinicians are presented with varicose veins on a daily basis. They 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.
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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 33-1). Using this classification, chronic venous insufficiency is generally restricted to disease of greater severity (ie, classes C4 to 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 (Figure 33-1). 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 on the population evaluated, men may have a higher rate of disease.5-7
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