Is sclerotherapy an effective treatment for varicose veins?

An article on the procedures, chemical agents, complications, and cost of sclerotherapy. Other treatment for varicose veins.

Varicose veins are unsightly, tortuous, and dilated veins commonly found in the legs and causes complications like emotional distress (damage to self-image), leg swelling, pain, chronic leg ulcers, rupture, bleeding and may be a source of heart attack  or stroke from a travelled blood clot called embolus. Varicosity can also occur in the esophagus, testes (varicocele), anus (hemorrhoids) and stomach but the commonest sites you can find varicose veins are the legs. It is commoner in females than males.

Other names for varicose veins are “green veins”, and “spider veins”.

Many treatment options have been advocated for curing varicose veins like
sclerotherapy, venous stripping,  use of creams like varikosette and laser therapy.

Today, the essay below will discuss the effectiveness of sclerotherapy for treating varicosity.

 

Procedures, chemical agents, cost & complications of sclerotherapy

The use of chemical  irritating agents to obliterate the varices has been advocated for long but the current reactivation of interest and increasing popularity of the method has been due the advent of more effective and perhaps less toxic sclerosants. Sclerotherapy is suitable for small varices with minimal development of incompetent perforators.

Patients presenting early with sapheno-femoral incompetence(varicose veins) may also be treated by injection after ligation of the saphenous vein at the groin. The method is particularly suited to the management of residual small varices that may follow definitive surgery (venous stripping) for varicose veins.

It is contraindicated in the presence of atherosclerosis, thrombophlebitis, infection, allergic states and in pregnancy.

Currently the sclerosant medium of choice is sodium tetradecyl sulphate (sotradecol) used as 3 % solution in a foam form. The modern technique aims at inducing adhesion between
the damaged opposing vein intima rather than thrombosis; this
latter is unavoidable but it should be minimal.

To this extent the sclerosant is injected into collapsed vein.
To a 0.5ml solution in a 1 ml syringe, 0.5ml of air is aspirated and shaken thoroughly to achieve a foam mixture . The patient stands to make the veins prominent and using a 25 gauge
needle, a vein is entered after a further 0.25ml of air has been aspirated into the syringe, the latter being used to check against paravenous injection. The foam mixture is then injected into the vein with the patient lying down and the leg elevated.

A small felt roll is then applied to ensure coaption of the vessel walls. The leg is placed in the horizontal position and further pressure applied by means of a sphygmomanometer cuff inflated to 10mmHg above the diastolic pressure for about 2 minutes.
Several points may need injecting but a maximum of 5ml of sodium tetradecyl sulphate at a time should not be exceeded.
It is recommended that the technique is not used above the mid thigh because of proximity to the saphena-femoral junction.
An elastic bandage is firmly applied from the base of the toes to the upper thigh . This may be loosened after 24 hours but should be kept on for a minimum of 6 weeks. Elastic compression stocking may also be used.

When cases are satisfactorily selected, the results of sclerotherapy are encouraging with minimal recurrence rate. 

The real problems of sclerotherapy are due to faulty technique and occur when a substantial volume of sclerosant is injected outside the lumen of the vein.

Accidental injection of sclerosant
in significant quantities into the deep veins can lead to marked thrombophlebitis progressing to deep vein thrombosis and on occasion, fatal embolism.

Patients with moderate varicosities who have sapheno-femoral incompetence may be treated by ligation of the
saphenous vein below the sapheno-femoral junction under local anaesthesia prior to treatment of the varicosities by sclerotherapy. Such cases are suitable for ambulatory or day case
surgery.

In recent years, such cases of sapheno-femoral incompetence are being safely managed by transcatheter duplex-ultrasonographic guided sclerotherapy. The results are encouraging.

However, the efficacy of injection sclerotherapy is still debated because of the high recurrence rate especially in grossly dilated veins and some centres have given it up. They are now useful for the obliteration of small varicosities and venous flares.

Sclerotherapy is most times not done in one session and the total cost of the injection sclerotherapy procedure is dependent on the the number of sessions.  A session of sclerotherapy cost around #100,000 to #120,000 naira. 3-5 sessions is then around #300,000 to #500,000 naira.

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