Enter the characters you see below Sorry, we just need to make sure you’re not a robot. A medicine is injected into the vessels, which makes them shrink. Sclerotherapy has been used in the treatment of spider veins and occasionally varicose veins for over 150 years. Like varicose vein surgery, sclerotherapy techniques have evolved during that time. Modern techniques including ultrasonographic guidance and foam sclerotherapy are the latest developments in this evolution.
The first reported attempt at sclerotherapy was by D Zollikofer in Switzerland, 1682 who injected an acid into a vein to induce thrombus formation. Both Debout and Cassaignaic reported success in treating varicose veins by injecting perchlorate of iron in 1853. Work continued on alternative sclerosants in the early 20th century. During that time carbolic acid and perchlorate of mercury were tried and whilst these showed some effect in obliterating varicose veins, side-effects also caused them to be abandoned. Sicard and other French doctors developed the use of sodium carbonate and then sodium salicylate during and after the First World War.
Further work on improving the technique and development of safer more effective sclerosants continued through the 1940s and 1950s. 1946, a product still widely used to this day. The next major development in the evolution of sclerotherapy was the advent of duplex ultrasonography in the 1980s and its incorporation into the practise of sclerotherapy later that decade. Knight was an early advocate of this new procedure and presented it at several conferences in Europe and the United States.
The work of Cabrera and Monfreaux in utilising foam sclerotherapy along with Tessari’s “3-way tap method” of foam production further revolutionised the treatment of larger varicose veins with sclerotherapy. Injecting the unwanted veins with a sclerosing solution causes the target vein to immediately shrink, and then dissolve over a period of weeks as the body naturally absorbs the treated vein. Sclerotherapy is a non-invasive procedure taking only about 10 minutes to perform. The downtime is minimal, in comparison to an invasive varicose vein surgery. Unlike a laser, the sclerosing solution additionally closes the “feeder veins” under the skin that are causing the spider veins to form, thereby making a recurrence of the spider veins in the treated area less likely. Sclerotherapy can also be performed using microfoam sclerosants under ultrasound guidance to treat larger varicose veins, including the great and small saphenous veins.
After a map of the patient’s varicose veins is created using ultrasound, these veins are injected whilst real-time monitoring of the injections is undertaken, also using ultrasound. The original Tessari method has now been modified by the Whiteley-Patel modification which uses 3 syringes, all of which are silicone free. Padbury and Benveniste found that ultrasound guided sclerotherapy was effective in controlling reflux in the small saphenous vein. A Cochrane Collaboration review of the medical literature concluded that “the evidence supports the current place of sclerotherapy in modern clinical practice, which is usually limited to treatment of recurrent varicose veins following surgery and thread veins. A Health Technology Assessment found that sclerotherapy provided less benefit than surgery, but is likely to provide a small benefit in varicose veins without reflux from the sapheno-femoral or sapheno-popliteal junctions. It did not study the relative benefits of surgery and sclerotherapy in varicose veins with junctional reflux. The European Consensus Meeting on Foam Sclerotherapy in 2003 concluded that “Foam sclerotherapy allows a skilled practitioner to treat larger veins including saphenous trunks”.
A second European Consensus Meeting on Foam Sclerotherapy in 2006 has now been published. If the sclerosant is injected properly into the vein, there is no damage to the surrounding skin, but if it is injected outside the vein, tissue necrosis and scarring can result. Skin necrosis, whilst rare, can be cosmetically “potentially devastating”, and may take months to heal. Most complications occur due to an intense inflammatory reaction to the sclerotherapy agent in the area surrounding the injected vein. In addition, there are systemic complications that are now becoming increasingly understood. These occur when the sclerosant travels through the veins to the heart, lung and brain. Saphenofemoral incompetence treated by ultrasound-guided sclerotherapy”. Fegan’s Compression Sclerotherapy of Varicose Veins, Hardcover Text, 2003.
Coppleson VM, The Treatment of Varicose Veins by Injection, Hardcover text,2nd Ed 1929. A, Ultrasonic guidance of injection into the superficial venous system. Part 2: Injection of incompetent perforating veins using ultrasound guidance. Cabrera Garrido Jr, Cabrera Garcia-Olmeda Jr, Garcia-Olmedo Dominguez MA. Elargissment des limites de la schleotherapie: Nouveaux produits sclerosants. Monfreux A, Traitement sclerosant des trones saphen’nies et collaterales de gros calibre par le method MUS. Modified Tessari Tourbillon technique for making foam sclerotherapy with silicone-free syringes. Archived from the original on 2011-09-17. Sadick N, Sorhaindo L, Laser Treatment of Telangiectatic and Reticular Veins, Ch 16, p157.
Comparative study of duplex-guided foam sclerotherapy and duplex-guided liquid sclerotherapy for the treatment of superficial venous insufficiency”. Sclerosing Foam in the Treatment of Varicose Veins and Telangiectases: History and Analysis of Safety and Complications”. Trenaunay syndrome with ultrasound-guided foam sclerotherapy”. CS1 maint: Explicit use of et al. Surgery versus sclerotherapy for the treatment of varicose veins”. Michaels JA, Campbell WB, Brazier JE, et al.
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