0.5% polidocanol for treatment of varicose veins

Background: The use of sclerosants approved by the US Food and Drug Administration for treatment of varicose veins, including sodium morrhuate, ethanolamine oleate, and sodium tetradecyl sulphate, has resulted in complications that include allergic reactions and occasional deaths. Polidocanol, which has not been approved by the Food and Drug Administration, has been well studied and well described in the literature as a safer, more effective sclerosant for varicose veins at 3.0% concentration. Objective: The purpose of this study was to examine the efficacy of 0.5% polidocanol as a sclerosant for varicose veins. Methods: A test dose of polidocanol is injected 1 week before the start of treatment to test for allergic response. Sclerotherapy sessions last 10 minutes, and an average of 10 to 20 mL of 0.5% polidocanol is injected through use of 30-gauge half-inch tuberculin syringes. The treated varicosities are compressed with Coban wrap and compression hosiery for 48 hours after treatment and with compression hosiery alone for another 2 weeks. Results: Having performed approximately 1600 sclerotherapy sessions using 0.5% polidocanol over the last 6 years, I have observed that an average of 3 sclerotherapy sessions are required to attain an 80% to 85% improvement in varicose veins. The number of sessions required for successful treatment ranged from 1 to 15. Results have been long lasting. Localized thrombus formation and hyperpigmentation occurred in some degree in every treated patient but generally did not require treatment for resolution. No ulcerations, pulmonary emboli, or anaphylactic reactions were observed. Superficial chemical thrombophlebitis occurred in 3 patients. Conclusions: Polidocanol is a painless, nonscarring, effective treatment for a condition that previously has been treated surgically. The minimal sclerosant concentration for the treatment of varicose veins is 0.5%.     

Comparative Trial Between Sodium Tetradecyl Sulfate and Glycerin in the Treatment of Telangiectatic Leg Veins

BACKGROUND: Thirteen patients were treated with either sodium tetradecyl sulfate (STS) or glycerin to compare the efficacy and adverse sequelae of each agent. OBJECTIVE: To determine the relative safety and efficacy of two sclerosant solutions. METHODS: Each patient's leg veins that were from 0.2 to 0.4 mm in diameter and that did not have incompetence from the saphenofemoral junction and whose feeding reticular veins had been already treated in a prior sclerotherapy session were randomly treated with either 0.25% STS or 72% glycerin solution. Patients were evaluated from 2 to 6 months postsclerotherapy for overall clinical improvement and incidence of adverse sequelae. RESULTS: Glycerin was comparable to STS in discomfort of injection but demonstrated a significant decrease in bruising, swelling, and postprocedural hyperpigmentation. Glycerin also demonstrated a better, more rapid clearance of treated telangiectasias. CONCLUSIONS: Seventy-two percent glycerin is a safe and effective sclerosant with fewer side effects and more rapid clearance of telangiectatic leg veins than STS.     

Efficacy and safety of great saphenous vein sclerotherapy using standardised polidocanol foam (ESAF): a randomised controlled multicentre clinical trial.

AIM: To assess the safety and efficacy of sclerotherapy of the great saphenous vein (GSV) comparing standardised polidocanol foam to liquid polidocanol in a randomised controlled trial (RCT). METHODS: A multicentre randomised controlled clinical trial was carried out in which saphenous trunks were treated by sclerotherapy. 106 patients with primary varicose veins due to an incompetent GSV were treated with either standardised 3% polidocanol foam or 3% liquid polidocanol. The primary efficacy criterion was elimination of reflux (<0.5 sec) measured 3 cm below the sapheno-femoral junction (SFJ) by duplex ultrasonography 3 months after the last injection. RESULTS: A significantly greater number of patients were successfully treated by foam sclerotherapy resulting in 69% elimination of reflux compared to 27% patients treated with liquid sclerosant. The secondary endpoints of vein occlusion, reflux time, refilling time and patient satisfaction also improved significantly more in the foam group. The mean number of treatment sessions was 1.3 in the foam group compared to 1.6 in the liquid group. Differences between study centres occurred with a mean of 96% reflux elimination in 6 centres versus 39% in 4 other centres. Centres with a high response rate injected a higher mean volume (4.3 vs. 3.6 ml) in the first session in a vein with a smaller diameter (7.5 mm vs. 8.4 mm). No difference in adverse drug reactions was observed between treatment groups. CONCLUSIONS: Standardised 3% polidocanol foam is more efficient and equally safe compared to 3% liquid polidocanol for treatment of GSV. In comparison to other studies a relatively small volume was injected into relatively large veins.     

Efficacy of sclerotherapy in varicose veins-- prospective, blinded, placebo-controlled study.

OBJECTIVE: The objective of this study was to investigate the efficacy of sclerotherapy for varicose veins in a randomized blinded study. METHODS: Twenty-five patients with varicose veins (C(2-4), E(P), A(SP), P(R)) were included. Fourteen subjects received polidocanol (Aethoxysklerol) and 11 patients received normal saline injections. Compression was applied for 1 week. One, 4, and 12 weeks later controls were performed using duplex ultrasonography. The quotient of venous by arterial volume flow was used as quantitative hemodynamic pattern. Patients and the examiner were unaware of which liquid had been injected. RESULTS: In comparison to group 2, 76.8% of the veins treated with polidocanol were completely occluded (p<0.0001). In group 1 the venoarterial flow index decreased from 1.45+/-0.66 to 1.06+/-0.2 (p=0.05). In 11 occluded veins of 14 (group 1), the venoarterial flow index decreased from 1.5+/-0.07 to 0.98+/-0.12 (p<0.05), which is a level found in competent veins. In group 2, the venoarterial flow index remained stable increased. CONCLUSIONS: Injection sclerotherapy using polidocanol (Aethoxysklerol) is efficient to obliterate varicose veins and to improve venous hemodynamics.     

Treatment of Varicose and Telangiectatic Leg Veins: Double-Blind Prospective Comparative Trial Between Aethoxyskerol and Sotradecol

BACKGROUND: One hundred twenty-nine patients were treated with either polidocanol (POL) or sodium tetradecyl sulfate (STS) to compare the efficacy and adverse sequelae of each agent. OBJECTIVE: To determine the safety and efficacy of two sclerosing solutions. METHODS: Each patient's leg veins that did not have incompetence from the saphenofemoral junction (SFJ) were divided into three categories by size (<1 mm, 1-3 mm, 3-6 mm). Each leg was randomly treated with either 0.25%, 0.5%, or 1.5% of STS or 0.5%, 1.0%, or 3% of POL respective of size. An independent, three-panel, blindly randomized photographic examination was obtained pretreatment and at 4 and 16 weeks. Patient satisfaction index and overall clinical improvement assessment were also obtained. RESULTS: All patients had an average of 70% improvement and were 70-72% satisfied in all vein categories treated with either solution. There was no significant difference in adverse effects between each group except for a decrease in ulcerations and swelling in the POL group. CONCLUSION: Both STS and POL are safe and effective sclerosing solutions for varicose and telangiectatic leg veins.     

Efficacy of Sclerotherapy in Varicose Veins—A Prospective, Blinded, Placebo-Controlled Study

Objective. The objective of this study was to investigate the efficacy of sclerotherapy for varicose veins in a randomized blinded study.
Methods. Twenty-five patients with varicose veins (C_2-4, E_P, A_SP, P_R) were included. Fourteen subjects received polidocanol (Aethoxysklerol) and 11 patients received normal saline injections. Compression was applied for 1 week. One, 4, and 12 weeks later controls were performed using duplex ultrasonography. The quotient of venous by arterial volume flow was used as quantitative hemodynamic pattern. Patients and the examiner were unaware of which liquid had been injected.
Results. In comparison to group 2, 76.8% of the veins treated with polidocanol were completely occluded ( p <0.0001). In group 1 the venoarterial flow index decreased from 1.45±0.66 to 1.06±0.2 ( p =0.05). In 11 occluded veins of 14 (group 1), the venoarterial flow index decreased from 1.5±0.07 to 0.98±0.12 ( p <0.05), which is a level found in competent veins. In group 2, the venoarterial flow index remained stable increased.  

Conclusions.

Injection sclerotherapy using polidocanol (Aethoxysklerol) is efficient to obliterate varicose veins and to improve venous hemodynamics.     

Double-Blind Prospective Comparative Trial between Foamed and Liquid Polidocanol and Sodium Tetradecyl Sulfate in the Treatment of Varicose and Telangiectatic Leg Veins

BACKGROUND: Twenty subjects were treated with either polidocanol (POL) or sodium tetradecyl sulfate (STS) to compare the efficacy and adverse sequelae of each agent. OBJECTIVE: To determine the safety and efficacy of two widely used sclerosing agents. METHODS: After the exclusion of saphenofemoral junction incompetency, each subject's leg veins were categorized by size (< 1, 1-3, and 3-6 mm in diameter). Each leg was then randomized to be treated with 0.5%, 1%, or 1% foam of POL or 0.25%, 0.5%, or 0.5% foam of STS according to vein size. An independent panel of four physicians, blinded to treatment, performed randomized photographic evaluations obtained pretreatment and 12 weeks post-treatment. Subject satisfaction index and overall clinical improvement assessment were also obtained. RESULTS: An average 83% improvement was noted for all vein sizes in all subjects with both POL and STS after a single treatment. Subjects were satisfied with treatment, regardless of the sclerosing agent used or the vein size treated. There was no statistically significant difference in adverse effects between each group. CONCLUSION: Both POL and STS are safe and effective sclerosing agents in the treatment of varicose and telangiectatic leg veins. Both are very tolerable and demonstrate similar post-treatment sequelae.     

Veränderung der venösen Funktion nach Schaumsklerosierung der Varikose

Objective

Foam sclerotherapy of varicose veins has recently proven to be an effective, economical, and safe treatment modality. The present study attempted to evaluate the hemodynamic changes after sclerotherapy and the clinical results.

Methods

In a prospective observational trial, 67 sites (two-thirds of which were recurrent varicose veins after previous treatment) in 53 patients were treated with polidocanol foam, and the results were assessed clinically and by duplex sonography, photoplethysmography, and strain gauge plethysmography.

Results

With the exception of two sites (3%), all treatments resulted at least in an improvement, and about 80% of the treated veins were completely occluded as demonstrated by duplex ultrasound examination. The hemodynamic results accordingly reflected a significant improvement of the venous function. There was no relationship between the results and the size of the treated vessel or whether a primary or recurrent varicose vein was treated. Only patients with postthrombotic syndrome showed poorer results.

Conclusion

Foam sclerotherapy is a highly effective and safe method for treating primary and recurrent varicose veins.     

Duplex Ultrasonography–Guided Foam Sclerotherapy of Incompetent Perforator Veins in a Patient with Bilateral Venous Leg Ulcers

BACKGROUND: Recent advances in the form of foam sclerotherapy have extended the indications for sclerotherapy in the treatment of varicose veins. OBJECTIVES: (1) To see if perforator veins can be closed by using foam sclerotherapy; (2) to evaluate whether using foam sclerotherapy for treatment of incompetent perforator veins has an influence on venous leg ulcer healing. METHODS: Incompetent perforator veins above bilateral venous leg ulcers were treated with duplex ultrasonography-guided sclerotherapy using polidocanol foam. RESULTS: After 4 days, significant improvement in the ulcers was visible; after 10 days, one ulcer had closed; and within 3 weeks, both ulcers were closed. Control duplex ultrasonography showed closed perforator veins. CONCLUSION: This case illustrates that duplex ultrasonography-guided foam sclerotherapy is an effective and minimally invasive way of treating incompetent perforator veins. The fast healing of the venous leg ulcers in this case report indicates that foam sclerotherapy could be a promising addition in the treatment of venous leg ulceration with incompetent perforator veins.     

Perforans Varicosis: Treatment of the Incompetent Perforating Vein Is Important

BACKGROUND: Varicose veins that arise from incompetent perforating veins are called perforans-varicosis. OBJECTIVE: This case report illustrates the relationship between incompetent perforating veins and varicosis. METHODS: An incompetent perforating vein, proximal of a varicose vein located at the dorsal side of the thigh, was treated by means of ultrasound-guided sclerotherapy with 1% polidocanol foam. The varicose vein was not treated. RESULTS: After 1 week, the varicose vein and the incompetent perforating vein showed no reflux. The varicose vein was practically invisible. The residual vein was treated with sclerotherapy. After 6 weeks the varicose vein was still invisible. CONCLUSION: This proximal incompetent perforating vein was important for the development and maintenance of the varicose vein. Treatment of this incompetent perforating vein resulted in complete disappearance of the reflux in the varicose vein. In this case ultrasound-guided sclerotherapy was successful in treating the incompetent perforating vein. More studies are needed to investigate the long-term effect of ultrasound-guided sclerotherapy as treatment of perforans-varicosis.     

Sclerosing Foam in the Treatment of Varicose Veins and Telangiectases: History and Analysis of Safety and Complications

OBJECTIVE: To review the use of sclerosing foam in the treatment of varicose veins, to describe the different techniques of foam preparation, and to report the complications of our 3-year experience with this treatment. METHOD: From November 1997 to the end of October 2000, 453 patients were treated with a sclerosing foam for large, medium, and minor varicosities with sodium tetradecylsulfate (STS) or polidocanol (POL). A first group of 257 patients (90 for minor varicosities and 167 for medium to large veins) received a sclerosing foam according to the Monfreux technique. From December 1999 to October 2000, 196 patients were treated with a sclerosing foam prepared according to Tessari's method (36 for minor size veins or teleangectasias and 170 for medium-large veins). Every patient was studied with (color-flow) duplex scanning before and after the treatment and large vein injections were administered under duplex guide. RESULTS: The immediate success rate was 88.1% in the first group for the medium-large veins. In the same districts we registered an early success rate in 93.3% for the patients treated with the Tessari's method. The complication rate (mostly minor complications) was 8.5% in the first group and 7.1% in the second group. CONCLUSION: The use of sclerosing foam may become an established therapy in the treatment of varicose veins with a high success rate, low cost, and low major complication rate. According to our actual experience and knowledge, the safe amount of foam should not exceed the 3-ml limit, but further advancements could come from standardization of the foam preparation technique.     

Comparative Study of Duplex-Guided Foam Sclerotherapy and Duplex-Guided Liquid Sclerotherapy for the Treatment of Superficial Venous Insufficiency

PURPOSE: To compare the preliminary results of hemodynamic changes between duplex-guided foam sclerotherapy and duplex-guided liquid sclerotherapy. METHODS: Seventy Seven limbs in 77 patients with isolated greater saphenous vein incompetence were treated with duplex-guided sclerotherapy. Thirty Seven limbs were treated with duplex-guided foam sclerotherapy and the remaining 40 limbs were treated with duplex-guided liquid sclerotherapy. Pretreatment exam was performed using a color duplex scanner and air plethysmography. The sclerosing foam was produced by Tessari's method using 1% and 3% polidocanol. The varicose vein was injected with 2 mL of 1% polidocanol or 1% polidocanol foam, and then 1 mL of 3% polidocanol or 3% polidocanol foam was injected into the greater saphenous vein under duplex guidance. Venous obstruction and recanalization were screened by serial posttreatment duplex examination, and posttreatment air plethysmography analysis was performed 3, 6, 9, and 12 months after the sclerotherapy. RESULTS: Duplex scanning demonstrated complete occlusion in the greater saphenous vein for duplex-guided foam sclerotherapy in 25 limbs (67.6%), which was a significantly higher proportion than for the duplex-guided liquid sclerotherapy (7 limbs, 17.5%, p<0.0001). Recurrent varicose veins were found in 3 patient (8.1%) in the duplex-guided foam sclerotherapy group and 10 (25%) in the duplex-guided liquid sclerotherapy group at 1-year (p=0.048). In duplex-guided foam sclerotherapy, venous filling index values remained normal during the subsequent follow-up examinations, whereas in duplex-guided liquid sclerotherapy, venous filling index began to increase, and there was a significant difference at 6 months between duplex-guided foam sclerotherapy and the duplex-guided liquid sclerotherapy (p<0.0005). At 9 months, there was a significant difference in the residual venous fraction between the two groups, and the residual venous fraction value continued to improve in duplex-guided foam sclerotherapy (p=0.033). CONCLUSIONS: Duplex-guided foam sclerotherapy could have greater promise compared to duplex-guided liquid sclerotherapy in the treatment of superficial venous insufficiency.     

A study of the local toxicity of agents used for variceal injection sclerotherapy

Injection sclerotherapy is widely used in the treatment of oesophageal varices. However, few studies have compared the local toxicity of sclerosant agents which may be important if serious local complications are to be avoided. In this study the depth of injury caused by submucosal injection of increasing concentrations of sodium tetradecyl sulphate, polidocanol, 5% ethanolamine oleate and 5% varicosid in rabbits stomach, has been compared by histopathological examination. Macroscopic ulceration was seen in 14.6% of injection sites. Increasing concentrations of sodium tetradecyl sulphate and polidocanol produced increasingly extensive microscopic inflammation. Five percent varicosid caused more inflammation than 5% ethanolamine and only 3% polidocanol and 5% varicosid caused full thickness inflammation. Only 5% ethanolamine produced inflammation consistently confined to the mucosa and submucosa. On the basis of this study we feel that 5% ethanolamine is the most suitable agent for injection sclerotherapy.     

Clinical Comparison of Sclerotherapy Versus Long-Pulsed Nd:YAG Laser Treatment for Lower Extremity Telangiectases

BACKGROUND: Sclerotherapy has traditionally been considered the gold standard of treatment for leg veins, but patient fear of multiple needle injections and side effects of treatment have fueled investigation into other treatment alternatives. As a result, vascular-specific laser and light sources have been developed in an effort to treat these vessels with minimal morbidity and improved efficacy. OBJECTIVE: To compare the clinical efficacy of leg telangiectasia treatment with sodium tetradecyl sulfate sclerotherapy to long-pulsed 1064 nm Nd:YAG laser irradiation. METHODS: A series of 20 patients with size-matched superficial telangiectases of the lower extremities were randomly assigned to receive two consecutive monthly treatments with injectable sodium tetradecyl sulfate on one leg and long-pulsed 1064 nm Nd:YAG laser irradiation on the other. Patients were evaluated by two masked assessors at each treatment visit and at 1 and 3 months after treatment to assess clinical improvement within matched sites. RESULTS: Leg telangiectases responded best to sclerotherapy in fewer treatment sessions than to long-pulsed 1064 nm Nd:YAG laser irradiation. The incidence of adverse sequelae was minimal and equivocal in both treatment groups. CONCLUSION: Despite recent advances in laser technology for treatment of lower extremity telangiectases, sclerotherapy continues to offer superior clinical effect in the majority of cases. Laser leg vein treatment appears to be most beneficial in patients with telangiectatic matting, needle phobia, or sclerosant allergy.     

Stability of Foam in Sclerotherapy: Differences between Sodium Tetradecyl Sulfate and Polidocanol and the Type of Connector Used in the Double-Syringe System Technique

BACKGROUND: Foam sclerotherapy is an increasingly popular modality in the treatment of varicose veins. Worldwide, the most popular agents used are sodium tetradecyl sulfate (STS) and polidocanol (POL). The double-syringe system technique to make foam out of a sclerosing solution and air has received wide attention for its ease and reproducibility. This study examined the possibility that the relative silicone content of various disposable connectors may affect overall foam stability. We also evaluated the differences in the stability of foam between STS and POL. MATERIALS AND METHODS: In the first part of the study, one nondisposable stainless steel connector and five disposable plastic connectors were used to create foam from STS 0.50% and air. The procedure was then repeated to produce foam from POL 0.50% and air from each of the six different connector types. As a measure of foam stability, once foam was created with each type of connector, the time required for half of the original volume of sclerosing solution to settle was recorded. In the second part of the study, foam was created with a nondisposable stainless steel connector only and various concentrations of STS and POL. Foam stability was then measured for these different concentrations of sclerosants. RESULTS: The time for sclerosing solution to settle to half of its initial volume was found to vary according to the specific sclerosant and concentration used, with no statistically significant variation based on connector type. CONCLUSIONS: The type of connector used in the double-syringe system technique to produce foam for sclerotherapy is not a factor in foam stability. Sclerosing solutions differ in their foaming stability.     

Diagnosis and treatment of atypical forms of varicose disease of pelvic veins

Results of sclerotherapy of 59 patients with atypical forms of varicose disease of pelvic veins were analyzed. Four atypical forms of the disease were revealed: suprapubic (30.5%), vulvar (20.3%), perineal (25.5%) and gluteal (23.7%). Clinical, ultrasonic and phlebographic investigations have found that a pathological caval reflux of blood involving the internal ileac vein and its inflows underlie the development of atypical forms. An original technology of sclerotherapy of atypical forms of varicose disease by means of multiple repeated administration of sclerosant in minimal doses has been developed capable to cause but proliferative processes in the varicose vein walls. Elastic compression was not used. Varicose disease of the lower extremity veins was revealed in 36 (61%) patients with atypical forms of varicose disease of the pelvic veins. The volume of treatment of such patients was supplemented with operation of crossectomy, catheter sclerotherapy of the main trunk of the large subcutaneous vein and injectional sclerotherapy of its inflows. Results of treatment were assessed by clinical examination of the patients, duplex scanning and investigation of quality of life on the basis of self-appraisal of the patients according to recommendations of the international association of phlebologists. Excellent results were obtained in 32.6%, good - in 46.1%, satisfactory - in 19.1%, unsatisfactory - in 2.2% of the patients.     

Venous disorders: treatment with sclerosant foam

AIM: Treatment of venous insufficiency has been revolutionized by introduction of less invasive endovenous procedures. Foam sclerotherapy competes with these for truly minimal less invasive care. The idea of using air and drug in combination is quite old. Orbach described an air block technique using froth in 1944 and in 1993 Cabrera proposed use of a true foam of sodium tetradecyl sulfate or polidocanol to treat varicose veins. When Tessari presented a three-way tap technique in 2000, very good microfoam could be made at a very low cost. Foam can be used in classical sclerotherapy but it is the new indications that excite interest. This report documents experience in treating severe chronic venous insufficiency (CVI), venous angiomata and varicose veins using foam sclerotherapy. METHODS: This report describes initial experience in treating 332 patients: 261 patients with varicose veins, 56 patients (77 limbs) with severe CVI, 6 patients with venous angiomata and 9 patients with Klippel-Trenaunay (KT) syndrome. Patients with telangiectasias were also treated but are not a part of this report. A compounding pharmacy supplied the 1-3% polidocanol that was prescribed for each patient according to guidelines on the Food and Drug Administration (FDA) website. Foam was produced by the Tessari technique. Ultrasound guidance was used. Venous access was obtained percutaneously through varices for saphenous vein and variceal closure and through specific targeted veins for treatment of CVI, angiomata and KT syndrome. Deep venous thrombosis (DVT) surveillance was done at 1, 7, 30, and 60 days. Specific perforating vein injection was done only occasionally. Foam volumes varied from 1 to 16 mL for each treatment. RESULTS: Obliteration of varicose and saphenous veins was entirely satisfactory (2.89 treatments/limb). There was no disability down time, no need for analgesics or sedation. Trapped thrombus in large varices required evacuation and caused local pain and cutaneous staining. Treatment goals but not cure were achieved in limbs with angiomata and KT syndrome. Treatment of CVI resulted in rapid, 2-6 weeks, ulcer healing, relief of painful lipodermatosclerosis and dermatitis and some decrease in skin hyperpigmentation. There was one failure in 77 limbs treated for CVI and one case of cutaneous necrosis in one limb treated for CVI and another in a limb treated for angiomata. Other adverse events (5.4%) lasting 3 to 20 min included dry cough (4), occular migraine (2), true migraine (2), other visual disturbances (3), chest tightness (2), panic attack (2), paresthesias (2) myoclonus (1) and cutaneous necrosis (2). DVT (1.8%) was limited to gastrocnemius veins (3 cases) and posterior tibial veins (3 veins). No pulmonary emboli or lung complications occurred. CONCLUSIONS: Treatment of a variety of venous disorders can be accomplished using foam sclerotherapy with results comparable to surgery and with an acceptably low rate of adverse events. These results, however, must be confirmed by larger experience in other institutions.     

Efficacy and safety of sclerotherapy using polidocanol foam: a controlled clinical trial.

OBJECTIVE: To assess the efficacy and safety of sclerotherapy performed with polidocanol foam compared to liquid polidocanol. METHODS: Controlled clinical trial with 1 year follow up in which each patient acted as his/her own control. A total of 75 patients (six men and 69 women) with reticular or postoperative varices were enrolled and sclerotherapy was performed with liquid and with foam (Tessari method) using the same quantity of sclerosant for homogeneous varicose regions, to a total of 150 procedures. The sclerosant concentration was adjusted according to the vein diameter as assess by ultrasonography. The foam group was given 50% lower concentrations of sclerosant than liquid sclerosant group. Clinical assessment (pain, inflammation, pigmentation) and ultrasound examination (diameter of the lumen and length of sclerosed vein) were carried out at 15, 30, 90, and 365 days. RESULTS: Foam allowed complete sclerosis at 90 days in 94.4% of patients compared with 53% for liquid (p<.001) and also allowed a more extensive venous sclerosis (10.1cm compared with 7.2 cm; p<.001). Pain, signs of inflammation, and pigmentation appeared more often with foam sclerosis, with significant difference. The degree of satisfaction was similar for both techniques. CONCLUSIONS: Efficacy of venous sclerosis with foam seems to be greater than with liquid although there is a higher risk of minor secondary effects.     

Saphenous ablation: sclerosant or sclerofoam?

During the last half of the 20th century, sclerotherapy as a major treatment of varicose veins came and went. At first, it was widely heralded as a substitute for surgery but after a prospective randomized study by Hobbs, interest in sclerotherapy waned. Just before the turn of the 21st century, Cabrera published his experience with foamed sclerosant in patients with great saphenous varices and arteriovenous malformations. Cabrera designed his treatment with the specific aim of obliterating the saphenous trunks. His technique consisted of filling the great saphenous vein in the thigh or the small saphenous vein in the calf with foamed sclerosant injected under ultrasound control. His initial report on long-term follow-up revealed that the results were at least comparable to surgery and perhaps somewhat better and his results have been confirmed by others. Investigations into treatment of small vein varices, including telangiectasias, has resulted in the finding that foam results in a 20% improved appearance compared to liquid sclerosant. The most popular sclerosants currently used as foams are polidocanol and sodium tetradecyl sulfate and of the many techniques used in making foams, the technique of Tessari has proven most popular. No randomized clinical trial comparing this technique to surgery has been published; however, the clinical series reports indicate that 80% to 90% of saphenous trunks remain occluded after 3 years when treated by foam sclerotherapy. Complications are seldom encountered but significant skin darkening and superficial thrombophlebitis are common. Temporary vision changes have occurred after foam and liquid sclerotherapy, with foam, these are always transient. Although the long-term efficacy of foamed sclerotherapy treatment is unlikely to be established for years, a number of phlebologists have taken up the practice because it has the advantage of not requiring general or regional anesthesia and takes much less time than equivalent surgical techniques.     

Sclerotherapy for Leg Telangiectasia—A Blinded Comparative Trial of Polidocanol and Hypertonic Saline

Background Hypertonic saline (HS) and polidocanol (POL) have been in use around the world for sclerotherapy of telangiectasia for many years. However, despite numerous articles in the literature extolling the virtues of their individual use, few studies scientifically compare their relative efficacies.
Objective To compare, in a statistically significant number of female patients, the relative efficacy of hypertonic saline and polidocanol as sclerosants of leg telangiectasia and reticular feeding veins, using each patient as her own control.
Methods . Eighty-one women with roughly matching leg telangiecasia were treated with sclerotherapy. One leg was injected with 20% saline/2% lignocaine, the other with 1% polidocanol, with the patients blinded as to the sclerosant used for each leg. Assessment of percent reduction of vessels, and the complications of matting and hemosiderin staining was conducted at 2 months by 3 methods: the patient's satisfaction, the treating physician's evaluation, and blinded assessment of before and after photographs.
Results . There was no statistically significant difference between HS and POL treated legs when assessed clinically or photographically. However, POL caused more staining and matting, and despite patients finding HS more painful at injection, patient satisfaction at follow-up was higher with the HS treated leg.
Conclusion . 20% HS and 1% POL have equal efficacy in sclerosing leg telangiectasia and reticular feeding veins. POL causes more adverse sequelae, although these may be related to the solution concentration.