Sclerotherapy

Sclerotherapy
Sclerotherapy of varicose veins is the term for injection treatment of veins.  This technique involves the infiltration (using very fine needles) into the varicose veins and spider veins of a solution that will close the vessel down. A number of different ones have been used over the years.

At Springdale we use mainly Fibrovein (sodium tetradecyl sulphate), an agent specifically made for vein sclerotherapy, that has been around from the 1940s and used extensively since that time. Consequently its safety profile has been well established.

It is well tolerated by most people, with only a very small proportion ever developing an allergy to it. Some clinics do not use this agent for fine spider veins, but it is excellent for these if used at appropriate concentrations. 

Most doctors around the world now use a foam preparation of the sclerosant solution.  I have mentioned more on this in the section of sclerosis using the ultrasound imaging technique to guide it.  A variation I developed on this, as shown below has been embraced by quite a few others around the world.
Sclerotherapy microfoam created with 5 micron in-line filters
For any that might develop a reaction to Fibrovein sclerotherapy there is a similarly acting newer agent Sclerovein (polidocanol) that we have available for use.   Initially designed as an anaesthetic agent it was found to damage veins and abandoned.  But later it was realised it could be employed for vein treatments. 

Being a local anaesthetic agent the total amount of Sclerovein needs to be carefully managed against the body weight of the patient.  Otherwise typical toxic effects of local anaesthetic agents can occur.

Beyond this other agents are around such as hypertonic saline (concentrated salt solution), chromated glycerine and iodine. The latter ones do have other difficulties in their use.

The former two are limited in their concentration and therefore in the size of vessel that can be treated – only smaller ones are affected. Iodine has a higher risk of allergy than the others do. It is also highly damaging to surrounding tissue if it tracks out of the vein (as can be hypertonic saline).

 

How Does it Work?

All the agents work by creating damage to the lining of the varicose vein. Fibrovein and Sclerovein have detergent actions (the other solutions work by local chemical irritation).

As with all cells, those lining the varicose veins have a lipid (fatty) membrane to allow them to absorb nutrients. The detergent molecule attaches to this layer, breaking it down. The body then heals this damage.

By compressing especially the leg veins with a graduated compression stocking, the varicose vein walls heal together closing them off.   This is the sclerosis of the veins.

In the face, as gravity draws blood away, no compression is required (we do not tend to use solutions in face vein treatment now, preferring the effective lasers now available).

Solution that extends into healthy vessels tends to get washed away, diluting it, and thereby rendering it ineffective there.

 

How Does This Vary From Past Sclerotherapy?

In the English speaking countries, there has been varied success with sclerotherapy of varicose veins over the years. The technique tended to focus on treating only visible vessels and attempting to achieve the result in one session. Most regarded it as a temporary stop-gap measure.

But in Europe, a much more logical approach has produced continued success. It is important always to close down the vessel under the highest pressure in the system first. Otherwise the problem will simply recur, not go away at all, or even look worse. Usually this requires at least two sessions for each area to achieve the effect.

I have enlarged on this more in the section on using the ultrasound imaging equipment to sclerose, or shut down, these veins.

Sclerotherapy of varicose veins is a very useful technique allowing clients to remain active throughout the treatment sessions. I fact fact people need to exercise regularly after treatment to aid the healing process.

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