Sclerotherapy

[2] This is due to the emergence of more effective technologies, including laser ablation and radiofrequency, which have demonstrated superior efficacy to sclerotherapy for treatment of these veins.

The first reported attempt at sclerotherapy was by D Zollikofer in Switzerland in 1682, who injected an acid into a vein to induce thrombus formation.

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.

However, it was poorly understood or accepted in England or the United States, a situation that continues to this day amongst some sections of the medical community.

The sclerosing solution damages the vein wall, causing inflammation and gradual scarring ("sclerosis") over the following weeks.

[Telangiectasia is a condition in which broken or widened small blood vessels that sit near the surface of the skin or mucous membranes create visible], and smaller varicose leg veins.

It is common practice for the patient to require at least two treatment sessions separated by several weeks to significantly improve the appearance of their leg veins.

[15] The sclerosant drugs (sodium tetradecyl sulfate, bleomycin or polidocanol) are mixed with air or a physiological gas (carbon dioxide) in a syringe or by using mechanical pumps.

The foam sclerosant drug is more efficacious than the liquid one in causing sclerosis[22] (thickening of the vessel wall and sealing off the blood flow), for it does not mix with the blood in the vessel and in fact displaces it, thus avoiding dilution of the drug and causing maximal sclerosant action.

[25] Preclinical studies also indicated that electroporation in combination with bleomycin impaired the barrier function of the endothelium by interacting with the organization of the cytoskeleton and the integrity of the junctions.

[29][30] A retrospective study of 17 patients with venous malformations who did not respond to previous invasive therapies showed an average decrease in lesion volume measured on MRI images of 86% with clinical improvement in all patients after an average of 3.7 months and 1.12 sessions per patient, with a reduced dose of bleomycin and a reduced number of sessions compared to standard bleomycin sclerotherapy[31] A study by Kanter and Thibault in 1996 reported a 76% success rate at 24 months in treating saphenofemoral junction and great saphenous vein incompetence with STS 3% solution.

[4] Padbury and Benveniste[5] found that ultrasound guided sclerotherapy was effective in controlling reflux in the small saphenous vein.

Barrett et al. found that microfoam ultrasound guided sclerotherapy was "effective in treating all sizes of varicose veins with high patient satisfaction and improvement in quality of life".

[37] Complications, while rare, include venous thromboembolism, visual disturbances, allergic reaction,[38] thrombophlebitis, skin necrosis, and hyperpigmentation or a red treatment area.

Telangiectatic matting, or the development of tiny red vessels, is unpredictable and usually must be treated with repeat sclerotherapy or laser.

[41] Most complications occur due to an intense inflammatory reaction to the sclerotherapy agent in the area surrounding the injected vein.

More recent reports have shown that bubbles from even a small amount of sclerosant foam injected into the veins quickly appear in the heart, lung and brain.

[citation needed] Contraindications include: bed rest, severe systemic diseases, poor patient understanding, needle phobia, short life expectancy, late stage cancer, known allergy to the sclerosing agent, and treatment with tamoxifen.