Sclerotherapy for Varicose and Spider Veins

Sclerotherapy: Definition & Goals - Vein Vanish Intro

• Definition: Minimally invasive chemical ablation; sclerosant solution injected into unwanted veins.
• Mechanism: Sclerosant damages endothelium → inflammation, fibrosis → vessel occlusion & resorption.
• Primary Goals:
  • Eliminate varicose veins & spider veins (telangiectasias).
  • Alleviate symptoms: pain, aching, heaviness, swelling.
  • Improve cosmetic appearance.
• Key Indications:
  • Varicose veins (CEAP C1-C3).
  • Telangiectasias, reticular veins.
  • Adjunct for venous malformations; post-surgery residual veins.
• Patient Benefits:
  • Outpatient, minimal discomfort & downtime.
  • No general anesthesia; quick recovery.
  • Safe, effective, cost-efficient.

⭐ Polidocanol (POL) and Sodium Tetradecyl Sulfate (STS) are common FDA-approved sclerosants, widely used.

Sclerosants: Types & MOA - Chemical Closure Crew

Sclerosants induce controlled phlebitis and fibrosis. Choice depends on vein size, location, and patient factors.

Procedure: Steps & Aftercare - Injection & Instructions

• Pre-Procedure:
  • Clinical assessment, Duplex USG mapping.
  • Informed consent obtained.
  • Aseptic skin preparation.
• Injection Technique:
  • Sclerosants: Polidocanol (POL), Sodium Tetradecyl Sulfate (STS). Concentrations vary by vein size.
  • Foam preparation (Tessari method: 1 part liquid sclerosant + 4 parts air/CO₂).
  • Fine needle (27-30G). Inject small volumes (0.1-0.5 mL per site).
  • Technique: Slow injection, observe for vein blanching.

  ⭐ Foam sclerotherapy (e.g., Tessari method: 1 part sclerosant + 4 parts air) significantly increases surface area contact and efficacy, allowing lower sclerosant volumes compared to liquid form.

• Post-Procedure & Aftercare:
  • Immediate: Compression pads/bandages over injection sites.
  • Ambulation encouraged immediately post-procedure.
  • Compression therapy: Graduated stockings (Class II: 20-30 mmHg) for 2-3 weeks (first 24-72h continuously).
  • Avoid: Sun exposure, hot baths, strenuous exercise for 1-2 weeks.
  • Follow-up: Typically at 2-4 weeks for assessment.

Adverse Effects & No-Gos - Safety Net Snippets

• Common:
  • Hyperpigmentation (hemosiderin; fades), bruising, pain
  • Telangiectatic matting, localized urticaria
• Rare/Serious:
  • DVT/PE (<1%), anaphylaxis
  • Tissue necrosis/ulceration (extravasation, arterial injection)
  • Nerve damage (transient sensory)
  • Stroke/TIA (PFO + foam), visual disturbances
• Absolute Contraindications:
  • Sclerosant allergy, acute DVT/PE/thrombophlebitis
  • Pregnancy (most Cat C)
  • Severe arterial disease (ABI <0.8), acute local infection
  • Immobility
• Relative Contraindications:
  • Breastfeeding, hypercoagulable states
  • Poorly controlled systemic illness (DM)
  • History DVT/PE, significant edema, known PFO (foam)

⭐ Hyperpigmentation is the most common adverse effect (up to 30%), often from hemosiderin deposition, increased with higher sclerosant concentration or extravasation.

High‑Yield Points - ⚡ Biggest Takeaways

• Sclerotherapy induces endothelial damage, fibrosis, and eventual vessel occlusion.
• Common sclerosants: Polidocanol (detergent, less pain), Sodium Tetradecyl Sulfate (STS), hypertonic saline.
• Indicated for telangiectasias (spider veins), small varicose veins, and reticular veins.
• Key contraindications: Pregnancy, acute DVT/PE, significant arterial insufficiency, known sclerosant allergy.
• Most common complication: post-inflammatory hyperpigmentation; others include telangiectatic matting, skin necrosis, allergic reactions.
• Compression therapy post-procedure is crucial for optimal results and minimizing complications like DVT_._