Varicosclerotherapy

Author:Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 29.10.2020

Dieser Artikel auf Deutsch

Synonym(s)

Sclerotherapy; Sclerotherapy of varices; Varicose Vein Sclerotherapy

Requires free registration (medical professionals only)

Please login to access all articles, images, and functions.

Our content is available exclusively to medical professionals. If you have already registered, please login. If you haven't, you can register for free (medical professionals only).


Requires free registration (medical professionals only)

Please complete your registration to access all articles and images.

To gain access, you must complete your registration. You either haven't confirmed your e-mail address or we still need proof that you are a member of the medical profession.

Finish your registration now

DefinitionThis section has been translated automatically.

Method for the targeted elimination of intra- and subcutaneous varices by injecting a sclerosing agent (in liquid form or as foam). Sclerosing agents cause pronounced damage to the endothelium of the vessels and possibly also to the entire vessel wall. Consecutively a thrombosis is formed and later the vein is transformed into a connective tissue strand. S.a.u. Sclerotherapy, foam sclerotherapy. The following principles should be observed:

  • The contact of the sclerosing agent with the varicose intima should be as concentrated as possible (anemic varices).
  • After the injection of the sclerosing agent, local compression must be applied; the resulting thrombus should be as small as possible.
  • The sclerosing agent should be as tissue-friendly as possible (harmlessness with extravasal injection).
  • The sclerosing agent should have the lowest possible allergenic and no teratogenic potential.

IndicationThis section has been translated automatically.

Intracutaneous varices; lateral branch varicose veins thinner than 0.7 cm; insufficient perforating veins. Vena accessoria thinner than 0.7 cm.

The sclerotherapy of the insufficient crusts and the saphenous vein is discussed in detail. Periulcerous varices or varices in the area of trophic disorders.

With strict indication: varices in pregnancy (middle trimester of pregnancy).

Reference values for foam Sclerotherapy with aethoxysclerol

  • Trunk varices > 5 mm 3-4% Aethoxysklerol 2-3ml, 4-6 injections/session
  • Trunk varices < 5 mm 2-3% Aethoxysklerol 1-2ml
  • Side branch varices < 5 mm 1-2% Aethoxysclerol 0.5-1ml
  • Reticular varices < 3mm 0.2-1% Aethoxysclerol <0.5ml (Bertanha M et al. 2017)

ImplementationThis section has been translated automatically.

ContraindicationThis section has been translated automatically.

Known allergy to the sclerosing agent. Acute thrombophlebitis; severe systemic diseases, diabetic late complications, immobility, bedriddenness, known hypercoagulability, thrombophilia with expired deep vein thrombosis, pregnancy in the 1st trimester and after the 36th week of pregnancy.

Complication(s)This section has been translated automatically.

Necrosis; hyperpigmentation; allergic reactions; nerve damage; matting (occurrence of telangiectasia in the area of sclerosed veins); migraine-like symptoms; ciliated scotomas; thromboembolism; arterial injection with tissue necrotizing. Rare are generalized drug exanthema.

PreparationsThis section has been translated automatically.

Polidocanol (e.g. aethoxysclerol: 0,25%, 0,5%, 1,0%, 2,0%, 3,0%, 4,0%); max TD 2 mg/kg bw.

Note(s)This section has been translated automatically.

For patients with a high risk of thrombosis, various doctors recommend the use of a Authors recommend prophylaxis with a low molar heparin or fondaparinux.

LiteratureThis section has been translated automatically.

  1. Bertanha M et al (2017) Sclerotherapy for Reticular Veins in the Lower Limbs: A Triple-Blind RandomizedClinical
    Trial. JAMA Dermatol 153:1249-1255.
  2. Cabrera J et al (2003) Treatment of venous malformations with sclerosant in microfoam form. Arch Dermatol 139: 1409-1416
  3. Guggenbichler S (2016) Spider vein sclerotherapy; per liquid sclerotherapy. Vasomed 28: 26-27
  4. Kendler M et al (2007) Generalized drug exanthema after sclerotherapy with chromated glycerin Scleremo. Phelbology36: 74-76
  5. Guidelines of the German Society of Phlebology (DGP) (2003) AWMF Guidelines Register No. 037/015
  6. Lorenz MB et al (2014) Sclerotherapy of varicosis in dermatology. JDDG 14: 391-394
  7. Ludwig M et al (2010) Vascular medicine in clinic and practice. Georg Thieme Publishing House Stuttgart S. 277
  8. Rabe E, Gerlach HE (2000) Practical phlebology. Georg Thieme Publisher Stuttgart S. 68-72
  9. Vin F (1997) Principes de la Sclérothérapie des Troncs Saphènes internes. Phlebology 50: 229-234

TablesThis section has been translated automatically.

Indications

Volume per injection (ml)

concentration (%)

Teleangiectasia (spider veins)

0,1-0,2

0,25-0,5

Central veins of spider veins

0,1-0,2

0,25-1,0

reticular varices

0,1-0,3

0,25-1,0

small varices

0,1-0,3

0,25-1,0

medium-sized varices

0,5-1,0

2-3

large varices

1,0-2,0

3-4

Authors

Last updated on: 29.10.2020