Dr. Pankaj Patel vascular surgeon performs sclerotherapy in mumbai india


	Venous Disease > Sclerotherapy

Sclerotherapy

Only suitable for below knee varicose veins

Need to exclude SFJ or SPJ incompetence

Main use is for persistent or recurrent varicose veins
after adequate saphenous surgery

Sclerosants

		5% Ethanolamine oleate
		0.5% Sodium tetradecyl sulphate

Different to sclerosants used for haemorrhoids

Needle placed in vein when full with patient standing

Empty vein prior to injection

Apply immediate compression and maintain for 4-6 weeks

Do not exceed maximum volume

Injection about 5 sites possible

Complications of sclerotherapy

	Extravasation causing pigmentation or ulceration
	Deep venous thrombosis

Recurrent varicose veins

	15 - 25 % of varicose vein surgery is for recurrence
	Outcome of recurrent varicose veins surgery is less successful
	Can be avoided with adequate primary surgery

Reasons for recurrence

Inaccurate clinical assessment

		Confusion as to whether varicosities are in LSV or SSV distribution
		Can be avoided with use of hand held doppler

Inadequate primary surgery

		10% cases SFJ not correctly identified
		20% cases tributaries mistaken for LSV
		Failure to strip LSV

Injudicious use of sclerotherapy

70% of those with SF incompetence treated with sclerotherapy alone will develop recurrence

Neovascularisation

With recurrent varicose vein need to image with duplex or varicography

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