Sclerotherapy is the targeted chemical ablation of varicose veins by intravenous injection of a liquid or foamed sclerosing drug. The treated veins may be intradermal, subcutaneous, and/or transfascial as well as superficial and deep in venous malformations. The aim of this guideline is to give evidence-based recommendations for liquid and foam sclerotherapy.
Methods
This guideline was drafted on behalf of 23 European Phlebological Societies during a Guideline Conference on 7th – 10th May 2012 in Mainz. The conference was organized by the German Society of Phlebology.
Results
This guideline focuses on the two sclerosing drugs which are licensed in the majority of the European countries, Polidocanol (POL) and Sodium tetradecyl sulphate (STS). Other sclerosants are not discussed in detail. In this paper the recommendations concerning indications, contraindications, concentrations, volumes and technique of liquid and foam sclerotherapy of varicose veins and venous malformations are reviewed.
GuyattGGuttermanDBaumannMHAddrizzo-HarrisDHylekEMPhillipsBRaskobGZelman LewisSSchünemannH. Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines: Report From an American College of Chest Physicians Task Force. Chest2006; 129: 174–181.
2.
DrakeLADinehartSMGoltzRWGrahamGFHordinskyMKLewisCWPariserDMSkougeJWWebsterSBWhitakerDCFranceschiC. Guidelines of care for sclerotherapy treatment of varicose and teleangiectatic leg veins. J Am Acad Dermatol1996; 34: 523–528.
3.
RabeEPannier-FischerFGerlachH. Guidelines for sclerotherapy of varicose veins. Dermatol Surg2004; 30: 687–693.
4.
Hamel-DesnosCOuvryPBenigniJPBoitelleGSchadeckMDesnosPAllaertFA. Comparison of 1% and 3% Polidocanol Foam in Ultrasound Guided Sclerotherapy of the Great Saphenous Vein: A Randomised, Double-Blind Trial with 2 Year-Follow-up. “The 3/1 Study”. Eur J Vasc Endovasc Surg2007; 34: 723–729.
5.
ChenC-H.ChiuC-SYangC-H. Ultrasound-Guided Foam Sclerotherapy for Treating Incompetent Great Saphenous Veins - Results of 5 Years of Analysis and Morphologic Evolvement Study. Dermatol Surg2012; 38: 851–857.
6.
Hamel-DesnosCDesnosPWollmannJCQuvryPMakoSAllaertFA. Evaluation of the efficacy of Polidocanol in the form of foam compared with liquid form in sclerotherapy of the long saphenous vein: Initial results. Dermatol Surg2003; 29: 1170–1175.
7.
AlosJCarrenoPLopezJA. Efficacy and safety of sclerotherapy using Polidocanol foam: A controlled clinical trial. Eur J Vasc Endovasc Surg2006; 31: 101–107.
8.
OuvryPAllaertFADesnosPHamel-DesnosC. Efficacy of Polidocanol Foam versus Liquid in Sclerotherapy of the Great Saphenous Vein: A Multicenter Randomised Controlled Trial with a 2-year Follow-up. Eur J Vasc Surg2008; 36: 366–370.
9.
RabeEOttoJSchliephakeDPannierF. Efficacy and Safety of Great Saphenous Vein Sclerotherapy Using Standardised Polidocanol Foam (ESAF): A Randomised Controlled Multicentre Clinical Trial. Eur J Endovasc Vasc Surg2008; 35: 238–245.
10.
RasmussenLH. Randomized clinical trial comparing endovenous laser ablation,radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br. J. Surg2011; 98: 1079–1087.
11.
ShadidNCeulenRNelemansPDirksenCVeraartJSchurinkGWvan NeerPVd KleyJde HaanESommerA. Randomized clinical trial of ultrasound-guided foam sclerotherapy versus surgery for the incompetent great saphenous vein. Br J Surg2012; 99: 1062–1070.
12.
MyersKAJolleyDCloughAKirwanJ. Outcome of Ultrasound-guided Sclerotherapy for Varicose Veins: Medium-term Results Assessed by Ultrasound Surveillance. Eur J Vasc Endovasc Surg2007; 33: 116–121.
13.
ZhangJJingZSchliephakeDEOttoJMaloufGMGuYQ. Efficacy and safety of Aethoxysklerol® (polidocanol) 0.5%, 1% and 3% in comparison with placebo solution for the treatment of varicose veins of the lower extremities in Chinese patients (ESA-China Study). Phlebology2012; 27: 184–190.
14.
GuexJJ. Ultrasound Guided Sclerotherapy (USGS) for Perforating Veins. Hawaii Med J2000; 59: 261–262.
15.
MasudaEMKesslerDMLurieFPuggioniAKistnerRLEklofB. The effect of ultrasound guided sclerotherapy of incompetent perforator veins on venous clinical severity scores. J Vasc Surg2006; 43: 551–556.
16.
Van NeerPVeraartJCJMNeumannH. Posterolateral thigh perforator varicosities in 12 patients: A normal deep venous system and successful treatment with ultrasound-guided sclerotherapy. Dermatol Surg2006; 32: 1346–1352.
17.
KahleBLengK. Efficacy of sclerotherapy in varicose veins - a prospective, blinded placebocontrolled study. Dermatol Surg2004; 30: 723–728.
18.
NorrisMJCarlinMCRatzJL. Treatment of essential telangiectasias: Effects of increasing concentrations of polidocanol. J Am Acad of Dermatol1989; 20: 643–649.
19.
RabeESchliephakeDOttoJBreuFXPannierF. Sclerotherapy of telangiectasias and reticular veins: a double-blind, randomized, comparative clinical trial of polidocanol, sodium tetradecyl sulphate and isotonic saline (EASI study). Phlebology2010; 25: 124–131.
20.
UncuH. Sclerotherapy: A study comparing polidocanol in foam and liquid form. Phlebology2010; 25: 44–49.
21.
PetersonJDGoldmanMPWeissRADuffyDMFabiSGWeissMAGuihaI. Treatment of Reticular and Telangiectatic Leg Veins: Double-Blind, Prospective Comparative Trial of Polidocanol and Hypertonic Saline. Dermatol Surg2012; 38: 1–9.
22.
KakkosSKBountouroglouDGAzzamMKalodikiEDaskalopoulosMGeroulakosG. Effectiveness and Safety of Ultrasound-Guided Foam Sclerotherapy for Recurrent Varicose Veins: Immediate Results. Journal of Endovascular Therapy2006; 13: 357–364.
23.
McDonaghBSorensonSGrayCHuntleyDEPuttermanPKingTEatonTMartinCHarryJLCohenAGuptanRC. Clinical spectrum of recurrent postoperative varicose veins and efficacy of sclerotherapy management using the compass technique. Phlebology2003; 18: 173–186.
Coleridge SmithP. Sclerotherapy and foam sclerotherapy for varicose veins. Phlebology2009; 24: 260–269.
26.
BradburyAWBateGPangKDarvallKAAdamDJ. Ultrasound-guided foam sclerotherapy is a safe and clinically effective treatment for superficial venous reflux. J Vasc Surg2010; 52: 939–945.
SukovatykhBSRodionovOASukovatykhMBKhodykinSP. Diagnosis and treatment of atypical forms of varicose disease of pelvic veins. Vestnik Khirurgii Imeni i - i - Grekova2008; 167: 43–45.
29.
ParaskevasP. Successful ultrasound-guided foam sclerotherapy for vulval and leg varicosities secondary to ovarian vein reflux: a case study. Phlebology2011; 26: 29–31.
30.
StückerMReichSHermesN. Safety and efficiency of perilesional sclerotherapy in leg ulcer patients with postthrombotic syndrome and/or oral anticoagulation with Phenprocoumon. JDDG2006; 4: 734–738.
31.
De WaardMMDer KinderenDJ. Duplex ultrasonography-guided foam sclerotherapy of incompetent perforator veins in a patient with bilateral venous leg ulcers. Dermatol Surg2005; 31: 580–583.
32.
HertzmanPAOwensR. Rapid healing of chronic venous ulcers following ultrasound-guided foam sclerotherapy. Phlebology2007; 22: 34–39.
33.
PangKHBateGRDarvallKALAdamDJBradburyAW. Healing and recurrence rates following ultrasound guided foam sclerotherapy of superficial venous reflux in patients with chronic venous ulceration. Eur J Vasc endovasc Surg2010; 40: 790–795.
34.
YamakiTNozakiMSasakiK. Color duplex-guided sclerotherapy for the treatment of venous malformations. Dermatol Surg2000; 26: 323–328.
35.
YamakiTNozakiMSakuraiH. Prospective randomized efficacy of ultrasound-guided foam sclerotherapy compared with ultrasound-guided liquid sclerotherapy in the treatment of symptomatic venous malformations. J Vasc Surg2008; 47: 578–584.
36.
BlaiseSCharavin-CocuzzaMRiomHBrixMSeinturierCDiamandJMGachetGCarpentierPH. Treatment of Low-flow Vascular Malformations by Ultrasound-guided Sclerotherapy with Polidocanol Foam: 24 Cases and Literature Review. Eur J Vasc Endovasc Surg2011; 41: 412–417.
37.
KernPRameletA-AWutschertRBounameauxHHayozD. Single blind randomized study comparing chromated glycerin, polidocanol solution and polidocanol foam for treatment of telangiectactic leg veins. Dermatol Surg2004; 30: 367–372.
38.
Rabe E, Pannier F, Gerlach H, Breu FX, Guggenbichler S, Wollmann JC. Leitlinie Sklerosierungsbehandlung der Varikose Phlebologie 2008; 37: 27-34.
39.
RaoJWildemoreJKGoldmannMP. Double-blind prospective comparative trial between foamed and liquid Polidocanol and Natrium Tetradecyl Sulfate in the treatment of varicose and telangiectatic leg veins. Dermatol Surg2005; 31: 631–635.
40.
Bullens-GoessensYIJMMentinkLF. Ultrasound-guided sclerotherapy of the insufficient short saphenous vein. Phlebologie Germany2004; 33: 89–91.
41.
Schultz-EhrenburgUTourbierH. Doppler-kontrollierte Verödungsbehandlung der Vena saphena magna. Phlebol u Proktol1984; 13: 117–122.
42.
VinF. Principes de la Sclérothéraphie des Troncs Saphènes Internes. Phlébologie1997; 50,2: 229–234.
43.
GohelMSEpsteinDMDaviesAH. Cost-effectiveness of traditional and endovenous treatments for varicose veins. Br J Surg2010; 97: 1815–1823.
44.
WrightDGobinJPBradburyAW. Varisolve European Phase III Investigators Group. Varisolve® polidocanol microfoam compared with surgery or sclerotherapy in the management of varicose veins in the presence of trunk vein incompetence: European randomized controlled trial. Phlebology2006; 21: 180–190.
45.
CavezziAFrulliniARicciSTessariL. Treatment of varicose veins by foam sclerotherapy: Two clinical series. Phlebology2002; 17: 13–8.
46.
Hamel-DesnosCOuvryPDesnosP. Sclérothérapie et thrombophilie: Démarche pour un consensus dans la sclérothérapie chez les thrombophiles. Phlébologie2003; 56: 165–69.
47.
BreuFXGuggenbichlerSWollmannJC. 2nd European Consensus Meeting on Foam Sclerotherapy, 28–30 April 2006, Tegernsee, Germany. Vasa2008; 37(Supplement 71): 1–32.
48.
GuexJJ. Les contre-indications de la sclérothérapie, mise à jour 2005. J Mal Vasc2005; 30: 144–149.
49.
Hamel-DesnosCMGilletJ-LDesnosPRAllaertFA. Sclerotherapy of varicose veins in patients with documented thrombophilia: a prospective controlled randomized study of 105 cases. Phlebology2009; 24: 176–182.
50.
GachetGSpiniL. Sclérothérapie des varices sous anticoagulants. Phlébologie2002; 55: 41–44.
51.
Kreussler: Fachinformationen Aethoxysklerol 0,25%/0,5%/1%/2%/3% Stand Oktober 2009, Chemische Fabrik Kreussler & Co GmbH.
52.
STD Pharmaceutical Products Ltd. Prescribing Information March 2012.
53.
GuexJJHamel-DesnosCGilletJLChleirFPerrinM. Sclérothérapie des varices par mousse écho-guidée: techniques de mise en œuvre, indications, résultats publiés. Phlébologie2008; 61: 261–270.
54.
YamakiTHamahataASoejimaKKonoTNozakiMSakuraiH. Prospective Randomised Comparative Study of Visual Foam Sclerotherapy Alone or in Combination with Ultrasound-guided Foam Sclerotherapy for Treatment of Superficial Venous Insufficiency: Preliminary Report. EJVES2012; 43: 343–347.
55.
MyersKAJolleyD. Factors Affecting the Risk of Deep Venous Occlusion after Ultrasound-guided Sclerotherapy for Varicose Vein. Eur J Vasc Endovasc Surg2008; 36: 602–605.
56.
TessariLCavezziAFrulliniA. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg2001; 27: 58–60.
57.
RathbunSNorrisAStonerJ. Efficacy and safety of endovenous foam sclerotherapy: meta-analysis for treatment of venous disorders. Phlebology2012; 27: 105–117.
