Varicosclerotherapy

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.

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)

Three methods are currently common:

• Varicosclerotherapy according to Tournay
• Varicesclerotherapy according to Sigg
• Varicosclerotherapy Foam sclerotherapy

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.

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

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.

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