Sclerotherapy in venous disease

Techniques for injecting varicose veins with sclerosant solutions have been in practice for more than 100 years. The stimulus for widespread practice by many emerging phlebologists came from the massive experience from Fegan and then from Hobbs.Scientific trials showed that sclerotherapy was effective if ther was no saphenous reflux but relatively ineffective if there was.Canadian and European workers quickly realized that techniques were required to destroy the main saphenous veins. The coincident emergence of venous ultrasound opened the way to effective advances.The past 10 to 15 years has seen an extraordinary increase in the growth of ultrasound-guided sclerotherapy such that it now rivals or has supplanted surgery in many centres.There were problems since the sclerosants used have a dose limit for each treatment session often potentially exceeded if large varicose veins were to be trated.This has now changed with the introduction of foamed sclerosant preparations. With foam, the entire system can usually be filled.The foam stays in the veins for far longer than fluid sclerosant and can be seen so well on ultrasound allowing it to be followed through all of the superficial pathways and blocked from entering deep veins.There is also a major push to comprehensively destroy the saphenous veins by endovenous thermal ablation using laser or radio-frequency and this is undoubtedly the next emerging phase in ambulatory management. One should plan two stages with laser ablation of the saphenous vein followed by ultrasound-guides echosclerotherapy for all persisting major tributaries.ContentsThe venous systemInvestigation in venous diseaseVenous diseases and malformationsThe swollen limbSclerotherapy: general considerationsVaricose veinsDeep venous thrombosisSuperficial thrombophlebitisChronic venous insufficiency and post-thrombotic ­syndromeVaricocele and the pelvic congestion syndromeMicro-sclerotherapyTechnical note