Indications for Sclerotherapy

The objectives of sclerotherapy include the treatment of varicosities, telangiectasias, and/ or reticular veins of the lower extremity (Tables 8.2 and 8.3) and prevention of possible complications; reduction or elimination of existing symptoms; improvement in altered hemodynamics; and achievement of a final result that satisfies aesthetic and functional criteria [6]. Sclerotherapy is considered the first line of treatment for small, intracutaneous varicose veins (reticular varicose veins and telangiectatic veins).With regard to the elimination of collateral and incompetent perforating veins, sclerotherapy competes with phlebextraction and with ligation of perforating veins or endoscopic dissection of perforating veins. A discussion of these latter techniques is beyond the scope of this section. In the treatment of valvular insufficiency of truncal veins with elimination of the proximal leakage point, as well as the incompetent venous portion, surgery is currently considered to be the method of first choice.However, treatment of incompetent perforating veins and truncal veins, particularly by foam sclerotherapy, is also possible and promising, as will be later discussed.

Table 8.2. Classification of abnormal veins   Vein type   Diameter   Color   Telangiectasia (spider veins)   0.1–1.0 mm   Red to cyanotic   Telangiectatic matting   <0.2 mm   Red   Communicating telangiectasia a   0.1–1.0 mm   Red to cyanotic   Telangiecatic and varicose vein mixture b   1.0–6.0 mm   Cyanotic to blue   Nonsaphenous varicose veins (reticular veins)   2–8 mm   Blue to blue-green   Saphenous varicose veins   >8 mm   Blue to blue-green     Source: This has been modified from Goldman MP (1991) Sclerotherapy: Treatment of varicose and telangiectatic leg veins. Mosby, St. Louis, p 56,with permission from the author a Veins that communicate directly with varicose veins of the saphenous system b Veins that do not communicate directly with the saphenous system

Table 8.3. Types of veins responsive to sclerotherapy Truncal veins Incompetent perforating veins Communicating/side branch varicosities Reticular veins Venulectases Telangiectasias (spider veins) Postsclerotherapy and postsurgical recurrent varicose veins