Complications and Risks

Table 8.8. Sclerosing agents

	Classes		Agents		FDA approval		Ingredients		Advantages		Disadvantages
	Osmotic agents		Hypertonic saline		Approved abortifacient		18–30% saline		Lack of allergenicity		Damage to cellular tissues Produce ulcerations Necrosis Hyperpigmentation Pain Muscle cramping
			Hypertonic glucose/saline (Sclerodex)		Not approved		250 mg/ml of dextrose, 100 mg/ml of sodium chloride, 100 mg/ml of propylene glycol, and 8 mg/ml of phenethyl alcohol		Minimized pain Less muscle cramping		Superficial necrosis Allergic reaction Hyperpigmentation Mild pain
	Chemical irritants		Chromated glycerin (Scleremo)		Not approved		1.11% chromated glycerin		Rare posttreatment hyperpigmentation, necrosis, and bruising, even if injected extravascularly		Weak agent, therefore requires more treatment sessions High viscosity Pain
			Polyiodinated iodine (Variglobin, Sclerodine)		Not approved		A water solution of iodide ions, sodium iodine, and benzyl alcohol		Direct destruction of the endothelium		Necrosis Pain
	Detergent sclerosing solutions		Sodium morrhuate		Approved		Sodium salts of the saturated and unsaturated fatty acids in cod-liver oil		N/A		Extremely caustic Necrosis Allergic reactions, including anaphylaxis Pain
			Ethanolamine oleate (Ethamolin)		Not approved		Ethanol amine and oleic acid		Decreased risk of allergic reaction		Hemolysisa Renal failure with recoverya Constitutional symptomsa Pulmonary toxicity Allergic reactions Pain
			Sodium tetradecyl sulfate		Approved		Sodium 1-isobutyl-4-ethyloctyl sulfate, benzoyl alcohol 2% (anesthetic), and phosphate		N/A		Epidermal necrosis Allergic reaction Hyperpigmen-tationb Pain
			Polidocanol (Aethoxysklerol)		Pending		Hydroxypolyeth- oxydodecane, distilled water, and ethyl alcohol		Will not produce ulcerations Necrosis is very rare Allergic reaction is very rare Less hyperpigmentation Painless		Necrosis (rare)a Allergic reaction (rare)

Table 8.11. Complications and risks of sclerotherapy

Allergic reaction, including anaphylaxis
Hyperpigmentation
Necrosis
Nerve damage
Orthostatic hypotension
Scintillating scotomas
Telangiectatic matting
Thromboembolism
Thrombosis (deep or superficial) pulmonary
embolism
Thrombophlebitis

Table 8.13. Allergic reactions from sclerosing agents

	Sclerosing agents		Reported reactions
	Chromated glycerin (Scleremo)		Hypersensitivity Hematuria (with ureteral colic) Ocular manifestations Hypertension Visual disturbances
	Ethanolamine oleate (Ethamolin)		Pleural effusion (infiltration) Anaphylactic shock Local inflammatory Coagulation in vitro Renal failure Hemolytic reaction Constitutional symptoms (with aching in the loins and passage of red-brown urine) Pyrexia and substernal chest pain
	Hypertonic glucose/saline (Sclerodex)		Allergic reaction to the propylene glycol component in susceptible patients
	Hypertonic saline		Hypertension Hematuria (painless)
	Polidocanol (Aethoxysclerol)		Anaphylactic shock (very rare) Urticaria Dyspnea Cardiac toxicity
	Polyiodinated iodine (Sclerodine,Variglobin)		Tissue necrosis Cutaneous reactions Varicophlebitis Bronchomucosal lesions
	Sodium morrhuate		Erythema (with pruritus) Urticaria Gastrointestinal disturbances (abdominal pain and diarrhea) Anaphylaxis Edema Dysrhythmia–cardiac