Injection sclerotherapy for varicose veins

Tisi PV, Beverley C, Rees A

Summary

Injection sclerotherapy for varicose veins

Varicose veins are enlarged, visibly lumpy knotted veins, usually in the legs. They can cause pain, burning discomfort, aching and itching as well as generalised aching, heaviness or swelling in the legs, cramps at night and restless leg syndrome. There is also little correlation between these symptoms and the extent or size of the varicose veins which, like minor venous abnormalities thread veins or venous flares, can be cosmetically unattractive. Wearing graduated compression stockings is one treatment option.

Injection sclerotherapy can be used for superficial varicose veins, residual or recurring varicose veins following surgery and thread veins to obliterate the varicose vein. An irritant liquid such as sodium tetradecyl sulphate (STD) is injected into the faulty blood vessel. Pressure pad dressings at the injection site and compression bandages may then be applied, options including crepe bandaging, proprietary elastic bandaging or compression stockings. Bandaging can cause discomfort and foot swelling and may slip. Possible complications of sclerotherapy include formation of blood clots, skin staining, inflammation, ulcers and tissue damage and reactions to the sclerosing agent.

Seventeen randomised controlled trials involving over 3,300 people were included in the review. One study comparing sclerotherapy to compression stockings in pregnancy found that sclerotherapy improved symptoms and cosmetic appearance. There was no overall benefit from using alternative agents to STD (four trials), or any evidence that a foam is superior to liquid (two trials). Adding local anaesthetic to the sclerosing agent did reduce the pain of injection in one study. Neither the type, nor duration of elastic compression (seven studies) or type of pressure pad (one study) after sclerotherapy had any clear effect on the effectiveness of sclerotherapy, on varicose vein recurrence rates, cosmetic appearance or symptomatic improvement, or on complications. Many of the included studies took place in the 1980s and there is very limited evidence on which to assess the merits of sclerotherapy for treatment of varicose veins or comparing graduated compression stockings to sclerotherapy. There were no controlled trials comparing sclerotherapy for thread veins with either laser treatment or simple observation; hypertonic dextrose had similar efficacy in terms of sclerosis to STD in one study.