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.
Evidence from RCTs suggests that the choice of sclerosant, dose, formulation (foam versus liquid), local pressure dressing, degree and length of compression have no significant effect on the efficacy of sclerotherapy for varicose veins. The evidence supports the current place of sclerotherapy in modern clinical practice, which is usually limited to treatment of recurrent varicose veins following surgery and thread veins. Surgery versus sclerotherapy is the subject of a further Cochrane Review.
Injection sclerotherapy is widely used for superficial varicose veins. The treatment aims to obliterate the lumen of varicose veins or thread veins. There is limited evidence regarding its efficacy.
To determine whether sclerotherapy is effective in improving symptoms and cosmetic appearance and has an acceptable complication rate; to define rates of symptomatic or cosmetic varicose vein recurrence following sclerotherapy.
The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2006), MEDLINE and EMBASE (both inception to October 2006) and reference lists of articles. Manufacturers of sclerosants were contacted for additional trial information.
Randomised controlled trials (RCTs) of injection sclerotherapy versus graduated compression stockings (GCS) or 'observation', or comparing different sclerosants, doses, formulations and post-compression bandaging techniques on people with symptomatic and/or cosmetic varicose veins or thread veins were considered for inclusion in the review.
Data were extracted by authors and Review Group Co-ordinators independently.
Seventeen studies were included. One study comparing sclerotherapy to GCS in pregnancy found that sclerotherapy improved symptoms and cosmetic appearance. Three studies comparing sodium tetradecyl sulphate (STD) to alternative sclerosants found no significant differences in outcome or complication rates; another study found that sclerotherapy with STD led to improved cosmetic appearance compared with polidocanol, although there was no difference in symptoms. Sclerosant plus local anaesthetic reduced the pain from injection (one study) but had no other effects. Two studies compared foam- to conventional sclerotherapy; one found no difference in failure rate or recurrent varicose veins; a second showed short-term benefit from foam in terms of elimination of venous reflux. The recanalisation rate was no different between the two treatments. One study comparing Molefoam and Sorbo pad pressure dressings found no difference in erythema or successful sclerosis. The degree and duration of elastic compression had no significant effect on varicose vein recurrence rates, cosmetic appearance or symptomatic improvement.