Pulmonary Embolism/Deep Venous Thrombosis

The occurrence of pulmonary emboli after sclerotherapy is very rare. Deep vein thrombosis and embolic episodes usually occur 4–28 days after sclerotherapy, and most cases have been associated with injection of large volumes of sclerosant (12 ml) at a single site. With the use of duplex-guided foam sclerotherapy, the amount and concentration of sclerosing solution is reduced [15, 18]. The sclerosing foam displaces the intravascular blood with very little dilution of the sclerosant, and the active surface of the sclerosant is increased as a result of the preparation of the foam [15]. Sclerosing foam is highly echogenic, and safe intravascular injections can be controlled by an experienced phlebotomist using duplex-guided foam sclerotherapy technique. Other techniques that will minimize damage to the deep venous system include leg elevation during the treatment of large varicose veins (impedes penetration into the deep venous system), postsclerotherapy compression of the treated vein with local compression, and a class II graduated compression stocking followed by immediate ambulation and frequent ambulation thereafter to dilute the sclerosant [6].