Conclusion

The permanent eradication of varicose veins with sclerotherapy continues to evolve as a result of the development of new, and improvement of old techniques. Advantages of sclerotherapy include the lack of anesthesia and avoidance of hospital stay, low morbidity rate, and no “down time” or loss of work. Standardization of treatment guidelines for the practice of sclerotherapy, however, remains elusive. Several sclerosing solutions are currently available for the treatment of varicose and telangiectatic vessels (Table 8.14). The “ideal” sclerosant, concentrations, or appropriate volumes have yet to be determined. Compression sclerotherapy for the treatment of varicose veins has been widely used for many years. However, there is still no uniform agreement regarding duration of compression, type of compression, caliber of vessel requiring compression and type or use of adjunctive compression padding. A great deal of variable data exists regarding the duration and effectiveness of compression. Should patients avoid hot showers or baths during the period of postsclerotherapy compression in order to eliminate unwanted vasodilatation? Likewise, parameters for pre- and post-treatment protocols, retreatment and follow-up intervals are presently not established. These are questions that both the practitioner and patient need to have answered.

Table 8.7. Sclerotherapy supplies and distributors   Sclerosing solutions   Brand names   Distributors   Chromated glycerin   Scleremo   Laboratories E. Bouteille 7, Rue des Belges 87100 Limoges, France Omega Montreal, QC, Canada H3M3A2   Ethanolamine oleate   Ethamolin   Block Drug Company 1 New England Avenue Piscataway, NJ 08855, USA   Hypertonic glucose/saline   Sclerodex   Omega Montreal, QC, Canada H3M3A2   Hypertonic saline 23.4%   N/A   American Regent Laboratories, Inc. Shirley, NY 11967, USA Henry Schein 135 Duryea Road Melville, NY 11747,USA Invenex Gibcol Inevex Division The Dexter Corporation Chagrin Falls, OH 44022, USA Omega Montreal, QC, Canada H3M3A2   Polidocanol   Aethoxysklerol   Kreussler & Co.GmbH Chemische Fabrik Rheingaustr. 87 65203 Wiesbaden, Germany Globopharm AQ P.O. Box 1187 8700 Kusnacht, Switzerland Laboratoiries Pharmaceutiques DEXO, S.A. 31 Rue D’Arras 92000 Nanterre, France   Polyiodinated iodine   Sclerodine,Variglobin   Sclerodine from: Omega Montreal, QC, Canada H3M3A2 Variglobin from: Globopharm AQ P.O. Box 1187 8700 Kusnacht, Switzerland   Sodium morrhuate   N/A   American Regent Laboratories, Inc. 219 Country Road Tenafly, NJ 07670, USA Palisades Pharmaceuticals, Inc. 219 Country Road Tenafly, NJ 07670, USA   Sodium tetradecyl sulfate   N/A   Eklins-Sinn, Inc. (A subsidiary of A.H. Robins Company) 2 Esterbrook Lane P.O. Box 5483 Cherry Hill,NJ 08034, USAS

Introduction of the use of diagnostic tests, such as continuous-wave Doppler ultrasound, DUS, and color-duplex sonography as aids in the treatment of incompetent varicose and perforating veins, have certainly allowed for improvement in diagnosis, treatment technique, outcome, and reduction in postsclerotherapy complications. At the moment, uniform guidelines for the use of diagnostic tests pretreatment, during treatment, and postsclerotherapy have not been established.
Foam sclerotherapy represents a major therapeutic advancement in the treatment of varicose veins, but there is no “foam sclerotherapy school.” Standardized procedures and instrumentation for transforming sclerosing solutions into sclerosing foam, as well as the type and concentration of sclerosing agents used, are currently lacking. The types of vessels treated with foam sclerotherapy range from spider veins only to exclusively large, incompetent varicose veins [15]. The benefit of foam sclerotherapy for smaller vessels and spider veins needs to be further demonstrated in randomized controlled studies.

Standard guidelines for treatment of complications such as perivenous extravasation and ulcer formation, postsclerosis pigmentation and TM (telangiectatic matting) currently do not exist. There is no controlled data regarding sclerotherapy when performed on patients taking certain medications, in particular, anticoagulants and Antabuse. This, too, should be studied. Clearly, attempts to unify medical opinion and to standardize the practice of sclerotherapy are worthy of ongoing consideration, research and discussion.