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Introduction
CHAPTER 72 Sclerotherapy and
Management of Varicose Veins
Neil Sadick
SUMMARY
Sclerotherapy is a highly effective technique for the treatment of varicose veins.
Sclerosants may be divided based on whether they exert osmotic or detergent
effects on the vessels.
Both liquid and foam sclerotherapy may be used, depending on vessel caliber.
Beginner Tips
Common sclerosants include sodium tetradecyl sulfate (STS), polidocanol, and
hypertonic saline.
Larger caliber vessels may benefit from foam sclerotherapy, which can be prepared
immediately prior to use.
Expert Tips
Vessels should be treated from deep to superficial.
Treating with Nd:YAG laser after sclerotherapy may be helpful and lead to markedly
increased levels of response.
Donโt Forget!
Maintaining or increasing activity in the postprocedure period is of vital importance.
Superficial thrombophlebitis is common after surgery, and localized urticarial
reactions may be seen as well.
Pitfalls and Cautions
Microemboli are frequently seen after foam sclerotherapy, and vision changes, while
rare, are possible.
DVT is a significant risk post treatment, and patients should be warned of this risk.
Patient Education Points
The risk of DVT and vision changes, while unusual, should be discussed at length with
all patients.
Compression stockings are very helpful in the postoperative period, and ace wraps
should be avoided.
Billing Pearls
In the United States, insurance generally does not cover sclerotherapy, even when
performed for symptomatic patients. Motivated patients with symptomatic disease may wish to contact their insurer to assess coverage.
CHAPTER 72 Sclerotherapy and