Optimizing Results and Follow-Up Care of Sclerotherapy

Ron Bush, MD, FACS

Midwest Vein & Laser Center

Dayton, Ohio

Disclosure

Ronald Bush, M.D., FACS

I have no financial relationship(s) to disclose.

Depends on Following:

• In what form is the sclerotherapy used?

• Liquid

• Foam

– C02

– Room Air

• What is the target?

• Spider veins

• Reticular veins

• Perforators

• Varicose veins

• Neovascularity

Sclerotherapy (Liquid)

• Reserved in our clinic for small spider telectangesia

• Expect clotting with partial resolution

• Consider combination therapy

• Evacuate thrombus to prevent hemosiderin staining

• Skin infarct may occur with forced injection

1 MONTH AFTER

SCLEROTHERAPY

Angiogenesis

Histological Slide: Sclerotherapy

Liquid Sclerotherapy in 5 mm Vein

Foam Sclerotherapy in 5 mm Vein

Preventing Complications

• Slow injections

• Low concentration percentages

• Treat the source

• Compression does help

• 15-20 mmHg

• Epi pen available if needed

Foam Sclerotherapy

• More effective

• Used everyday

• 10,000 patient treatments - No DVT

• Have seen rare incidences of superficial phlebitis

• Cerebral & ocular manifestations are possible

Minimizing Complications With Foam

• Limit volume

• Use C02 as gas mixture• No difference between C02 & room air in vivo

• Big difference between C02 and room air regarding potential complications

• Use tumescent compression

Tumescent Compression

Reduces volume of treated vein

Allows longer contact

Controls foam migration

Video: Tumescent Compression

Follow-Up For Sclerotherapy

• Spider veins• 3-4 week intervals

• Neovascularity and perforators• US at 2 weeks & retreat if necessary

• Spider veins 0.2% Sotradecol®

• Foam for neovascularity and perforators- 1% or 3% if anticoagulated

Combination Therapy

• Using heat injury and chemical injury produce the best results in spider veins

• In spider veins, decrease target with heat first, then less chemical (sclero) is needed

• For calf perforators, combining laser and chemical may be advantageous

Summary

• Sclerotherapy causes damage by destruction of endothelial cells, cessation of blood flow, & eventual cell wall fibrosis

• Foam is more effective than liquid

• Use C02 as your gas mixture

• If possible, use combination therapy

• Know pathophysiology of complex you are treating

(Midwest Vein & Laser Center, 2010)

(Midwest Vein & Laser Center, 2010)

www.bushvenouslectures.com