MEDLINE Abstracts: Sclerotherapy
Tessari L, Cavezzi A, Frullini A
Dermatol Surg. 2001;27:58-60
Background:Recently a new method of using a foam sclerosing agent for the treatment of leg veins has been described. We present a pilot study of a new technique for producing the sclerosing foam (Tessari's method) (SFT) and its use in sclerotherapy of major and minor varicosities.
Objective: A preliminary multicenter experience of sclerotherapy performed by means of this new kind of sclerosing foam made of purified sodium tetradecylsulfate is described. The authors evaluated the safety and efficacy of different doses and concentrations of the drug as well as different methods of preparing the foam in addition, the results of this technique were evaluated.
Methods: Over a 6-week period the three authors performed sclerotherapy or duplex-guided sclerotherapy using SFT, treating 77 patients. The SFT was formed using a three-way stopcock and two syringes, mixing air with liquid sodium tetradecylsulfate to create a foam. Each author used different concentrations (0.1-3%) and doses (2-8 ml) of SFT according to the size and number of the veins. Alternate methods of preparing the foam were examined as well. Seventy percent of the sclerotherapy sessions were performed on either the long or short saphenous veins, recurrent varices, or collaterals. Thirty percent of the treatments were for reticular varices and telangiectases.
Results: At 1-month follow-up, the vast majority of treated larger veins were either obliterated or showed a normal state of cephalad blood flow. Results for minor varicosities were good, but with related complications of hyperpigmentation and small areas of cutaneous necrosis. Two patients experienced transient scotomas and one patient developed segmental phlebitis of a collateral vein. The best foam was obtained by mixing one part liquid sodium tetradecylsulfate and four to five parts air, but the duration of the foam product was also related to several other factors.
Conclusion: This preliminary pilot study demonstrates that the technique of producing sclerosing foam according to Tessari's method (three-way stopcock device) is very promising, especially for larger veins. No serious complications were reported, and further standardization of the method may improve the results and feasibility of this technique. Further studies are needed to validate this new technique.
Bernstein EF
Dermatol Surg. 2001;27:31-33
Background:Laser treatment for removal of lower extremity spider veins is emerging as a modality of choice in patients with small spider veins, those who have previously undergone sclerotherapy or vein stripping, and those refusing sclerotherapy.
Objective: To determine clinical characteristics of patients presenting for laser treatment of leg veins.
Methods: The clinical characteristics of 500 patients presenting for laser treatment of spider veins were evaluated to investigate characteristics leading to their development, and to characterize the type of patients presenting for laser treatment.
Results: Patients presenting for treatment range widely in age and have had spider veins for an average of 14 years. Both pregnancy and previous sclerotherapy were factors that contributed to the development or exacerbation of spider veins.
Conclusion: As laser treatment of spider veins improves, this modality will play an increasing role in the management of lower extremity telangiectasias.
Bihari I I, Magyar E E
Dermatol Surg. 2001;27:133-136
Background: Sclerotherapy of telangiectasias is widely used for their treatment, but causes skin ulceration in 0.2-1.2% of patients. The cause of this complication is still unclear.
Objective: We hypothesized that an arteriole is occluded because the sclerosant gets into an arteriovenous (AV) shunt. We have looked for these communications underneath the telangiectasias.
Methods: Doppler examination was performed in 155 cases above the telangiectasias to reveal the presence of an AV shunt.Twenty-two positive sites were excised and histologically screened for AV shunts.
Results: Pulsatile sound could be detected by Doppler transducer above spider veins in 112 cases (72.2%). Of the 22 Doppler-positive telangiectasias, 19 AV microshunts could be found histologically.
Conclusions: Understanding the mechanism of this complication can lead to its prevention. No more than 0.2 ml of sclerosant should be administered to a single site. The warning sign of backwash of sclerosant into arterials is the temporary blanching of the skin from the arterial spasm.
Kauvar AN
Semin Cutan Med Surg. 2000; 19:245-252
New developments in laser technology have enabled improved therapy of small and large leg telangiectasia. While sclerotherapy remains the gold standard of treatment, laser therapy should be considered a first line approach for isolated, superficial, fine-caliber, nonarborizing telangiectasia and postsclerotherapy telangiectatic matting. Laser therapy is an excellent option for patients who are fearful of needles or have demonstrated a poor response to sclerotherapy injections. Recent studies have demonstrated good clearance of leg telangiectasia and reticular veins using a variety of laser systems with deeper penetrating, near-infrared wavelengths and higher fluences in conjunction with various epidermal cooling methods. As with sclerotherapy, optimal results are achieved with lasers when larger feeding vessels are treated first using appropriate modalities.
Varma S, Lanigan SW
Clin Exp Dermatol. 2000;25:419-422
Telangiectatic leg veins (TLV) are experienced by millions of women and men. As they cause significant cosmetic embarrassment, many women seek effective treatment. Options include sclerotherapy and treatment with different lasers. We investigated the safety and efficacy of an 810-nm diode laser in the treatment of TLV. Ten females had treatment to a ≥ 25 cm2 area of TLV four times at 4-weekly intervals at 25-35 W, 0.1 s duration, 0.5 s interval and a 5-mm circular spot size (fluence of 12.7-17.8 J/cm2). Assessment of response was performed 4 weeks after the final treatment and patients were asked to complete a questionnaire requesting information regarding the treatment. No statistically significant clearing of the leg veins was demonstrated although some improvement was noted in individual patients. Side-effects were negligible, consisting of discomfort or mild pain. There was no scarring, purpura or pigment alteration. A visual analogue scale questionnaire (0-10) revealed that patients found the treatment acceptable (range, 4-10).Overall difference as assessed by the patients ranged from 0 to 8.4 and degree of satisfaction with the treatment from 0 to 9.8.Currently, the treatment of choice for TLV remains sclerotherapy. Our results suggest that the 810-nm diode laser is safe and well tolerated. Further research could establish whether effectiveness can be improved with higher fluences or in combination with sclerotherapy.
Tafazzoli A, Rostan EF, Goldman MP
Dermatol Surg. 2000;26:653-656
Background: One of the most common adverse sequelae of sclerotherapy is cutaneous hyperpigmentation.
Objective: We used the Q-switched ruby laser to treat postsclerotherapy hyperpigmentation.
Methods: Eight patients developed pigmentation lasting more than 1 year (1-2 years on average) after sclerotherapy treatment for reticular and telangiectatic veins in the legs ranging in size from 0.2 to 4 mm in diameter. All patients were treated with a Q-switched ruby laser at 694 nm, 4 mm beam size, and fluence range of 5.6-10.5 J/cm2.
Results: Ninety-two percent of lesions lightened after treatment. There was significant (75-100%) resolution of hyperpigmentation in 58% of treated areas, 25% improvement in 33% of treated areas, and no improvement in the remaining areas.
Conclusion: Our impression is that given a choice of lasers, the Q-switched ruby laser provides the greatest efficacy for treating postsclerotherapy hyperpigmentation.
Wimmershoff MB, Schreyer AG, Glaessl A, et al
Dermatol Surg. 2000; 26:584-587
Background: Lymphatic malformation, a benign malformation of the skin and the subcutaneous tissues, is divided into two major groups: the classical and the localized forms. Pathologically lymphatic malformation often consists of sequestered lymphatic cisterns with thick muscle walls lying deeply in the subcutaneous tissue. Communicating via dermal lymphatic channels with superficial pseudovesicles, they can vary in size depending on the pressure transmitted by the cisterns beneath.
Methods: We present a patient with mixed capillary/lymphatic malformation and coexisting port-wine stain since birth. To demonstrate the anatomic extent and the subcutaneous involvement we performed a 3D reconstruction of a magnetic resonance imaging (MRI). The diagnostic procedures therapeutic possibilities, and complications regarding this rare appearance are reviewed.
Results: Good results could be obtained with CO2 laser vaporization of the superficial lesions and computed tomography (CT)-guided transcutaneous sclerotherapy for the deeper cisterns with doxycycline.
Conclusion: The combination of CO2 laser treatment and sclerotherapy with doxycycline seems to present a treatment option for cutaneous and subcutaneous lymphangioma circumscriptum with rare side effects.
Bergan JJ, Weiss RA, Goldman MP
Dermatol Surg. 2000; 26:535-541
Background: Tissue necrosis after sclerotherapy has been observed, but is unexplained.
Objective: To present the complication of extensive tissue necrosis following high-concentration sclerotherapy for varicose veins.
Methods: Cases coming to the attention of the authors are presented briefly with commentary and discussion to explain the mechanisms of tissue destruction.
Results: Although the complication of extensive tissue necrosis has been ascribed to intra-arterial injection, in fact, careful study of the cases described here shows that intravenous injection was present in each case. A theory of distribution of the sclerosant into the arterial arborization is proposed. This theory would explain the distribution of sclerosant into the arterial tree and would also explain the causation of extensive tissue necrosis. Mention is made of experimental work in which intra-arterial injection was not the mechanism of causation of tissue necrosis.
Conclusion: Extensive tissue necrosis following high-concentration sclerotherapy may be rare, but its occurrence is serious and its treatment may be incomplete.
Min RJ, Navarro L
Dermatol Surg. 2000;26:410-414
Background: Surgical ligation and stripping of the greater saphenous vein has been the gold standard for treatment of saphenofemoral junction incompetence for several years. Although sclerotherapy of the greater saphenous vein has also been advocated by some phlebologists, the procedure can be technically challenging and has resulted in inadvertent nontarget injection.
Objective: The purpose of this study was to assess the effectiveness and safety of transcatheter duplex-guided sclerotherapy for the treatment of varicose veins due to saphenofemoral junction reflux.
Methods: Fifty-one greater saphenous veins in 50 patients were treated with transcatheter sclerotherapy. Using local anesthesia and ultrasound guidance, the greater saphenous vein was entered 15-45 cm below the saphenofemoral junction. An infusion catheter was placed over a guidewire and positioned under ultrasound guidance, and 3% sodium tetradecyl sulfate was administered below the saphenofemoral junction and along the course of an "empty" greater saphenous vein via the catheter.
Results: Catheter placement and treatment was possible in all patients, with 2-5 ml of 3% sodium tetradecyl sulfate administered per session. At the 24-hour and 1-week follow-ups, all treated greater saphenous vein segments were closed following initial treatment, with no flow detectable by continuous wave or color Doppler interrogation. No patients required re-treatment, with all veins remaining closed at 2- to 12-months follow-up. There have been no adverse reactions.
Conclusion: Transcatheter duplex ultrasound-guided sclerotherapy should improve both the safety and efficacy of treatment compared to conventional ultrasound-guided sclerotherapy and offers an alternative to surgical ligation and stripping for those patients wishing to avoid surgery.
MEDLINE Abstracts: Sclerotherapy
Preliminary Experience With a New Sclerosing Foam in the Treatment of Varicose Veins
Tessari L, Cavezzi A, Frullini A
Dermatol Surg. 2001;27:58-60
Background:Recently a new method of using a foam sclerosing agent for the treatment of leg veins has been described. We present a pilot study of a new technique for producing the sclerosing foam (Tessari's method) (SFT) and its use in sclerotherapy of major and minor varicosities.
Objective: A preliminary multicenter experience of sclerotherapy performed by means of this new kind of sclerosing foam made of purified sodium tetradecylsulfate is described. The authors evaluated the safety and efficacy of different doses and concentrations of the drug as well as different methods of preparing the foam in addition, the results of this technique were evaluated.
Methods: Over a 6-week period the three authors performed sclerotherapy or duplex-guided sclerotherapy using SFT, treating 77 patients. The SFT was formed using a three-way stopcock and two syringes, mixing air with liquid sodium tetradecylsulfate to create a foam. Each author used different concentrations (0.1-3%) and doses (2-8 ml) of SFT according to the size and number of the veins. Alternate methods of preparing the foam were examined as well. Seventy percent of the sclerotherapy sessions were performed on either the long or short saphenous veins, recurrent varices, or collaterals. Thirty percent of the treatments were for reticular varices and telangiectases.
Results: At 1-month follow-up, the vast majority of treated larger veins were either obliterated or showed a normal state of cephalad blood flow. Results for minor varicosities were good, but with related complications of hyperpigmentation and small areas of cutaneous necrosis. Two patients experienced transient scotomas and one patient developed segmental phlebitis of a collateral vein. The best foam was obtained by mixing one part liquid sodium tetradecylsulfate and four to five parts air, but the duration of the foam product was also related to several other factors.
Conclusion: This preliminary pilot study demonstrates that the technique of producing sclerosing foam according to Tessari's method (three-way stopcock device) is very promising, especially for larger veins. No serious complications were reported, and further standardization of the method may improve the results and feasibility of this technique. Further studies are needed to validate this new technique.
Clinical Characteristics of 500 Consecutive Patients Presenting for Laser Removal of Lower Extremity Spider Veins
Bernstein EF
Dermatol Surg. 2001;27:31-33
Background:Laser treatment for removal of lower extremity spider veins is emerging as a modality of choice in patients with small spider veins, those who have previously undergone sclerotherapy or vein stripping, and those refusing sclerotherapy.
Objective: To determine clinical characteristics of patients presenting for laser treatment of leg veins.
Methods: The clinical characteristics of 500 patients presenting for laser treatment of spider veins were evaluated to investigate characteristics leading to their development, and to characterize the type of patients presenting for laser treatment.
Results: Patients presenting for treatment range widely in age and have had spider veins for an average of 14 years. Both pregnancy and previous sclerotherapy were factors that contributed to the development or exacerbation of spider veins.
Conclusion: As laser treatment of spider veins improves, this modality will play an increasing role in the management of lower extremity telangiectasias.
Reasons for Ulceration After Injection Treatment of Telangiectasia
Bihari I I, Magyar E E
Dermatol Surg. 2001;27:133-136
Background: Sclerotherapy of telangiectasias is widely used for their treatment, but causes skin ulceration in 0.2-1.2% of patients. The cause of this complication is still unclear.
Objective: We hypothesized that an arteriole is occluded because the sclerosant gets into an arteriovenous (AV) shunt. We have looked for these communications underneath the telangiectasias.
Methods: Doppler examination was performed in 155 cases above the telangiectasias to reveal the presence of an AV shunt.Twenty-two positive sites were excised and histologically screened for AV shunts.
Results: Pulsatile sound could be detected by Doppler transducer above spider veins in 112 cases (72.2%). Of the 22 Doppler-positive telangiectasias, 19 AV microshunts could be found histologically.
Conclusions: Understanding the mechanism of this complication can lead to its prevention. No more than 0.2 ml of sclerosant should be administered to a single site. The warning sign of backwash of sclerosant into arterials is the temporary blanching of the skin from the arterial spasm.
The Role of Lasers in the Treatment of Leg Veins
Kauvar AN
Semin Cutan Med Surg. 2000; 19:245-252
New developments in laser technology have enabled improved therapy of small and large leg telangiectasia. While sclerotherapy remains the gold standard of treatment, laser therapy should be considered a first line approach for isolated, superficial, fine-caliber, nonarborizing telangiectasia and postsclerotherapy telangiectatic matting. Laser therapy is an excellent option for patients who are fearful of needles or have demonstrated a poor response to sclerotherapy injections. Recent studies have demonstrated good clearance of leg telangiectasia and reticular veins using a variety of laser systems with deeper penetrating, near-infrared wavelengths and higher fluences in conjunction with various epidermal cooling methods. As with sclerotherapy, optimal results are achieved with lasers when larger feeding vessels are treated first using appropriate modalities.
Laser Therapy of Telangiectatic Leg Veins: Clinical Evaluation of the 810 nm Diode Laser
Varma S, Lanigan SW
Clin Exp Dermatol. 2000;25:419-422
Telangiectatic leg veins (TLV) are experienced by millions of women and men. As they cause significant cosmetic embarrassment, many women seek effective treatment. Options include sclerotherapy and treatment with different lasers. We investigated the safety and efficacy of an 810-nm diode laser in the treatment of TLV. Ten females had treatment to a ≥ 25 cm2 area of TLV four times at 4-weekly intervals at 25-35 W, 0.1 s duration, 0.5 s interval and a 5-mm circular spot size (fluence of 12.7-17.8 J/cm2). Assessment of response was performed 4 weeks after the final treatment and patients were asked to complete a questionnaire requesting information regarding the treatment. No statistically significant clearing of the leg veins was demonstrated although some improvement was noted in individual patients. Side-effects were negligible, consisting of discomfort or mild pain. There was no scarring, purpura or pigment alteration. A visual analogue scale questionnaire (0-10) revealed that patients found the treatment acceptable (range, 4-10).Overall difference as assessed by the patients ranged from 0 to 8.4 and degree of satisfaction with the treatment from 0 to 9.8.Currently, the treatment of choice for TLV remains sclerotherapy. Our results suggest that the 810-nm diode laser is safe and well tolerated. Further research could establish whether effectiveness can be improved with higher fluences or in combination with sclerotherapy.
Q-switched Ruby Laser Treatment for Postsclerotherapy Hyperpigmentation
Tafazzoli A, Rostan EF, Goldman MP
Dermatol Surg. 2000;26:653-656
Background: One of the most common adverse sequelae of sclerotherapy is cutaneous hyperpigmentation.
Objective: We used the Q-switched ruby laser to treat postsclerotherapy hyperpigmentation.
Methods: Eight patients developed pigmentation lasting more than 1 year (1-2 years on average) after sclerotherapy treatment for reticular and telangiectatic veins in the legs ranging in size from 0.2 to 4 mm in diameter. All patients were treated with a Q-switched ruby laser at 694 nm, 4 mm beam size, and fluence range of 5.6-10.5 J/cm2.
Results: Ninety-two percent of lesions lightened after treatment. There was significant (75-100%) resolution of hyperpigmentation in 58% of treated areas, 25% improvement in 33% of treated areas, and no improvement in the remaining areas.
Conclusion: Our impression is that given a choice of lasers, the Q-switched ruby laser provides the greatest efficacy for treating postsclerotherapy hyperpigmentation.
Mixed Capillary/Lymphatic Malformation With Coexisting Port-wine Stain: Treatment Utilizing 3D MR and CT-guided Sclerotherapy
Wimmershoff MB, Schreyer AG, Glaessl A, et al
Dermatol Surg. 2000; 26:584-587
Background: Lymphatic malformation, a benign malformation of the skin and the subcutaneous tissues, is divided into two major groups: the classical and the localized forms. Pathologically lymphatic malformation often consists of sequestered lymphatic cisterns with thick muscle walls lying deeply in the subcutaneous tissue. Communicating via dermal lymphatic channels with superficial pseudovesicles, they can vary in size depending on the pressure transmitted by the cisterns beneath.
Methods: We present a patient with mixed capillary/lymphatic malformation and coexisting port-wine stain since birth. To demonstrate the anatomic extent and the subcutaneous involvement we performed a 3D reconstruction of a magnetic resonance imaging (MRI). The diagnostic procedures therapeutic possibilities, and complications regarding this rare appearance are reviewed.
Results: Good results could be obtained with CO2 laser vaporization of the superficial lesions and computed tomography (CT)-guided transcutaneous sclerotherapy for the deeper cisterns with doxycycline.
Conclusion: The combination of CO2 laser treatment and sclerotherapy with doxycycline seems to present a treatment option for cutaneous and subcutaneous lymphangioma circumscriptum with rare side effects.
Extensive Tissue Necrosis Following High-concentration Sclerotherapy for Varicose Veins
Bergan JJ, Weiss RA, Goldman MP
Dermatol Surg. 2000; 26:535-541
Background: Tissue necrosis after sclerotherapy has been observed, but is unexplained.
Objective: To present the complication of extensive tissue necrosis following high-concentration sclerotherapy for varicose veins.
Methods: Cases coming to the attention of the authors are presented briefly with commentary and discussion to explain the mechanisms of tissue destruction.
Results: Although the complication of extensive tissue necrosis has been ascribed to intra-arterial injection, in fact, careful study of the cases described here shows that intravenous injection was present in each case. A theory of distribution of the sclerosant into the arterial arborization is proposed. This theory would explain the distribution of sclerosant into the arterial tree and would also explain the causation of extensive tissue necrosis. Mention is made of experimental work in which intra-arterial injection was not the mechanism of causation of tissue necrosis.
Conclusion: Extensive tissue necrosis following high-concentration sclerotherapy may be rare, but its occurrence is serious and its treatment may be incomplete.
Transcatheter Duplex Ultrasound-Guided Sclerotherapy for Treatment of Greater Saphenous Vein Reflux: Preliminary Report
Min RJ, Navarro L
Dermatol Surg. 2000;26:410-414
Background: Surgical ligation and stripping of the greater saphenous vein has been the gold standard for treatment of saphenofemoral junction incompetence for several years. Although sclerotherapy of the greater saphenous vein has also been advocated by some phlebologists, the procedure can be technically challenging and has resulted in inadvertent nontarget injection.
Objective: The purpose of this study was to assess the effectiveness and safety of transcatheter duplex-guided sclerotherapy for the treatment of varicose veins due to saphenofemoral junction reflux.
Methods: Fifty-one greater saphenous veins in 50 patients were treated with transcatheter sclerotherapy. Using local anesthesia and ultrasound guidance, the greater saphenous vein was entered 15-45 cm below the saphenofemoral junction. An infusion catheter was placed over a guidewire and positioned under ultrasound guidance, and 3% sodium tetradecyl sulfate was administered below the saphenofemoral junction and along the course of an "empty" greater saphenous vein via the catheter.
Results: Catheter placement and treatment was possible in all patients, with 2-5 ml of 3% sodium tetradecyl sulfate administered per session. At the 24-hour and 1-week follow-ups, all treated greater saphenous vein segments were closed following initial treatment, with no flow detectable by continuous wave or color Doppler interrogation. No patients required re-treatment, with all veins remaining closed at 2- to 12-months follow-up. There have been no adverse reactions.
Conclusion: Transcatheter duplex ultrasound-guided sclerotherapy should improve both the safety and efficacy of treatment compared to conventional ultrasound-guided sclerotherapy and offers an alternative to surgical ligation and stripping for those patients wishing to avoid surgery.
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