Role of Sclerotherapy in Treating Varicose Veins

Introduction to Sclerotherapy

Sclerotherapy is an effective second-line treatment for small to medium-sized varicose veins (1-5 mm) and is recommended after endovenous thermal ablation but before surgery according to current guidelines from the American Family Physician 1, 2, 3

Endovenous sclerotherapy involves ultrasound-guided injection of a sclerosing agent into superficial veins, causing inflammation of the endothelium, resulting in fibrosis and occlusion of the vein 3
A needle is inserted into the vein lumen and the sclerosing agent is injected, often with air to create foam that displaces blood and reacts with the vascular endothelium 2
Common sclerosing agents include hypertonic saline, sodium tetradecyl (Sotradecol), and polidocanol (Varithena), with no evidence that any agent is superior in terms of effectiveness or patient satisfaction 2

Primarily indicated for small (1-3 mm) and medium (3-5 mm) varicose veins 2
Recurrent varicose veins after surgery are also an indication for sclerotherapy 2

A 2014 Cochrane review concluded that foam sclerotherapy is as effective as surgery for great saphenous vein varices 3

First-line treatment for symptomatic varicose veins with documented valvular reflux is endovenous thermal ablation, according to the American Family Physician 3
Second-line treatment is sclerotherapy, particularly for small to medium-sized veins (1-5 mm) 2
Third-line treatment is surgery, according to the 2013 National Institute for Health and Care Excellence clinical guidelines 2