Sclerotherapy: step by step – liquid sclerotherapy
https://doi.org/10.21518/1995-1477-2020-1-2-22-29
Abstract
Classic sclerotherapy using drugs in the native (liquid) state is almost the oldest method of minimally invasive treatment of various forms of varicose veins of lower extremities and not only. Despite more than 300 years of development of the sclerotherapy methodology, enormous international experience and almost thorough study of its mechanisms, the development of new sclerosing drugs and technologies of their delivery to the lumen of the target vein continues. Measures aimed at reducing the frequency of undesirable side effects after sclerotherapy and improving the quality of life of patients during treatment and after its completion are discussed separately. Currently, there are several guidelines that regulate phlebosclerosing treatment in various clinical situations in terms of evidence-based medicine. This publication provides a brief historical background on the formation of sclerotherapy technology, presents basic principles for liquid sclerotherapy based on the analysis of international and Russian recommendations for the treatment of chronic venous diseases. Indications, contraindications and the basic methods of carrying out sclerotherapy with the use of officinal, registered in the Russian Federation phlebosclerosing detergent agents are presented, their actual physical and chemical properties, similarities and distinctions, and also optimal concentrations and doses are discussed. The classic sclerotherapy technique which has become known as “empty vein technique” is described in detail and illustrated.
In addition, current clinical examples demonstrating successful use of compression sclerotherapy are presented. Again, the authors conclude that liquid sclerotherapy with the use of modern phlebosclerosing agents such as lauromacrogol 400 and sodium tetradecyl sulfate, performed according to the classical “empty vein” technology, demonstrates high efficiency and safety regarding large varicose veins of various localizations.
About the Authors
V. Yu. BogachevRussian Federation
Vadim Yu. Bogachev, Dr. of Sci. (Med), professor, Department of Faculty Surgery No. 2
1, Ostrovityanov St., Moscow, 117997, Russia;
31, Dmitry Ulyanov St., Moscow, 117447, RussiaV. N. Lobanov
Russian Federation
Viktor N. Lobanov, Phlebologist, Head of Clinic
31, Dmitry Ulyanov St., Moscow, 117447, Russia;
References
1. Fegan G. Varicose veins, compression sclerotherapy. Berrington Press; 1990. 114 p.
2. Rabe E., Wollmann Ch. (ed.). Sclero Guide. Rabe Medical Publishing Bonn; 2009.
3. Bergan J., Bunke-Paquette N. (ed.). The Vein Book. Second edition. OXFORD University press; 2014.
4. Kiriyenko A.I., Bogachev V.Yu., Zolotukhin I.A. Compression sclerotherapy. Practical Guide for Doctors. Moscow: Bakoulev SCCVS of RAMS; 2004. 40 p. Available at: https://ptv.okis.ru/files/6/8/5/685/sclero.pdf.
5. Rabe E., Pannier F. Sclerotherapy of varicose veins with polidocanol based on the guidelines of the German Society of Phlebology. Dermatol Surg. 2010;36(2):968–975. doi: 10.1111/j.1524-4725.2010.01495.x.
6. Khunger N., Sacchidanand S. Standard guidelines for care: sclerotherapy in dermatology. Indian J Dermatol Venereol Leprol. 2011;77(2):222–231. doi: 10.4103/0378-6323.77478.
7. Rabe E., Breu F.X., Cavezzi A., Coleridge Smith P., Frullini A. et al. European guidelines for sclerotherapy in chronic venous disorders. Phlebology. 2014;29(6):338–354. doi: 10.1177/0268355513483280.
8. Wittens C., Davies A.H., Bækgaard N., Broholm R., Cavezzi A. et al. Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49(6):678–737. doi: 10.1016/j.ejvs.2015.02.007.
9. Ctoyko Yu.M., Kirienko A.I., zatevakhin I.I. et al. Russian Clinical Guidelines for the Diagnostics and Treatment of Chronic Venous Diseases. Flebologiya = Flebologiya. Journal of Venous Disorders. 2018;12(3):146–240. (In Russ.) doi: 10.17116/flebo20187031146.
10. Gianesini S., Obi A., Onida S., Baccellieri D., Bissacco D., et al. Global guidelines trends and controversies in lower limb venous and lymphatic disease: Narrative literature revision and experts’ opinions following the vwINter international meeting in Phlebology, Lymphology & Aesthetics, 23–25 January 2019. Phlebology. 2019;34(1S):4–66. doi: 10.1177/0268355519870690.
11. Bogachev V.Y. Sclerotherapy. Step by step. Telangiectasia. Нospital-replacing technologies:Ambulatory surgery. 2019;(1–2):52–58. (In Russ.) doi: 10.21518/1995-1477-2019-1-2-52-58.
12. Guex J.J. Les contre-indications de la sclérothérapie, mise à jour 2005. J Mal Vasc. 2005;30(3):144−149. doi: 10.1016/s0398-0499(05)83831-4.
13. Rabe E., Schliephake D., Otto J., Breu F., Pannier F. Sclerotherapy of telangiectases and reticular veins: a double-blind, randomized, comparative clinical trial of polidocanol, sodium tetradecyl sulphate and isotonic saline (EASI study). Phlebology: The Journal of Venous Disease. 2010;25(3):124−131. doi: 10.1258/phleb.2009.009043.
14. Goldman M. Treatment of varicose and telangiectatic leg veins: double-blind prospective comparative trial between aethoxyskerol and sotradecol. Dermatologic Surgery. 2002;28(1):52−55. doi: 10.1046/j.1524-4725.2002.01190.x.
15. McDonagh B., Sorenson S., Gray C., Huntley D.E., Putterman P., King T., Eaton T., Martin C., Harry J.L., Cohen A., Guptan R.C. Clinical spectrum of recurrent postoperative varicose veins and efficacy of sclerotherapy management using the compass technique. Phlebology: The Journal of Venous Disease. 2003;18(4):173−186. doi: 10.1258/026835503322597992.
16. Labas P., Ohradka B., Cambal M., Reis R., Fillo J. Long-term results of compression sclerotherapy. Bratisl Lek List. 2003;104(2):78−81.
17. Konschake W., Valesky E., Stege H., Jünger M. Evidence of compression therapy. Hautarzt. 2017;68(8):625–631. doi: 10.1007/s00105-017-3999-z.
Review
For citations:
Bogachev V.Yu., Lobanov V.N. Sclerotherapy: step by step – liquid sclerotherapy. Ambulatornaya khirurgiya = Ambulatory Surgery (Russia). 2020;(1-2):22-29. (In Russ.) https://doi.org/10.21518/1995-1477-2020-1-2-22-29

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