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Vein Sclerotherapy I

 

What is vein sclerotherapy?

Vein sclerotherapy creates thrombus in diseased veins and induces permanent sclerosis by IV injection of sclerosing agent. Sclerotherapy can replace surgery in treatment of varicose veins, or can be used as an adjunct to surgery. It has been applied safely in Europe for over 30-40 years. Comparison of surgery and vein sclerotherapy showed that surgery provided better outcome in varicose veins originating from saphenous vein (GSV and SSV) valve insufficiency. On the other hand, vein sclerotherapy was more effective in varicose veins arising from insufficiency of the perforating veins, communicating veins and capillaries of the lower limb (non-saphenous veins).

 

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Historical background of vein sclerotherapy

Historical records describe Hippocrates destroying endothelial cells with a slender rod of iron to treat varicose veins. If varicose veins could be treated with only needles without having to resort to surgery, it would be the most ideal treatment. This may have brought about the development of vein sclerotherapy.

Since ferric chloride was used as a sclerosing agent in 1835 by Chassignac and 1851 by Chales Gabriel Pravaz, Monteggio and D'Etoilles used absolute alcohol in the 1840s. In the 1910s, it was found that mercury injected into the arm for treatment of syphilis blocked veins and came to be used as a sclerosing agent.

Early sclerosing agents fell out of use due to serious side effects such as sepsis, pulmonary thromboembolism, high risk of allergic reaction, tissue necrosis, pain and frequent treatment failure. However, the last 4 to 5 decades saw development of low toxicity and safe drugs around Europe, especially, Germany, France, the UK and Ireland. Sclerotherapy has been widely used in the US since 15 years ago. A relative safe agent of sodium morrhuate (SM) was introduced in 1930.

From 1946, sodium tetradecyl sulfate (STS) has been used in sclerotherapy. The pharmacological mechanism of STS has been explained by Schneider and Fisher. Ethanolamine Oleate (EO) is synthesized from ethanolamine and oleic acid. Lastly, polidocanol was developed in Germany as a local anesthetic in 1936.

 

History of Sclerotherapy

Christopher Ubren (1635) – animal study (opium)

Invention of hypodermic syringe (1840's)

Linser (1916) hypertonic saline injection + compression

- father of modern compression sclerotherapy

Major & Scortue – sclerotherapy

McPheeters (1938) – multiple injection & immediate ambulation

T.Knight & F.Vin (1989) – DGS duplex guided sclerotherapy

 

History of sclerosing agent

1835 – ferric chloride

1840 – absolute alcohol

1855 – iodo-tannic liquor

1880 – chloral

1904 – 5% phenol solution

1906 – potassium iodo-iodine

1911 – sodium salicylate

1917 – quinine, urethane

1917 – hypertonic glucose

1919 – sodium bicarbonate

1922 – 12% quinine sulfate – Modern sclerosing agent

1926 – hypertonic saline with procaine

1930 – sodium morrhuate

1933 – chromated glycerin

1937 – ethanolamine oleate

1946 – sodium tetradecyl sulfate(Fibrovein, Sotradecol, Thombojet, Thrombovar)

1949 – phenolated mercury & ammonium

1966 – polidocanol (Aethoxysclerol)

1969 – hypertonic saline/dextrose

 

-To be continued-