Sclerotherapy is a procedure used to treat blood vessels or vascular malformations (vascular malformations) and also in the lymphatic system. The drug is injected into the vessel, which makes it shrink. It is used for children and young adults with vascular or lymphatic malformations. In adults, sclerotherapy is often used to treat spider veins, small varicose veins, hemorrhoids and hydrocele.
Sclerotherapy is one method (along with surgery, radio frequency and laser ablation) for the treatment of spider veins, occasionally varicose veins, and venous malformations. In sclerotherapy with ultrasound guides, ultrasound is used to visualize the underlying vein so doctors can provide and monitor the injection. Sclerotherapy often occurs under ultrasound guidance after venous abnormalities have been diagnosed with duplex ultrasonography. Sclerotherapy under ultrasound guidance and using microfoam sclerosant has proven effective in controlling the reflux of sapheno-femoral and sapheno-popliteal connections. However, some authors believe that sclerotherapy is unsuitable for veins with reflux from larger or lower saphenous junctions, or for vena with axial reflux.
Video Sclerotherapy
Aspek historis
Sclerotherapy has been used in the treatment of varicose veins and occasionally varicose veins for over 150 years. Like varicose vein surgery, sclerotherapy techniques have evolved over that time. Modern techniques including ultrasound guides and foam sclerotherapy are the latest developments in this evolution.
The first attempt reported on sclerotherapy was by D Zollikofer in Switzerland, 1682 which injects acid into blood vessels to induce thrombus formation. Both Debout and Cassaignaic reported success in treating varicose veins by injecting iron perchlorate in 1853. Desgranges in 1854 cured 16 cases of varicose veins by injecting iodine and tannins into the veins. This was approximately 12 years after the possibility of the emergence of a large vein saphenous vein in 1844 by Madelung. However, due to the high rates of side effects with drugs used at the time, sclerotherapy was practically abandoned in 1894. With improvements in surgical and anesthetic techniques during that time, stripping became the treatment option.
Work continued on alternative sclerosan in the early 20th century. During that time carboxylic acid and mercury perchlorate were tried and while this showed some effect in removing varicose veins, side effects also caused them to be abandoned. Prof. Sicard and other French doctors developed the use of sodium carbonate and then sodium salicylate during and after the First World War. Quinine is also used with several effects during the early 20th century. At the time of Coppleson's book in 1929, he advocated the use of sodium salicylate or quinine as the best sclerosant choice.
Further work to improve the techniques and development of safer, safer sclerosants continued into the 1940s and 1950s. Of particular importance was the development of sodium tetradecyl sulfate (STS) in 1946, a product that is still widely used today. George Fegan in the 1960s reported treating over 13,000 patients with sclerotherapy, significantly improving the technique by focusing on venous fibrosis rather than thrombosis, concentrating on controlling significant reflux points, and emphasizing the importance of compression in treated legs. This procedure was accepted medically in mainland Europe during that time. However it is poorly understood or accepted in the UK or the United States, a situation that continues to this day among some parts of the medical community.
The next major development in the evolution of sclerotherapy was the emergence of duplex ultrasonography in the 1980s and its incorporation into the practice of sclerotherapy in that decade. Knight was an early lawyer of this new procedure and presented it at several conferences in Europe and the United States. The Thibault article is the first in this topic to be published in peer-reviewed journals.
The work of Cabrera and Monfreaux in utilizing foam sclerotherapy along with Tessari's "3-way tap method" further foam production revolutionized the treatment of larger varicose veins with sclerotherapy. It has now been further modified by Whiteley and Patel to use 3 non-silicon syringes for a more durable foam.
Maps Sclerotherapy
Method
Injecting unwanted veins with sclerosing solution causes the target vein to shrink immediately, and then dissolves within a few weeks as the body naturally absorbs the treated veins. Sclerotherapy is a non-invasive procedure that takes only about 10 minutes to do. Downtime is minimal, compared to invasive varicose surgery.
Sclerotherapy is the "gold standard" and is preferred over the laser to remove large spider veins (telangiectasiae) and smaller varicose veins. Unlike lasers, the sclerosing solution also closes the "feeding vein" beneath the skin causing the spider vessels to form, thus making repeated spider veins in the treated area less likely. Some dilute sclerosant injections are injected into the abnormal surface veins of the involved foot. The patient's feet are then compressed with the stockings or bandages they wear normally for two weeks after treatment. Patients are also encouraged to walk regularly during that time. It is a common practice for patients to require at least two treatment sessions separated by several weeks to significantly improve the appearance of their toe veins.
Sclerotherapy can also be performed using sclerosant microfoam under ultrasound guidance to treat larger varicose veins, including large and small saphenous veins. After the patient's varicose veins are made using ultrasound, these veins are injected while real-time monitoring of the injections is performed, also using ultrasound. Sclerosant can be observed entering the vein, and further injection is done so that all abnormal veins are treated. Follow-up ultrasound scans are used to confirm the closure of the treated veins, and any residual varicosities can be identified and treated.
Foam sclerotherapy
Foam sclerotherapy is a technique that involves injecting "foaming sclerosant drugs" in a vein using a pair of syringes - one with a sclerosant in it and one with gas (initially air). The original Tessari method has now been modified by Whiteley-Patel modification using 3 syringes, all of which are silicon-free. Sclerosant medications (sodium tetradecyl sulfate or polidocanol) are mixed with air or physiological gas (carbon dioxide) in a syringe or by using a mechanical pump. This increases the surface area of ​​the drug. The sclerosant foam drug is more efficacious than the fluid that causes sclerosis (thickening of blood vessel walls and clogging the bloodstream), because it does not mix with blood in the blood vessels and actually replaces it, thus avoiding dilution of the drug and causing maximum sclerospora action. It is therefore useful for longer and larger vein. Experts in foam sclerotherapy have created "toothpaste" such as thick foam for their injection, which has revolutionized the treatment of non-surgical varicose veins and vein malformations, including Klippel Trenaunay syndrome.
Clinical evaluation
A study by Kanter and Thibault in 1996 reported a 76% success rate at 24 months in treating saphenophen- ulm junction and severe venous saphene incompetence with a 3% STS solution. Padbury and Benveniste found that ultrasound guided sclerotherapy was effective in controlling reflux in small saphenous veins. Barrett et al. found that microfoam ultrasound sclerotherapy was "effective in treating all varicose veins with high patient satisfaction and improved quality of life".
A Cochrane Collaboration review of the medical literature concluded that "evidence supports the current place of sclerotherapy in modern clinical practice, which is usually limited to the treatment of recurrent varicella veins after surgery and yarn veins." A second Cochrane Collaboration review comparing surgery with sclerotherapy concluded that sclerotherapy had greater benefits than surgery in the short term but the operation had greater benefits in the long run. Sclerotherapy is better than surgery in terms of treatment success, complication rate and cost in one year, but surgery is better after five years. However, the evidence does not have excellent quality and further research is needed.
Healthcare Assessment found that sclerotherapy provides less benefit from surgery, but tends to provide small benefits to varicose veins without reflux from sapheno-femoral or sapheno-popliteal connections. It does not study the relative merits of surgery and sclerotherapy in varicose veins with junctional reflux.
The European Consensus Meeting on Foam Sclerotherapy in 2003 concluded that "Foam Sklerotherapy enables a skilled practitioner to treat larger blood vessels including saphenous stems". The second European Consensus Meeting on Foam Sclerotherapy in 2006 has now been published.
Complications
Complications, although rare, include venous thromboembolism, visual impairment, allergic reactions, thrombophlebitis, skin necrosis, and hyperpigmentation or red treatment areas.
If sclerosant is injected properly into the vein, there is no damage to the surrounding skin, but if injected outside the veins, tissue necrosis and scarring may occur. Skin necrosis, although rare, can be cosmetically "potentially devastating", and may take several months to heal. Very rarely when a small amount of dilute (& lt; 0.25%) sodium tetradecyl sulfate (STS) is used, but has been seen when higher concentrations (3%) are used. Skin blanching often occurs when STS is injected into arterioles (small arterial branches). Telangiectatic matting, or the development of small red vessels, is unpredictable and should usually be treated with repeated sclerotherapy or laser.
Most complications occur because of intense inflammatory reactions to sclerotherapy agents in the area around the injected vein. In addition, there are systemic complications that are now becoming increasingly understood. This occurs when the sclerosant travels through the blood vessels to the heart, lungs and brain. A recent report linking stroke with foam treatment, although this involves a tremendous injection of foam. Recent reports indicate that bubbles from even a small amount of foam sclerosan injected into the blood vessels quickly appear in the heart, lungs and brain. The importance of this is not fully understood at this point and major research suggests that foam sclerotherapy is safe. Sclerotherapy is fully FDA approved in the US.
References
External links
- Management of venous malformations in Klippel-Trenaunay syndrome with foam sclerotherapy with ultrasound guidance
- Information on Lymphatic Malformations and the use of sclerotherapy to treat it from Children's Hospital, Seattle
- Ultrasound video of the ongoing sclerotherapy
- Video Sclerotherapeutic procedure
- The American College of Phlebology is an association of venous disease providers practicing sclerotherapy and other vein modalities.
Source of the article : Wikipedia
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