Sclerotherapy

Excerpt

Sclerotherapy is a group of techniques characterized by the injection of an irritating substance into a blood vessel to damage the vessel endothelium, induce inflammation with subsequent endofibrosis, and destroy the vessel. The irritating substances are termed sclerosing agents and include osmotic agents such as glycerin and hypertonic saline, detergents like polidocanol and sodium tetradecyl sulfate (STS), and iodinated substances. Sclerotherapy is most commonly a primary or adjunctive therapy for cosmetically distressing or symptomatic venous varicosities of the lower extremities, but it also may be employed when treating certain hemorrhoids. Sclerotherapy remains the gold standard therapeutic intervention for lower extremity superficial varicose veins, reticular veins, and telangiectasia.

The treatment of venous insufficiency and varicosities dates back to Galen, Celsus, and Hippocrates. However, the modern medical references to sclerotherapy appeared in the 1850s. High infection rates secondary to treatments with perchloride of iron of mercury at that time resulted in the abandonment of sclerosing interventions until the early 1900s with the introduction of hypertonic saline as a sclerosing agent. Reiner introduced STS as a sclerosing agent in the 1940s, and the modern era of sclerotherapy was born.