Sclerotherapy in the treatment of varicose veins

Varicose veins are a common but important condition, accounting for around 2% of the national healthcare expenditure. Between 7-30% of the adult population have detectable trunk varicosities. Treatment options include surgery, endovenous laser ablation (EVLA), radiofrequency ablation (RFA) and sclerotherapy (foam or liquid) and there is no agreed consensus for a management algorithm. Sclerotherapy remains a novel, cost-effective way of treating varicose veins. It can be performed safely, as an out-patient procedure under local anaesthesia on a number of occasions leading to excellent rates of treatment success. It produces a lower level of pain post-procedure and has a quicker return to work with lower days of sick leave. It is extremely safe with low complication rates, and the commoner side effects of pigmentation and phlebitis are usually transient and self-resolving. It can be carried out as a set of treatments rather than a single procedure and success rates are high with between a 68.2-93.8% primary success achieved. Options include repeated treatment courses or combination therapy with surgery (sapheno-femoral/popliteal tie-off and sclerotherapy to distributing veins). Recurrence is variable but easier to treat with further injections should it occur. Whilst generally success rates are slightly lower than surgery alone sclerotherapy remains a viable treatment option especially in small veins and when a joint procedure is undertaken with control of proximal reflux. It can also be used on multiple occasions as a neo-adjuvant treatment after surgery for residual disease and has high levels of patient satisfaction. Studies are heterogeneous using a wide variety of sclerosants, strengths and methods concluding that further study is needed to produce a treatment algorithm for varicose veins. Sclerotherapy will play a significant part in the future especially in the treatment of recurrent veins given its benefits as an out-patient treatment and quicker return to work without a general anaesthetic.