Sclerotherapy for vascular lesions — SAQ

Stem

A 42-year-old woman wants treatment of thigh spider veins and reticular feeders. She asks whether foam is “stronger,” whether she can be treated while trying to conceive, and how this differs from laser. Outline a safe sclerotherapy approach.

Questions

a) Define sclerotherapy and the intended pathophysiologic sequence after detergent injection. (2 marks)

b) Name two detergent sclerosants and contrast liquid vs foam in one practical sentence each. (2 marks)

c) List four contraindications or strong reasons to delay/decline elective sclerotherapy. (3 marks)

d) Name two common local complications and one reason duplex ultrasound may be required before treating larger veins. (3 marks)

Model answers

a)

Percutaneous injection of sclerosant to injure endothelium → local thrombosis → organisation/fibrosis → lumen obliteration.

b)

• Polidocanol and STS (sodium tetradecyl sulfate).
• Liquid: often used for finest telangiectasias; foam: displaces blood, more wall contact for larger channels.

c)

Any four: pregnancy; known sclerosant allergy; acute DVT/PE; critical arterial disease of the limb; local infection; inability to ambulate/high untreated VTE risk as selection concerns.

d)

• Complications: hyperpigmentation/staining, matting, ulceration (extravasation), thrombophlebitis.
• Duplex: detect axial/truncal reflux so CVD is managed in hierarchy—not spiders alone when significant reflux exists.