Sclerosants used in Sclerotherapy for Varicose Veins and Spider Veins (Telangiectasia)

Sclerosants are agents which are injected into veins for the purpose of removing them. The internal vein walls are chemically cauterized and this leads to permanent closure and eventual removal of the vein as it transitions from a fibrosed cord to scar tissue and then complete absorption through a process called apoptosis.

Sclerotherapy has been practised for more than two thousand years as there are records of the ancient Greeks inserting agents through hollow chicken bones pushed into varicose veins. Since then a large variety different agents have been used but in this century it is generally accepted that in the field of phlebology there are only two classes of sclerosing agents which are regarded as acceptable; these being the detergent sclerosants and the irritant sclerosants. 

Detergent Sclerosants.
Worldwide today the detergent sclerosants are the most popular agents in use because of their efficiency and safety record. They also have the distinct advantage of being used in the form of a foam rather than a solution through a simple process of agitating them with air or oxygen or carbon dioxide. The Tessari Method.

1. “Fibrovein”. Sodium Tetradecyl Sulphate.
   Has been in use since 1946 and has been extensively investigated in terms of it’s safety profile.  
2. “Polidocanol”. Aethoxysclerol
   Also in use since the 1940’s and originally used as a local anaesthetic. 
   
   

Irritant Sclerosants.
Often used as an adjunct to the Detergent Sclerosants.

1. Glycerine.
   Glycerine has been in use since the 1920’s and still remains a popular sclerosant around the world. It is a weak sclerosant which makes it only suitable for spider veins (telangiectasia) but it is has a very low risk of causing post sclerotic pigmentation and also a very low risk of skin ulceration.
   
   
2. Hypertonic Saline.
   Pure Hypertonic saline has no risk of causing allergy but it is a weak sclerosant and has now largely been replaced in the 21^st century by the detergent sclerosants. Hypertonic saline has limited benefit in the treatment of larger veins and it has distinct disadvantages in that it causes significant pain if it leaks into the tissue because the vein is missed on injection.  It is also more prone to causing skin ulceration.  Hypertonic saline is also unsuitable in the treatment of larger veins because of the excessive salt load which may cause destruction of red blood cells and also cause damage to the kidneys.