Sclerotherapy of varicose veins, varicose veins and spider veins began centuries. In fact, the first time spoken of sclerotherapy is in Indian medicine in the years 800-600 BC, when the veins and cauterized and phlebectomies were made.
The first treatments of varicose veins
Hippocrates, in 460-377 BC, he was varicose veins by injecting different substances to cause its thrombosis and obliteration of them.
Chassaignac, Valette, Petrequin and Desgranges made the first formal sclerosis with iron perchloride and presented their work at the Academy of Medicine in Paris in 1853, and Delore advocated at the Congress of Lyon that the injection should be sclerosing and not coagulant, ie , which must not produce fibrosis and thrombosis. Due to complications at first was a prohibited method and inadvisable.
During the First World War it was observed that the mercurial preparations were used for the treatment of syphilis caused sclerosis of the veins of the arms, Paul Linser then popularized in 1916, sclerosis of varicose veins of the lower extremities injecting a serum hypertonic saline.
It is not until J. Sicard (1919-1920) that sodium salicylate is used in the treatment of varicose veins, later being R.Tourney that standardizes the technique and discloses worldwide. And since then, he has continued to make progress knowledge in the art of sclerosis of varices until today, we have a wide variety of techniques and methods to try to safe, effective and aesthetic form varicose veins and spider veins with sclerotherapy techniques.
The importance of diagnosis of varicose veins
Before indicating the most appropriate treatment by specialists in Angiology and Vascular Surgery it is important to determine its origin, which can be done by a venous clinical history, physical examination and adequate detailed examination with Eco-doppler. After determining the etiology of varicose veins is possible to decide what will be the most appropriate treatment, including treatment eslcerosante.
Sclerotherapy for varicose veins
Sclerosis involves the injection of a substance within the venous dilation, which causes irritation inside the vessel, with peeling wall, all causes thrombosis, collapse and / or fibrosis of the vessel and subsequently absorption occurs, with disappearance of the same.
Depending on the size of the vein sclerosing various substances, ranging from micro - foam, liquid or sclerosis to crioesclerosis are used.
The size of the vein is important to determine the type of sclerosing: the Crioesclerosis is justified only in reticular veins and telangiectasia of small and very shallow.
The crioesclerosis is the association of cold sclerotherapy. It is used C02 cooling liquid sclerosing liquid at -40 °, thereby to inject vessel vasoconstriction is achieved, and thus a lower injection sclerotherapy and optimal treatment outcome is achieved.
The type of needle is also important: in crioesclerosis 25 to 27 G needles used with syringes small because the glass is only small caliber and with this kind of needles can be channeled.
The additional measures are making good subsequent compression treatment in the form of elastic stocking Class I.
The crioesclerosis is justified in small veins less than 2mm in diameter, and its treatment should be performed after sclerosing the larger veins. Given the size of these veins often magnifiers, glasses or skin power sources are used to display the vessel and its power or feeder vessel. The material is very fine needles and syringes to inject 2-3 ml product, always without exerting undue pressure as this can break the glass. Sclerosing extravasation can lead to complications of the most common, as is the matting.
Complications of sclerotherapy
• sclerotherapy usually does not cause serious complications, beyond small hematomas at the puncture sites, which are reabsorbed and disappear in a few days.• Beyond the hematomas, one of the possible complications after sclerotherapy is skin pigmentation. Its frequency varies greatly depending on the series, type of treated veins, techniques and materials used. It consists of a brown-purple tint in the path of the sclerotic vein thrombosis because of it. It is possible to evacuate the clot before it causes skin pigmentation, since once established, it will take a year to disappear. Treatment is also premature evacuation thrombus, anti-inflammatory creams, vitamin K and hydroquinone.
• The matting, another complication is the appearance of veins around the sclerotic areas, small veins (0.2 mm). In most cases it is due to the presence of vanishing points for insufficient perforating vein.
• urticaria, rare complication is a rare allergic reaction due to the injection of any drug (in this case, the sclerosing).
• The most serious, although rare, sclerotherapy complication is skin ulcers: skin necrosis secondary to extravasation of sclerotherapy and usually occurs at the site of the puncture. It is because very irritating sclerosing injections or high doses, although its appearance is exceptional.
While complications are rare, its incidence is very rare in the crioesclerosis, where there have been described pigmentation or skin lesions. Therefore it is considered that the crioesclerosis is the ideal treatment in small vessels, as it provides many advantages in terms of technical performance, aesthetics and safety.
Principal author: Dr. José María Mestres Sales, in collaboration with Dr.. Mestres Alomar.