Philippe Kern

European guidelines for sclerotherapy in chronic venous disorders

Aim Sclerotherapy is the targeted chemical ablation of varicose veins by intravenous injection of a liquid or foamed sclerosing drug. The treated veins may be intradermal, subcutaneous, and/or transfascial as well as superficial and deep in venous malformations. The aim of this guideline is to give evidence-based recommendations for liquid and foam sclerotherapy. Methods This guideline was drafted on behalf of 23 European Phlebological Societies during a Guideline Conference on 7–10 May 2012 in Mainz. The conference was organized by the German Society of Phlebology. These guidelines review the present state of knowledge as reflected in published medical literature. The regulatory situation of sclerosant drugs differs from country to country but this has not been considered in this document. The recommendations of this guideline are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines. Results This guideline focuses on the two sclerosing drugs which are licensed in the majority of the European countries, polidocanol and sodium tetradecyl sulphate. Other sclerosants are not discussed in detail. The guideline gives recommendations concerning indications, contraindications, side-effects, concentrations, volumes, technique and efficacy of liquid and foam sclerotherapy of varicose veins and venous malformations.

Sclerotherapy of Telangiectasias: A Painless Two-Step Technique

BACKGROUND Sclerotherapy of telangiectasias and reticular leg veins can be unpleasant and painful for some patients. OBJECTIVE To determine pain level with two different sclerotherapy techniques in a prospective randomized trial. METHODS Patients with symmetrical telangiectasias and reticular veins on both legs (C1A or SEPASPN1) were randomized to the standard (successive injections of chromated glycerin mixed with one‐third lidocaine‐epinephrine 1%) or two‐step technique (first treating only reticular veins with a single injection at the base of each cluster of telangiectasias and then successively injecting all remaining telangiectasias a few minutes later. Pain was assessed using a 100‐point visual analogue scale (0 = no pain, 100 = maximum pain). RESULTS Data from 53 consecutive patients could be evaluated. The two‐step technique was significantly less painful (28.2) than the standard technique (40.6, p < .001). CONCLUSION The two‐step technique with chromated glycerin mixed with one‐third lidocaine‐epinephrine 1% significantly reduces sclerotherapy pain. This may be a useful technique for patients who are particularly sensitive or afraid of sclerotherapy.

Chronisch-venöse Insuffizienz

Obwohl sich die chronisch-venose Insuffizienz betrachtlich auf die Morbiditat und Lebensqualitat der betroffenen Patienten auswirkt, wird sie in vielen Fallen vernachlassigt. Um die optimale Behandlung festzulegen, ist eine sorgfaltige Dopplersonographie durch einen Angiologen oder Phlebologen erforderlich. In den letzten Jahren wurde das therapeutische Standardarsenal, zu dem die elastische Kompression und die klassische Varizenchirurgie zahlen, durch interventionelle endovenose Therapien erweitert.