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ASDS releases consensus document on sclerotherapy

Appropriate patient evaluation, proper choice of technique and post-procedure compression are essential to successful sclerotherapy for varicose and telangiectatic leg veins, according to consensus guidelines issued by the American Society of Dermatologic Surgery.

The consensus document was developed by an expert committee formed by the American Society of Dermatologic Surgery (ASDS)’s board of directors in 2013 and outlines evidence-based recommendations on the diagnostic assessment and treatment of varicose and telangiectatic leg veins using sclerotherapy.
Within the document, the committee reported that sclerotherapy is indicated as an appropriate treatment for improving the appearance of varicose veins and cosmetically unacceptable small vessels. The procedure is contraindicated in patients with allergies to sclerosants, significant systemic disease, acute superficial or deep vein thrombosis, local or severe generalized infections, confinement to bed or advanced arterial occlusive disease.

The document defined the three categories of sclerosants currently used — detergents, hypertonic solutions and chemical irritants — as well as their mechanisms of action. The experts also addressed the use of conventional liquid vs. foam sclerotherapy approaches. According to the document, clinicians generally agreed that conventional liquid sclerotherapy is more effective for telangiectasias and reticular veins smaller than 4 mm in diameter, whereas reticular veins larger than 8 mm in diameter benefit more from foam sclerotherapy.

The committee also wrote that treating a given vessel diameter with the lowest effective concentration of sclerosant, as well as the lowest possible volume, is considered the optimal approach.

Protocols for postsclerotherapy compression were discussed within the guidelines, citing one study in particular in which 3 weeks of continuous compression achieved the best results. The authors also discussed common complications from sclerotherapy, such as telangiectatic matting and hyperpigmentation, and listed strategies for decreasing the risk of these complications.

“The ASDS consensus documents on sclerotherapy will be helpful in educating their members on safe and effective sclerotherapy of varicose and telangiectatic leg veins,” the authors wrote.

Disclosure: The authors have no relevant disclosures.