gms | German Medical Science

Background: The most universal and indispensable method for treatment of varicose veins is sclerotherapy. Basic issues such as the choice of solution concentration and type in every individual clinical situation remain very important, as the incidence of complications (especially hyperpigmentation, matting, skin necrosis) remains unacceptably high with standard detergents such as Polidocanol or sodium tetradecyl sulfate [1]. Therefore, clinicians continue to search for new solutions, including hypertonic ones (e.g. 70% Glucose solution). In addition, promising approaches to reduce the risk of hyperpigmentation are pharmacological drugs (eg, heparinoid Sulodexide), which reduce the incidence of this adverse effect in clinical trials [2]. The aim of the study is to improve the algorithm of sclerotherapy in order to reduce the hyperpigmentations rate by combining solutions of detergents with hyperosmolar ones, as well as the usage of venoactive drugs.

Methods: A prospective study included 86 patients with varicose veins that were treated with sclerotherapy from January 2019 to September 2020 on the basis of one specialized phlebological center in Ukraine. All patients were divided into 2 groups: the main group (42 patients) where sclerotherapy was performed taking into account the proposed algorithm for the prevention of hyperopigmentation, and the comparison group (44 patients) where sclerotherapy was performed with generally accepted methods. The algorithm for the prevention of hyperpigmentation included the following rules: in the treatment of varicose veins the foam-form form 1-1.5% solution of Polidocanol was used. For the treatment of C1 clinical form, the first stage was sclerotherapy of reticular veins (0.5-0.75% solution of Polidocanol) and on second stage a liquid solution of Polidocanol 0.25-0.33% for telangiectasia with optical magnification was used. The solvent in all cases was 70% glucose solution. All patients received Sulodexide 250 IU 2 times a day for 1 to 3 months, and also used compression stockings of the 2^nd compression class from 1 to 3 months. Evaluation of treatment results was performed 1, 3 and 6 months after sclerotherapy, by objective examination, ultrasound and photo documentation.

Results: Any serious complications after sclerotherapy, such as bleeding, signs of venous thromboembolism, injection site necrosis, or systemic allergic reactions weren’t observed. The number of necessary sessions of sclerotherapy to obtain the desired aesthetic effect in the main group was 3±3.2 against 2±1.1 in the control group. During treatment, 23.8% (10 patients) of the main group and 34% (15 patients) of the comparison group required microcoagulotomy during follow-up examinations. The frequency of hyperpigmentation after 1 month was recorded in 35.7% (15 patients) of the main group against 56.8% (25 patients) of the comparison group. The area of hyperpigmentation persisted after 3 months in 11.9% (5 patients) of the main group against 29.5% (13 patients) of the comparison group. The number of hyperpigmentations after 6 months remained in 4.7% (2 patients) of the main group against 13.6% (6 patients) of the comparison group.

Conclusion: The proposed algorithm for sclerotherapy is an effective and safe method of treating patients with varicose veins. This approach reduces the amount of hyperpigmentation by 21.1% at the 1 month and by 11.5% 6 months after sclerotherapy compared to standard treatment.