RPhS Review - Sclerotherapy

The categories of sclerosant solution are chemical agents, osmotic agents and detergents.

Sodium morrhuate, STS, polidochanol and ethanolamne oleate are detergent sclerosants.

Sodium morrhuate and sodium tetradecyl sulfate (STS) are considered strong detergent sclerosant solutions. They have been shown to macerate the endothelial lining of veins within 1 second of exposure.

23.4%

Osmotic sclerosants (e.g. hypertonic saline) do not cause desquamation of endothelial cells.

Glycerin is ranked as the weakest osmotic sclerosant.

Zone 1 endothelium is irreversibly damaged by sclerosant solution. In Zone 3, vascular endothelium is not injured because the sclerosant is diluted below its injurious concentration. Zone 2 endothelium will recanalize because it is partially injured.

True. Sodium morrhuate and sodium tetradecyl sulfate (STS) are considered strong sclerosant solutions. They have been shown to macerate the endothelial lining of veins within 1 second of exposure.

Patient posture has a strong effect on the effectiveness of sclerosant solutions when used in non foamed mixtures. A 2 cm vein in the standing patient would have a diameter of 0.5 cm when the leg is elevated and 1 cm when the patient assumes a supine position.

True. Distance from injection site, volume of sclerosant used and concentration are very important considerations in traditional sclerotherapy. When using foam scerotherapy, the concentration and volume should be smaller - there is less dilution of the chemical as it travels to Zone 2 and Zone 3.

Sodium morrhuate is exempted from FDA approval as it has been used since 1920. It is unstable in solution.

Sodium morrhuate is not synthetic. It is derived from cod liver oil

Yes. It can cause cutaneous necrosis when it extravasates outside the vein.

Yes

Ethanolamine oleate is a synthetic product. It is a weak detergent sclerosant. It is used to treat esophageal varices.