Comparison of the Safety and Efficacy of Foam Sclerotherapy With 1:2 Polidocanol to Air Ratio Versus 1:4 Ratio for the Treatment of Reticular Veins of the Lower Extremities

Abstract

BACKGROUND Foam sclerotherapy is a common treatment of lower extremity reticular veins. The effect of different liquid–gas ratios on foam stability and efficacy has been controversial. OBJECTIVE To evaluate the use of 2 different polidocanol (POL) to air ratios for the treatment of reticular veins of the lower extremities. METHODS AND MATERIALS Patients with lower extremity reticular veins were randomized to foam sclerotherapy with POL mixed with 4 mL of room air for one lower extremity or 2 mL for the other lower extremity. All telangiectasias were treated with glycerin immediately after treatment of the reticular veins. Adverse events (AEs) and efficacy were evaluated by both subject and blinded investigator. RESULTS Thirty subjects completed the study. No statistically significant difference was seen in AEs between the 2 different POL to air ratios by subject questionnaire and blinded investigator scores at all time points. Subjects and blinded investigator reported a mean improvement between 0% and 50% at Day 21 and 26% to 75% at Day 90, which was not significantly different between groups. CONCLUSION Two different POL to air ratios, 1:2 versus 1:4, were similarly safe and efficacious for the treatment reticular veins of the lower extremities.

Skin hyperpigmentation after sclerotherapy with polidocanol: A systematic review

“…The volumes used were not always mentioned in the publications. The maximum volumes for liquid polidocanol at all concentrations and foam polidocanol were 28 ml and 10 ml, respectively 7,9–20 …”

“…Liquid and foam with concentrations of 0.25%–1% were used to treat telangiectasias and reticular veins. The evaluation of all RCTs and non‐RCTs showed more hyperpigmentation with increasing concentrations: with polidocanol 0.25% (liquid and foam), the range of hyperpigmentation was 2%–25% 7,9–13 ; with polidocanol 0.5% (liquid and foam), the range of hyperpigmentation was 12.5%–67.9% 7,10,13–18 ; and with polidocanol 1% (liquid and foam), the range of hyperpigmentation was 13%–73% 7,10,12–14,16,17,19,20 …”

“…The evaluation of all RCTs and non-RCTs showed more hyperpigmentation with increasing concentrations: with polidocanol 0.25% (liquid and foam), the range of hyperpigmentation was 2%-25% 7,[9][10][11][12][13] ; with polidocanol 0.5% (liquid and foam), the range of hyperpigmentation was 12.5%-67.9% 7,10,[13][14][15][16][17][18] ; and with polidocanol 1% (liquid and foam), the range of hyperpigmentation was 13%-73%. 7,10,[12][13][14]16,17,19,20 A comparison of 0.25% polidocanol liquid and 0.25% polidocanol foam showed that the range of hyperpigmentation was comparable: 4.4%-25% for liquid polidocanol and 2%-20% for foam polidocanol. 7,[9][10][11][12][13] Two studies directly compared the side effects of 0.25% polidocanol liquid and 0.25% polidocanol foam.…”

“…With 0.5% polidocanol, the rate of hyperpigmentation was lower with liquid sclerosant (12.5%-30%) 7,10,13,14,17,18 than with foam (13%-67.9%). 10,13,[15][16][17] With polidocanol 1%, the rate of post-treatment hyperpigmentation associated with liquid polidocanol 7,10,[12][13][14]17,19,20 was higher than that associated with foam 10,13,16 (14.3%-73% vs. 14.8%-23%). The volumes used were not always mentioned in the publications.…”

“…The maximum volumes for liquid polidocanol at all concentrations and foam polidocanol were 28 ml and 10 ml, respectively. 7,[9][10][11][12][13][14][15][16][17][18][19][20] In all studies that included foam sclerotherapy with concentrations of 0.25%-1% polidocanol (seven studies), the foam was produced using the Tessari method. Two studies involving 0.25% polidocanol used the Monfreux technique.…”