Pharmacology of Sclerotherapy

Abstract

Sclerotherapy is the therapeutic use of sclerosants in the controlled destruction of undesired target tissues. Sclerosants have been used in vascular and nonvascular settings, both as primary and adjunctive therapy. Effective sclerotherapy requires a conceptual understanding of key questions about the process being treated, including the method of delivery, the presence of flow, and the required contact time to initiate sclerosis. However, beyond technique and delivery, practical and safe application of sclerotherapy requires an understanding of the uses, limitations, dosing, and side effects of sclerosants used during interventional radiology procedures. Agents discussed here include detergents and surfactants [ethanol, Sotradecol 1 (Bioniche Pharma, Pointe Claire, Quebec and Angiodynamics, Latham, NY), ethanolamine oleate], hypertonics (saline, glucose), and a review of several other types that are used less frequently.

Vascular anomalies: classification, imaging characteristics and implications for interventional radiology treatment approaches

“…However, the majority of complications with both STS and polidocanol are minor, with pain at the injection site and local skin necrosis being the most common 53,63,64 and likely related to tissue extravasation with damage of adjacent vessels at the injection site. 64,65 A recent study has shown greater efficacy with foamed vs liquid injection of polidocanol, 57 and new guidelines suggest both polidocanol and STS should be administered in foam form. 66 The use of foam instead of liquid allows greater volume coverage and increased surface area contact with the vessel endothelium, while also slowing flow through the lesion to maximize contact with the vessel.…”

Venous malformations: clinical diagnosis and treatment

“…The exact mechanism by which ethanol acts as an in vivo sclerosant is to denude the endothelial cell from the vascular wall and precipitate its protoplasm then cause fractures to the level of the internal elastic lamina. Platelet aggregation on the denuded surface then embolizes the vessel from the periphery to the center (43,44). Ethanol is believed to preferentially displace water molecules at the membrane surface, thereby penetrating the lipid bilayer and compromising the structural integrity of the cell membrane (44).…”

“…Platelet aggregation on the denuded surface then embolizes the vessel from the periphery to the center (43,44). Ethanol is believed to preferentially displace water molecules at the membrane surface, thereby penetrating the lipid bilayer and compromising the structural integrity of the cell membrane (44). This triggers necrosis and apoptosis of the treated tissue, inducing intravascular thrombosis and intense inflammatory response (45).…”

Update of endovenous treatment modalities for insufficient saphenous veins—A review of literature

“…Sclerosants act by altering surface tension of endothelial cells 176 Sotradecol is a more potent sclerosant than polidocanol. The mean dept of injury and the percentage of media damage are significantly higher for sotradecol compared to polidocanol 166 .…”