Sclerotherapy for Reticular Veins in the Lower Limbs

Abstract

IMPORTANCE Reticular veins are subdermal veins located in the lower limbs and are mainly associated with aesthetic complaints. Although sclerotherapy is the treatment of choice for reticular veins in the lower limbs, no consensus has been reached regarding to the optimal sclerosant.OBJECTIVE To compare the efficacy and safety of 2 sclerosants used to treat reticular veins: 0.2% polidocanol diluted in 70% hypertonic glucose (HG) (group 1) vs 75% HG alone (group 2). DESIGN, SETTING, AND PARTICIPANTS Prospective, randomized, triple-blind, controlled, parallel-group clinical trial with patients randomly assigned in a 1:1 ratio between the 2 treatment groups from March through December 2014, with 2 months' follow-up. The study was conducted in a single academic medical center. Eligible participants were all women, aged 18 to 69 years, who had at least 1 reticular vein with a minimum length of 10 cm in 1 of their lower limbs. INTERVENTIONSThe patients underwent sclerotherapy in a single intervention with either 0.2% polidocanol plus 70% HG or 75% HG alone to eliminate reticular veins. MAIN OUTCOMES AND MEASURESThe primary efficacy end point was the disappearance of the reticular veins within 60 days after treatment with sclerotherapy. The reticular veins were measured on images obtained before treatment and after treatment using ImageJ software. Safety outcomes were analyzed immediately after treatment and 7 days and 60 days after treatment and included serious adverse events (eg, deep vein thrombosis and systemic complications) and minor adverse events (eg, pigmentation, edema, telangiectatic matting, and hematomas).RESULTS Ninety-three women completed the study, median (interquartile range) age 43.0 (24.0-61.0) years for group 1 and 41.0 (27.0-62.0) years for group 2. Sclerotherapy with 0.2% polidocanol plus 70% HG was significantly more effective than with 75% HG alone in eliminating reticular veins from the treated area (95.17% vs 85.40%; P < .001). No serious adverse events occurred in either group. Pigmentation was the most common minor adverse event, with a 3.53% treated-vein pigmentation length for group 1 and 7.09% for group 2, with no significant difference between the groups (P = .09).CONCLUSIONS AND RELEVANCE Sclerotherapy with 0.2% polidocanol diluted in 70% HG was superior to 75% HG alone in sclerosing reticular veins, with no statistical difference for complications. Pigmentation occurred in both groups, with no statistical difference between them. No serious adverse events occurred in either group. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02054325

Efficacy and safety of glucose, glucose and polidocanol combination, liquid polidocanol and polidocanol foam in the treatment of reticular veins: A randomized study in rabbits

“…Although there is not a consensus for hypertonic glucose (HG) use in guidelines, it is the most commonly sclerosing agent used in Brazil, with 54% efficacy. 26 In the present study, as well as in previous studies, HG was associated to high risk of ulceration 10,14 (Figure 4).…”

“…11 Comparative randomized controlled trials on sclerotherapy for telangiectasia and reticular veins are scarce in the literature. 3,13,14…”

Photodynamic Therapy Versus Glucose for the Treatment of Telangiectasia: A Randomised Controlled Study in a Rabbit Ear Model

“…Vessel length measurement using Image J software appears to be a better method because it is an objective measurement and has been used successfully in previous studies. 20 The quantification of vessels in the control groups (Groups 1 and 2) showed no alterations, as expected, and indicated that the light and PS parameters did not cause any damage. The PDT group (Group 4) showed an average reduction of 26% in vessels, reached until 50% (Fig.…”

Global guidelines trends and controversies in lower limb venous and lymphatic disease

“…In 2017, JAMA reported the possibility of obtaining a better effect than 75% hypertonic glucose alone by adding 70% hypertonic glucose to 0.2% polidocanol, with no difference in complication rates. 202 Always in 2017, it was demonstrated that Sodium tetradecyl sulfate 0.15% and polidocanol 0.31% are the best concentrations for 0.8 mm to 1 mm leg telangiectasia, both according to the histological and clinical evaluation. Sodium tetradecyl sulfate foam is comparable to polidocanol foam at these concentrations as well.…”

“…In 2017, JAMA reported the possibility of obtaining a better effect than 75% hypertonic glucose alone by adding 70% hypertonic glucose to 0.2% polidocanol, with no difference in complication rates. 202…”