Sclerotherapy of varicose veins and varicosities – Spiders


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Sclerotherapy of varicose veins and varicosities – Spiders

Sclerotherapy is injected into the lumen of the vein sclerosing substance which causes a controlled local inflammation and fibrosis with consequent closure of the vein.

 

 

Sclerotherapy or sclerotherapy of varicose

It is called the injection sclerotherapy in them of various chemicals that can trigger an inflammatory response in the endothelium of the vein, leading first to thrombosis and finally to fibrous organization and cancellation of the varicosity.

It can be performed on an outpatient basis and the patient can return home and does not need rest or medication.

Not all can be sclerosed varices. Sclerotherapy in no case should be applied to all types of varices. If this were done, would be a high rate of failure and complications.

 

 

Mechanism of action of amyotrophic

Raised chemical phlebitis finally leads to the production of scar tissue.

 



Classification of sclerosing agents

SENIOR SCLEROSING

* Iodine

It is used in the form of Lugol’s solution (iodine association and sodium iodide). It is found in concentrations of 1% and 3%. It is the oldest and probably the most effective sclerosing. Shortly allergen. Painful injection. In cases of overdose can occur with fever iodism passenger.

Trade name:   Variglobin – View here more about the Variglobin 

* Sodium tetradecyl:

Powerful. It occurs in concentrations of 0.2% to 5%. Very easy application. Problems: necrosis, perivenitis, pigmentation, telangiectasias postesclerosis relatively common, many allergic reactions. The pain is delayed intraarterial injection.

Trade name:   Fibro-Vein – View here more about the Fibro-Vein

* Polidocanol:

It occurs in concentrations of 0,5,1,2 and 3%. Clear, non-staining. Your injection is painless and easy to use. It has good power and allergies are sclerosing raras.La paravenous injection can cause sores.

Trade name:   Etoxisclerol – View here more about the Etoxisclerol

MINOR SCLEROSING

* Sodium salicylate:

Concentrations of 20 and 60%. Paravenous injection is immediately painful. No pigmentation or telangiectasia produce practically except excessive concentrations. Sclerosing its power is reduced, making it ineffective in the venous trunks medium and large caliber and the point of reflux. Injection is painful, it is used frequently associated with lidocaine.

* Glycerin Chrome:

Sclerosing very weak, subject to telangiectases and small veins. Rarely produces sores.

THE IDEAL SCLEROSING

Perfect sclerosing Features:

- Purified substance and chemical stability

- Easy to use

- Minimum effective dose

- Low viscosity

- Not be painful to the local injection or cause cramping or discomfort following the same

- Not cause inflammatory reactions in the surrounding tissues

- Produce a solid and lasting fibrosis

- Do not require rest after injection

- Require short-term treatment

- Not toxic

- Not to be allergenic.

TECHNICAL AND TREATMENT PLAN

Use of a syringe 3 to 5 ml. The choice of the gauge of the needle depends upon the desired glass sclerose and viscosity of the product used, the fine needles are reserved for the treatment of telangiectasia.

During the first session, a low concentration is used to assess your tolerance.

The sitting patient is placed over the vessel puncture to be monitored is blood and venous blood. The injection will be slow to promote maximum contact with the wall of sclerosing venosa.La leg can and must lift to empty the vein and encourage contact with the wall and prevent dilution of the sclerosant. For less important sclerotic veins or telangiectasias, where accuracy is critical maneuver, the patient will lie. Immediately after injection, compression is applied selectively puncture and venous pathway treaty, which complete with an elastic bandage limb. This compression is critical.

The technique can be tuned by injecting sclerosing a small air bubble (air-block) to favor the micronization of sclerosing and better emptying of the vein, as well as a safety mechanism.

The interval between treatment sessions will be at least two weeks, and must observe for signs of intolerance or any complications.

It paravenous injection avoided because of the risk of periphlebitis and necrosis. The injection must take place without pain and without resistance. Any feel discomfort during injection immediately force the interruption thereof.

Depending on concentration and decreasing over pressure dressing, reduce the effects of Doppler half negativos.Por avoids errors veins-arteries.

On the back of the foot not practiced sclerotherapy.

The technique called Sigg try to reduce to a minimum the risk of MS by security mechanisms, which are:

* Using a thick needle, 1.2 mm thick, so if we accidentally located an artery rather than a vein, the strength and the volume of blood to come into the syringe would indicate such situation, avoiding the error .

* Using a glass syringe plunger to run well, to allow notice any resistance to injection sclerotherapy.

* Use the “air-block”.

Sclerotherapy should be planned in advance. They are classic four schemes:

Technique “bottom-up”: first sclerosing varicose veins distally and treatment ends with the obliteration of nutrient trunks. It is a slow and cautious approach that requires numerous sessions.

Stage technique: attempting to eradicate one session all the varicose veins. This technique is difficult and not without risk.

Technical “top-down” is first sclerosed nutrient trunks, rabbles and piercing. In the first phase varicose paths are ignored and only if they persist are injected during treatment. Difficult technique.

 

Association sclerosis and surgery complement sclerosis little aggressive surgery (Ligation rod, stripping segmental, etc.). Points suppressing reflux. Varicose recurrences are less frequent.

Indications of sclerotherapy

Reticular varicose veins can be effectively treated by sclerosis.

Varicose ulcer nutricias a can also be treated using sclerosis.

Sclerosis of venules and telangiectasias, not associated with a systematized varicose syndrome produces good and lasting results.

Angiomatosis.

Varices side: good indication (SIGG technique).

Recurrent varices after surgery (good indication)

Klippel-Trenaunay Syndrome.

When reflux in V. Saphenous recurrence to sclerotherapy is above 30%, so that surgery is indicated.

CONTRAINDICATIONS SCLEROSIS

Bedridden patients needing a prolonged and, therefore, have a high risk of deep venous thrombosis (DVT).

Patients with a history of venous thromboembolism (VTE).

Patients with uncontrolled hypertension.

Pregnancy.

Nephrotoxicity and liver.

Bronchial asthma.

Uncontrolled diabetes.

Known hypersensitivity to the drug sclerosing.

Incidents and accidents SCLEROSIS

Local incidents

* Phlebitis and periphlebitis.

Usually appears by an overdose of the drug.

Treatment consists in the application of NSAIDs, elastic containment and avoidance of rest which may favor the development of deep vein thrombosis.

Subsequently intravaricoso hematoma can be evacuated by a small thrombectomy. 
* Pigmentation

The pigmentations are constituted by melanin and, above all, by haemosiderin, the inflammatory reaction involves extravasation of erythrocytes that give rise to skin tattoo. The spots come out telangiectasia: excess dose, concentration, or bandages deficit.

It is advisable to avoid compression of the puncture path and sclerotic and intravenous thrombus drainage has occurred.Once the pigment is difficult to treat successfully, it may be useful to use hydroquinone associated with a corticosteroid. You can try the Cream depigmenting Klingman and Desferal , which used wisely gives good results in a high number of cases.Sometimes this pigmentation fades with time, and at other ends to provide an important aesthetic alteration, so that should prevent its occurrence.

* Variculas

Telangiectasias is generally maintained by an underlying vein since sclerosis has been removed by drainage pathway, but not the filler. Treatment involves feeding route paralyze or telangiectasia.

* Edema

To avoid this is to make a good elastic containment.

Accidents locoregional

* Injection extravascular

May cause an inflammatory reaction more or less important to necrosis. The importance of this complication will depend on the concentration and depth of injection.

Intraarterial injection with

Can cause extensive loss of limb or even be required amputation of it. Fortunately it is a rare complication, but obviously very serious. To prevent this, one must be very careful especially in inguinal fold, popliteal, internal malleolar or dorsal region of the foot, making sure it is in vein. Treatment involves hospitalization of the patient and intra-arterial administration of corticosteroids and, by general, intravenous heparin, antibiotics and symptomatic therapy.

* Deep vein thrombosis (DVT)

Rara.

GENERAL ACCIDENT

Minor accidents

* Reaction vagal

It is relatively common especially in patients who are very emotional.

Major accidents

* Allergy

The treatment is that of all allergic reaction, are useful corticosteroids, antihistamines, may be necessary to administer adrenaline and atropine or general principles of resuscitation.

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