Medication Summary

No oral or topical medications are of proven efficacy for venous disease. Several over-the-counter preparations make claims of efficacy, but prospective trials have not supported the use of any of these agents.

The selection of sclerosing agents and of concentrations and volumes to be used for sclerotherapy must be individualized for each patient and for each type and location of vein. The interested reader is referred to the bibliography for existing textbooks that treat the topic exhaustively.

Class Summary

These drugs are injected into varicose veins to produce endothelial destruction resulting in formation of a fibrotic cord. Eventually all the vascular tissue layers are reabsorbed.

Polidocanol (Asclera)

View full drug information

Polidocanol is a sclerosing agent indicated for uncomplicated spider veins (varicose veins ≤1 mm in diameter) and uncomplicated reticular veins (varicose veins 1-3 mm in diameter) in lower extremities.

When injected intravenously, it induces endothelial damage, causing platelet aggregation at the site of damage. This results in vessel occlusion that is eventually replaced with connective fibrous tissue.

Questions

Goldman MP, Guex JJ, Weiss RA. Sclerotherapy: Treatment of Varicose and Telangiectatic Leg Veins. 5th ed. Philadelphia: Saunders; 2011. 1-416.
Piazza G. Varicose veins. Circulation. 2014 Aug 12. 130 (7):582-7. [QxMD MEDLINE Link].
Chiesa R, Marone EM, Limoni C, Volonte M, Schaefer E, Petrini O. Chronic venous insufficiency in Italy: the 24-cities cohort study. Eur J Vasc Endovasc Surg. 2005 Oct. 30(4):422-9. [QxMD MEDLINE Link].
Racette S, Sauvageau A. Unusual sudden death: two case reports of hemorrhage by rupture of varicose veins. Am J Forensic Med Pathol. 2005 Sep. 26(3):294-6. [QxMD MEDLINE Link].
Chang SL, Huang YL, Lee MC, Hu S, Hsiao YC, Chang SW, et al. Association of Varicose Veins With Incident Venous Thromboembolism and Peripheral Artery Disease. JAMA. 2018 Feb 27. 319 (8):807-817. [QxMD MEDLINE Link].
Cho ES, Kim JH, Kim S, et al. Computed tomographic venography for varicose veins of the lower extremities: prospective comparison of 80-kVp and conventional 120-kVp protocols. J Comput Assist Tomogr. 2012 Sep. 36(5):583-90. [QxMD MEDLINE Link].
Carradice D, Leung C, Chetter I. Laser; best practice techniques and evidence. Phlebology. 2015 Nov. 30 (2 Suppl):36-41. [QxMD MEDLINE Link].
Nael R, Rathbun S. Treatment of varicose veins. Curr Treat Options Cardiovasc Med. 2009 Apr. 11(2):91-103. [QxMD MEDLINE Link].
Nijsten T, van den Bos RR, Goldman MP, et al. Minimally invasive techniques in the treatment of saphenous varicose veins. J Am Acad Dermatol. 2009 Jan. 60(1):110-9. [QxMD MEDLINE Link].
Bruijninckx CM. Fatal pulmonary embolism following ultrasound-guided foam sclerotherapy combined with multiple microphlebectomies. Phlebology. 2015 Sep 2. [QxMD MEDLINE Link].
Muller-Buhl U, Leutgeb R, Engeser P, Achankeng EN, Szecsenyi J, Laux G. Varicose veins are a risk factor for deep venous thrombosis in general practice patients. Vasa. 2012 Sep. 41(5):360-5. [QxMD MEDLINE Link].
Rao J, Wildemore JK, Goldman MP. Double-blind prospective comparative trial between foamed and liquid polidocanol and sodium tetradecyl sulfate in the treatment of varicose and telangiectatic leg veins. Dermatol Surg. 2005 Jun. 31(6):631-5; discussion 635. [QxMD MEDLINE Link].
Brooks M. FDA OKs New Minimally Invasive Treatment for Varicose Veins. Available at http://www.medscape.com/viewarticle/815039. Accessed: December 3, 2013.
Alder G, Lees T. Foam sclerotherapy. Phlebology. 2015 Nov. 30 (2 Suppl):18-23. [QxMD MEDLINE Link].
Dudelzak J, Hussain M, Goldberg DJ. Vascular-specific laser wavelength for the treatment of facial telangiectasias. J Drugs Dermatol. 2009 Mar. 8(3):227-9. [QxMD MEDLINE Link].
Mao J, Zhang C, Wang Z, Gan S, Li K. A retrospective study comparing endovenous laser ablation and microwave ablation for great saphenous varicose veins. Eur Rev Med Pharmacol Sci. 2012 Jul. 16(7):873-7. [QxMD MEDLINE Link].
Goodyear SJ, Nyamekye IK. Radiofrequency ablation of varicose veins: Best practice techniques and evidence. Phlebology. 2015 Nov. 30 (2 Suppl):9-17. [QxMD MEDLINE Link].
Cesarone MR, Belcaro G, Ricci A, et al. Prevention of edema and flight microangiopathy with Venoruton (HR), (0-[beta-hydroxyethyl]-rutosides) in patients with varicose veins. Angiology. 2005 May-Jun. 56(3):289-93. [QxMD MEDLINE Link].
O'Hare JL, Stephens J, Parkin D, Earnshaw JJ. Randomized clinical trial of different bandage regimens after foam sclerotherapy for varicose veins. Br J Surg. 2010 May. 97(5):650-6. [QxMD MEDLINE Link].
Weiss RA, Feied CF, Weiss MA. Vein Diagnosis & Treatment: A Comprehensive Approach. 1st ed. New York, NY: McGraw-Hill; 2001. 1-304.

Media Gallery

Patient with large tortuous varicose veins, high-volume venous reflux, and early stasis changes of the medial ankle.
Typical chronic medial leg ulceration associated with long-standing venous insufficiency. The ulcer had been present for 12 years and was refractory to every treatment approach until treatment of the refluxing superficial varices was performed. Treatment consists of endovenous ablation, foam sclerotherapy, or ambulatory phlebectomy.

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Author

Robert Weiss, MD Associate Professor, Department of Dermatology, Johns Hopkins University School of Medicine

Robert Weiss, MD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American College of Phlebology, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, MedChi The Maryland State Medical Society

Disclosure: Received honoraria from Angiodynamics for speaking and teaching; Received intellectual property rights from CoolTouch Corp for consulting; Received grant/research funds from Cynosure for independent contractor; Received grant/research funds from Palomar for independent contractor.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

John G Albertini, MD Private Practice, The Skin Surgery Center; Clinical Associate Professor (Volunteer), Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine; Past President, American College of Mohs Surgery

John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: QualDerm Partners; Novascan<br/>Have a 5% or greater equity interest in: QualDerm Partners - North Carolina.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Kelly M Cordoro, MD Assistant Professor of Clinical Dermatology and Pediatrics, Department of Dermatology, University of California, San Francisco School of Medicine

Kelly M Cordoro, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Medical Society of Virginia, Society for Pediatric Dermatology, Women's Dermatologic Society, Association of Professors of Dermatology, National Psoriasis Foundation, Dermatology Foundation

Disclosure: Nothing to disclose.

Acknowledgements

Craig F Feied, MD, FACEP, FAAEM, FACPh Professor of Emergency Medicine, Georgetown University School of Medicine; General Manager, Microsoft Enterprise Health Solutions Group

Craig F Feied, MD, FACEP, FAAEM, FACPh is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Phlebology, American College of Physicians, American Medical Association, American Medical Informatics Association, American Venous Forum, Medical Society of the District of Columbia, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.