Sclerosing agent for lower extremity venous disease

Agent	Class	Formulation	Composition	Test dose	Advantages	Disadvantages	Vessel size (mm)	Concentration (%)	Injection/vein (mL)	Max dose
Polidocanol (Aethoxysclerol)	Detergent	1% 3%	Hydroxypolyethoxydodecane, distilled, ethyl alcohol	0.5 mL	Painless Not toxic to tissue Rare ulceration No skin necrosis	Allergy Telangiectatic matting Hyperpigmentation No necrosis with extravasation	<0.5	0.25 to 0.5	0.25	3% solution
							0.5 to 1	0.5 to 0.75	0.5	50 kg: 5 mL
							1 to 3	0.75 to 1	0.5 to 0.75	60 kg: 6 mL
							3 to 5	1 to 2	0.75 to 1	70 kg: 7 mL
							>5	3 to 5	To max	80 kg: 8 mL
										90 kg: 9 mL
Hypertonic saline*	Osmotic	14.6% 23.4%	Sodium chloride	Not required	No allergy	Pain Muscle cramping Ulceration/necrosis Hyperpigmentation	<0.5	11.7 to 15	0.25	None^¶
							0.5 to 1	11.7 to 15	0.5
							1 to 3	15 to 23.4	0.5 to 1
							3 to 5	–	–
							>5	–	–
Sodium tetradecyl sulfate	Detergent	1% 3%	Sodium 1-isobutyl-4thyloctyl sulfate, benzoyl alcohol 2%, phosphate	0.5 mL	Less telangiectatic matting	Allergy Hyperpigmentation Ulceration/necrosis Epidermal necrosis with extravasation at higher concentrations	0.2 to 1	0.1 to 0.3	0.25	10 mL of 3% solution^Δ
							1 to 3	0.25 to 0.5	0.5
							3 to 5	0.5 to 1	0.5 to 1
							>5	1.5 to 3	To max
Glycerin	Osmotic	72%	Glycerol, 1, 2, 3-propanetrial, glycerine	0.5 mL	No matting No ulceration No necrosis	Highly allergenic due to chromate moiety Contact sensitivity Rare: Hematuria Urethral colic Difficult to work with (extremely viscous)	<1	25 to 72	0.25	10 mL of 72% solution

* Hypertonic saline/glucose combination (Sclerodex) is available outside the United States.
¶ None labeled. Limit use as with any product with saline.
Δ United States and Canada (elsewhere see drug insert).

Data from:

Tisi PV, Beverley C, Rees A. Injection sclerotherapy for varicose veins. Cochrane Database Syst Rev 2006; 18:CD001732.
Goldman MP. Treatment of varicose and telangiectatic leg veins: Double-blind prospective comparative trial between aethoxyskerol and sotradecol. Dermatol Surg 2002; 28:52.
Parsi K, Exner T, Connor DE, et al. In vitro effects of detergent sclerosants on coagulation, platelets and microparticles. Eur J Vasc Endovasc Surg 2007; 34:731.
Weiss RA, Weiss MA. Incidence of side effects in the treatment of telangiectasias by compression sclerotherapy: Hypertonic saline vs. polidocanol. J Dermatol Surg Oncol 1990; 16:800.
Bukhari RH, Lohr JM, Paget DS, et al. Evaluation of lidocaine as an analgesic when added to hypertonic saline for sclerotherapy. J Vasc Surg 1999; 29:479.
Davis LT, Duffy DM. Determination of incidence and risk factors for postsclerotherapy telangiectatic matting of the lower extremity: A retrospective analysis. J Dermatol Surg Oncol 1990; 16:327.
Norris MJ, Carlin MC, Ratz JL. Treatment of essential telangiectasia: Effects of increasing concentrations of polidocanol. J Am Acad Dermatol 1989; 20:643.

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Sclerosing agent for lower extremity venous disease