Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Letter to the Editor
2011:77:3;336-338
doi: 10.4103/0378-6323.79719
PMID: 21508579

Foam sclerotherapy in various vascular and lymphatic malformations

GR Ratnavel
 Department of Dermatology, Venereology and Leprosy, Government Stanley Medical College and Hospital, Chennai, India

Correspondence Address:
G R Ratnavel
Department of Dermatology, Venereology and Leprosy, Government Stanley Medical College and Hospital, Chennai - 1
India
How to cite this article:
Ratnavel G R. Foam sclerotherapy in various vascular and lymphatic malformations. Indian J Dermatol Venereol Leprol 2011;77:336-338
Copyright: (C)2011 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Sclerotherapy is the procedure in which chemical energy delivered intravascularly is capable of denaturating biological molecules in the vessel wall. Foam sclerotherapy, in which the sclerosant is mixed with air or physiological gases, is more efficacious than direct injection of sclerosant, [1] as air in the foam prolongs the contact of the agent with the endothelium. Hence, maximum sclerosant action can be obtained at a lesser concentration and quantity. The foamed agent exerts its effect at microcirculation, which is inaccessible to other procedures. We here share our experience in treating varicose veins, hemangiomas and lymphangiomas with foam sclerotherapy.

After ethical clearance, informed and written consent, we enrolled 20 patients with varicose veins (legs), seven with hemangioma (tongue, gluteal region, hand, trunk of size from a minimum of 3 cm x 2 cm to a maximum of 12 cm x 8 cm) and one with lymphangioma (posterior one-third of the tongue) of the mean age group of 32.7 years (14-54 years) of both sexes for a study period of 1 year from April 2009 to April 2010.

Patients with primary varicose veins (varicosities due to incompetent valves in the veins without perforator or junctional incompetencies), telangiectasias, patients unfit for surgery or with recurrence after surgery and those after surgical ligation of major refluxes were included. Those with deep venous thrombosis, reflux from major junctions, perforator incompetence, coagulation abnormalities, hypersensitivity to the sclerosant, pregnant or lactating women and those who were on oral contraceptive pills or hormone replacement therapy were excluded.

Duplex Doppler ultrasonogram of the vascular system, ultrasonogram of the abdomen and pelvis and coagulation profile were performed. In hemangiomas and lymphangiomas, in addition, contrast-enhanced computed tomography (CT) scan and magnetic resonance imaging were performed.

Sodium tetradecyl sulfate 3% (STS), an EDA- and FDA-approved detergent sclerosant was diluted with normal saline. Quantity per session and concentration used were based on the diameter of the vessel, size of the hemangioma and response to therapy. The concentration of the injected sclerosant is determined mainly by the mural thickness of vein, which is directly correlated with lumen diameter as given below.

  • <0.5 mm - 0.1%
  • 0.6-1.5 mm - 0.25%
  • 1.5-4 mm - 0.5-1%
  • 4-6 mm - 1-2%

Calculation of dilution volumes are as given below.

C f = C i [ V s / (V s + V d )]

C f - final concentration (in %) of sclerosant

C i - initial concentration (in %) of sclerosant

V s - initial volume (in ml) of undiluted sclerosant

V d - diluent volume (in ml) of 0.9% saline solution

After diluting, foaming of the sclerosant was done by the "Tessari" method, [2] in which a 5-ml syringe was filled with room air, another syringe was filled with 1 ml of the diluted sclerosant and the two syringes were connected to a 3-way stop cock [Figure - 1]. Foaming was done by a to and fro movement of both the syringes. The vein was cannulated using a scalp vein set from the distal end and the hemangiomatous mass [3] was cannulated at the base and, after ensuring that blood was coming out through the cannula, the vein was emptied by elevation of the limb and the foam sclerosant was slowly introduced. Compression bandaging was performed, which was to be worn for 2 weeks, and the patients were advised to be ambulant, to keep their legs elevated, to avoid strenuous exercise and standing still for long periods.

Figure 1: Foaming by the "Tessari": method and hemangioma-tongue being cannulated

They were followed-up every 2 weeks and the procedure was repeated after every 4 weeks depending on the clinical response (fibrosis of vessels, reduction in the size of the hemangioma). Doppler ultrasonogram was repeated every 2 months.

Of the 20 patients with varicose veins, 15 (75%) showed remarkable improvement symptomatically and cosmetically (two to five sessions), two (10%) showed partial improvement, two (10%) had complications like staining of the skin and ulceration and one (5%) had recurrence.

Of the seven patients with hemangioma, six (85.7%) showed near-complete resolution (two to eight sessions) and one (14.3%) showed partial resolution. One patient with lymphangioma showed near-complete resolution in four sessions [Figure - 2] and [Figure - 3].

Figure 2: Before and after treatment photographs - lymphangioma posterior one-third of the tongue and varicose vein-leg
Figure 3: Before and after treatment photographs - varicose veins (leg)

Although complications like allergic reactions, leg swelling, cutaneous necrosis, thromboplebitis, deep vein thrombosis, transient ischemic attacks and pulmonary embolism have been reported, [4],[5] we noticed only staining of skin and cutaneous ulceration, which healed with conservative management. We observed a faster healing of venous ulcers and stasis eczemas, which usually respond slowly to conservative treatment.

Although other procedures like surgery, laser and radiofrequency ablation and electrodessication are available for the treatment of varicose veins, foam sclerotherapy is a simple, safer, feasible, and affordable office procedure, which has an enhanced success rate over other procedures. It favors quicker healing of venous ulcers and stasis eczemas.

References
1.
Yamaki T, Nozaki M, Iwasaka S. Comparative study of duplex-guided foam sclerotherapy and duplex-guided liquid sclerotherapy for the treatment of superficial venous insufficiency. Dermatol Surg 2004;30:718-22.
[Google Scholar]
2.
Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg 2001;27:58-60.
[Google Scholar]
3.
Winter H, Dräger E, Sterry W. Sclerotherapy for treatment of hemangiomas. Dermatol Surg 2000;28:11-5.
[Google Scholar]
4.
Scurr JR, Fisher RK, Wallace SB. Anaphylaxis Following Foam Sclerotherapy: A Life Threatening Complication of Non Invasive Treatment for Varicose Veins. EJVES Extra 2007;13:87-9.
[Google Scholar]
5.
Campbell B. Varicose veins and their management. BMJ 2006;333:287-92.
[Google Scholar]

Fulltext Views
381

PDF downloads
81
Show Sections