0.5% polidocanol for treatment of varicose veins

Background: The use of sclerosants approved by the US Food and Drug Administration for treatment of varicose veins, including sodium morrhuate, ethanolamine oleate, and sodium tetradecyl sulphate, has resulted in complications that include allergic reactions and occasional deaths. Polidocanol, which has not been approved by the Food and Drug Administration, has been well studied and well described in the literature as a safer, more effective sclerosant for varicose veins at 3.0% concentration. Objective: The purpose of this study was to examine the efficacy of 0.5% polidocanol as a sclerosant for varicose veins. Methods: A test dose of polidocanol is injected 1 week before the start of treatment to test for allergic response. Sclerotherapy sessions last 10 minutes, and an average of 10 to 20 mL of 0.5% polidocanol is injected through use of 30-gauge half-inch tuberculin syringes. The treated varicosities are compressed with Coban wrap and compression hosiery for 48 hours after treatment and with compression hosiery alone for another 2 weeks. Results: Having performed approximately 1600 sclerotherapy sessions using 0.5% polidocanol over the last 6 years, I have observed that an average of 3 sclerotherapy sessions are required to attain an 80% to 85% improvement in varicose veins. The number of sessions required for successful treatment ranged from 1 to 15. Results have been long lasting. Localized thrombus formation and hyperpigmentation occurred in some degree in every treated patient but generally did not require treatment for resolution. No ulcerations, pulmonary emboli, or anaphylactic reactions were observed. Superficial chemical thrombophlebitis occurred in 3 patients. Conclusions: Polidocanol is a painless, nonscarring, effective treatment for a condition that previously has been treated surgically. The minimal sclerosant concentration for the treatment of varicose veins is 0.5%.