Sclerotherapy

	Only suitable for below knee varicose veins
	Need to exclude SFJ or SPJ incompetence
	Main use is for persistent or recurrent varicose veins after adequate saphenous surgery
	Sclerosants
5% Ethanolamine oleate 0.5% Sodium tetradecyl sulphate
	Different to sclerosants used for haemorrhoids
	Needle placed in vein when full with patient standing
	Empty vein prior to injection
	Apply immediate compression and maintain for 4-6 weeks
	Do not exceed maximum volume
	Injection about 5 sites possible

	Extravasation causing pigmentation or ulceration
	Deep venous thrombosis

	15 - 25 % of varicose vein surgery is for recurrence
	Outcome of recurrent varicose veins surgery is less successful
	Can be avoided with adequate primary surgery

	Inaccurate clinical assessment
Confusion as to whether varicosities are in LSV or SSV distribution Can be avoided with use of hand held doppler
	Inadequate primary surgery
10% cases SFJ not correctly identified 20% cases tributaries mistaken for LSV Failure to strip LSV
	Injudicious use of sclerotherapy
70% of those with SF incompetence treated with sclerotherapy alone will develop recurrence
	Neovascularisation
With recurrent varicose vein need to image with duplex or varicography