Interventional Treatment

Sclerotherapy

  • It is used in obliterating telangiectasis, varicose veins and venous segments with reflux.
  • It is used in conjunction with surgical procedures for correcting CVI.
  • The indications for use of sclerotherapy are:

spider veins (<1mm)

venous lakes

varicose veins (1-4 mm size)

bleeding varicosities

small cavernous hemangiomas (venous malformations)

  • Sclerosing agents – hypertonic solution of sodium chloride (23.4% solution), sodium tetradecyl sulfate, polidocanol, sodium morrhuate.
  • They must be diluted to avoid tissue necrosis and inflammation.
  • It improves the hemodynamics in 12 weeks
  • a complication is hyperpigmentation of the surrounding skin from hemosiderin degradation. This complication may be treated by micro thrombectomy where multiple small incisions are used directly over the thromboses varicosity to extrude the thrombus. This results in less hyper-pigmentation within 1 – 3 weeks.

Ablative therapy with endogenous radio frequency and laser.

  • Here thermal energy is used in the form of radio frequency or laser to ablate the vein.
  • Local heat generated damages the intimal vein lining leading to thrombosis and eventually fibrosis.
  • There is complete obliteration n 85% after 2 years  with recanalization rate of 11%
  • 90% were free from saphenous vein reflux.
  • 95% were satisfied and had improved symptoms.
  • Potential complications of radio frequency are:

DVT in 16% needing color doppler surveillance.

  • Laser treatment with 810-nm or 940-nm diode has obliterated saphenous vein in 93% at 2 years with no cases of DVT.
  • In both RFA and laser, tumescent anesthesia is used to prevent skin burns and reduce pain with early return to activity.

Endovascular therapy

  • This has become increasingly important to restore the venous circulation by removing the obstruction.
  • 10 – 30% of the patients with severe CVI have iliac vein stenosis or occlusion and need stenting which is being increasingly performed now.
  • In a large series with iliac veins stenting:

50% were relieved of pain and

33% had total resolution of the edema,

55% had total ulcer healing.

The patency of iliac vein stenting at 3 years is 75%.

Close follow-up is mandatory as restenosis occurs in 23% and should have a re-stent.