Journal of Clinical and Aesthetic Dermatology

APR 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY April 2017 • Volume 10 • Number 4 E 1 Introduction Superficial "thread" veins are probably the most unsatisfactory problem in a venous clinical practice. They are hated by patients and very satisfying to treat, but they can be very difficult to treat successfully and occasionally can be a source of huge patient dissatisfaction. This consensus document focuses on microsclerotherapy complications as the use of a sclerosant in the treatment of truncal veins carries a number of different risks beyond the remit of this article. For the purpose of these guidelines, microsclerotherapy is defined as the treatment of veins of 4mm diameter or less. The following are all possible risks of microsclerotherapy: • Allergy / Anaphylaxis • Migraine / Visual effects • Ulceration / Infection • Matting • Staining / Pigmentation / Blood entrapment • Pain • Treatment failure / Expectation management • Deep Vein Thrombosis Apart from an allergic reaction and migraine, all the others are probably related to injection technique. Allergy/Anaphylaxis Although the risk of an anaphylaxis reaction is very rare (incidence less than 1 in 10,000 for sodium tetradecyl sulphate 1 ), anaphylaxis may occur in your practice one day and you must be properly prepared. The sclerosants most commonly used are sodium tetradecyl sulphate (Fibrovein), polidocanol (Aethoxysklerol, Sclerovein), and more rarely chromated glycerine (Scleremo). Hypertonic saline is rarely used in the United Kingdom but more commonly used in the United States and the risk of allergy or anaphylaxis to this sclerosant seems highly unlikely (although it does not have its own risks). In the author's experience, two episodes of anaphylaxis have occurred in over 40 years of practice and injecting over 50 patients weekly. Both anaphylactic reactions occurred with sodium tetradecyl sulphate and one patient had a severe reaction resulting in breathing cessation and requiring resuscitation and adrenaline (See ACE Group guidelines on Anaphylaxis). It is very important that everyone who administers drugs, particularly intravenously, has a full understanding of resuscitation and regular updating of their skills. Migraine/Visual Effects 2 Everyone who injects sclerosant will eventually have patients who have visual sequelae. The most serious visual effect witnessed by the author entailed the patient (his wife) developing a homonymous hemianopia after the injection of about 1mL of 0.5% polidocanol liquid into some tiny thread veins prior to a beach holiday. It lasted about 20 minutes and subsequent treatments (at her request) have never caused any issues. A lot of discussion has occurred in the medical press about visual sequelae after microsclerotherapy, but visual effects are rare, with a quoted incidence of about 1 in 100 to 1 in 1,000 treatments. The author also feels the risk, in his experience, is more likely to occur with liquid sclerosants rather than foam. Sclerosants circulate systemically following treatment, but the exact mechanism for migraine or visual effects remains unknown. Microsclerotherapy Complications Stephen Tristram, MD Definition Sclerotherapy is a common procedure used to treat aesthetically unsightly veins by the injection of a sclerosant into the vessel. It is a procedure widely practiced by specific vascular clinics, but also performed by many practitioners working within aesthetic clinics. JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY Aesthetic complications Guidelines

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