Introduction: The presented method consists of a selective intravenous injection of a sclerosing agent in the form of a liquid or foam, resulting in chemical ablation of the venous endothelium and possibly the underlying layers of the venous wall. Detergent sclerosants disrupt cell wall surface tension, resulting in hyperhydration of cells. Injection of a sclerosant into the vein in the form of a microfoam results in a greater displacement of intravascular blood, which reduces the deactivation of the sclerosant by contact with blood proteins, producing a better effect.
Materials and Methods: Since 2018, the European Medicines Agency (EMA) in Bulgaria has issued an official permit for the use of Fibrovein in our country. Since then, the preparation has been imported in the following forms: 5 mL vials of 0.2% and 2 mL ampoules of 0.5%, 1%, and 3%. Chemical ablation of various types of varicose veins, such as stem varices—VSM and VSP, lateral, branch varices, perforant varices, reticular varices, metallic varices, varices around venous ostia, and recurrent varices after surgical or endovascular treatment, has been performed.
Discussion: Our main conclusion and that of the many reports published so far between 2018 and 2022 is the undisputed advantage of endovascular chemical ablation over the open surgical method, especially when the sclerosing agent sodium tetradecyl sulfate is applied in the form of a highly viscous sclerosing foam.
Conclusions: The future of chemical ablation in stem cell varicose veins will be defined in the use of the foam form. The intervention is performed in a very short period of time, entirely in outpatient settings. The analysis of the world literature published so far shows that sclerosing treatment of varicose veins is an extremely low-risk treatment method as long as it is performed according to the existing international guidelines.
Антонова С, Спасов А, Радев А, Минимално инвазивни методи за лечение на варикозни вени на долните крайници. Обзор на съществуващите съвременни методи, Сърце – бял дроб, XХVIII, 1, 2022, 10-22.
Baccaglini U, Spreafico G, Castoro C, Sorrentino P: Consensus Conference on Sclerotherapy of Varcose Veins of the lower limbs. Phlebology 1997; 12: 2–16.
Baccaglini U, Stemmer R, Partsch U: Internationale Fragebogenraktion zur Praxis der Verödungsbehandlung. Phlebologie 1997; 29: 129-142.
De Waard MM, Der Kinderen DJ. Duplex ultrasonography-guided foam sclerotherapy of incompetent perforator veins in a patient with bilateral venous leg ulcers. Dermatol Surg 2005; 31: 580-583.
Fеgan WG, Compression sclerotherapy: Theory, Method and Praxis, eBook, Springer-Verlag, London, 2003, Chapter pp 59-78.
Fegan WG, Varicose veins: compression sclerotherapy. London: Heinemann; 1967.
Fegan WG, Continuous compression technique of injecting varicose veins. Lancet 1963;282:109.
Goldman MP, Beadoing D, Marley W at al. Compression in the treatment of leg telangiectasia: A preliminary report. J Dermatol Surg Oncol 1990; 16: 322-325.
Goldman MP, Guex J, Treatment of varicose and telangiectatic leg veins, 2005: 173-199.
Goldman MP, Kaplan RP, Oki LN, et al. Sclerosing agents in the treatment of telangiectasia: comparison of the clinical and histologic effects of intravascular polidocanol, sodium tetradecyl sulfate, and hypertonic saline in the dorsal rabbit ear vein model. Arch Dermatol 1987;123:1196.
Goldman MP. A comparison of sclerosing agents: clinical and histologic effects of intravascular sodium morrhuate, ethanolamine oleate, hypertonic saline (11.7%), and Sclerodex in the dorsal rabbit ear vein. J Dermatol Surg Oncol 1991;17:354.
Goldman MP, Raymond-Martimbeau P. Clinical and histologic evaluation of polyiodinated iodine with and without hypertonic saline/dextrose in the rabbit ear model. Dermatol Surg 1997;23:701.
Hertzmann AB, The blood supply of various skin areas as estimated by the photoelectric plethysmograph. Amer J Physiol 1938; 1924: 329-340.
Herzmann PA, Owens R. Rapid healing of chronic venous ulcers following ultrasound-guided foam sclerotherapy. Phlebology 2007; 22: 34-39.
Hübner K. Praktische Sklerotherapie, 2008, 15-218.
Kreussler: Fachinformation Aethoxysklerol 0,25%, 0,5 %, 1 %, 2 % und 3 %; Stand Oktober 2009, Chemische Fabrik Kreussler & Co GmbH.
Maurins U, Hoffman BH, Lösch C, Jöckel KH, Rabe E, Pannier F. Distribution and prevalence of reflux in the superficial and deep venous system in the general population-results from the Bonn Vein Study, Germany. J Vasc Surg. 2008, Sep; 48(3): 680-687.
Rabe E (Hrsg): Grundlage der Phlebologie. Viavital Verlag, Köln 2003.
Schneider W, Fischer H. Zur Histologie der Varizenverödung am Menschen mit den neuen Sklerosierungsmitteln. Arch Klein exp Dem 1964; 220: 234-249.
Schneider W, Fischer H. Fixirung und bindegewebige Organisation artefizieller Thrombosen bei der Varizenverödung. Dtsch Med Wschr 1964; 89: 2410-2412.
Schneider W. Contrabution to the history of the sclerosing treatment of varices and to its anatomo-pathologic study. Soc Fran Phlebol 1965; 18:117.
Shields JL, Jansen GT, Therapy for superficial telangiectasis of the lower extremities, J Dermatol Surg Oncol, 1982; 8: 857.
Stücker M, Reich S, Hermes H et al. Safety and efficiency of perilesional sclerotherapy in leg ulcer with postthrombotic syndrome and/or oral anticoagulation with Phenoprocoumon. JDDG 2006; 4: 734-738.
Tretbar LL, Spider angiomata: treatment with sclerosant imjections. J Kankas Med Soc. 1978; 79: 198.
Wolf E. Die histoligischenVeränderigen der Venen nach intravenösen sublimaten Spritzungen. Med Klin 1920;16:806.
Yamaki T, Nozaki M, Sakurai H et al. Prospective randomized efficacy of ultrasound-guided foam sclerotherapy compared with ultrasound guided liquid sclerotherapy the treatment of symptomatic venous malformations. J Vasc Surg 2008; 47: 578-584.
