What are the different agents that make up the solution used for sclerotherapy vein treatment?
What is in Sclerotherapy Solution?
Doctor Answers 8
3 commonly used agents for Sclerotherapy
The three most commonly used agents are concentrated salt water (hypertonic saline), Sotradechol and Polidocanol. Different physicians have different comfort levels with the different agents. The newest technique involves using the agent in a foam to provide longer lasting contact with the vessel once injected but this might be reserved for slightly larger veins.
There are several Sclerotherapy solutions available
Sodium tetradecyl sulfate is currently the FDA-approved sclerosant.
The agents I prefer to use, however, are Polidocanol and Glycerin because they are both safe and effective, and there is a decreased incidence of pigmentation developing over the injected vessels which occurs in about 15% of patients who receive sodium tetradecyl sulfate injections. Polidocanol should receive FDA approvel in the coming months. Saline can work quite well as a sclerosant and is extremely safe, but can make the injections very uncomfortable.
Sclerotherapy Medications / Solutions / Definitions
Polidocanol (Asclera) and Sodium tetradecyl sulfate (Sotradecol) are the two FDA approved medications in the United States for sclerotherapy. Although they both provide good cosmetic results, I prefer polidocanol / Asclera as I have gotten slightly better results and patient satisfaction ratings with it. They are both man-made manufactured chemicals and are classified pharmaceutically as dilute detergents. They are safe with a low side-effect profile.
There is also hypertonic saline (very high concentration salt water), Glycerine, or Sclerodex (mixture of saline & dextrose), but I tend to prefer the Asclera and Sotradecol. The others either cause too much discomfort during injection or have specific issues with side-effects that I like to avoid. Hypertonic saline in particular has quite a bit of pain / discomfort associated with the injections, although it does seem to give good cosmetic results in most patients.
I hope that information was helpful to you.
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Different agents used for Sclerotherapy
- Polidocanol, 0.5% - 1%
- Sodium tetradecyl sulfate 0.2% - 0.5%
- Saline and dextrsoe (Sclerodex)
- Hypertonic saline
All of these are used for Sclerotherapy with varying success. They each have advantaes and disadvantages.
Glycerin is classified as an osmotic agent. Hypertonic saline and Sclerodex are hyperosmolar agents. Polidocanol and Sodium tetradecyl sulfate are classified as detergents.
Trade names for Polidocanol are Sclerovein. Trade names for sodium tetradecyl sulfate are Sotradecol, fibrovein and thrombovar.
There are 3 types of sclerotherapy solutions -detergents, osmotics and irritants. Of these. the most commonly used are detergents (polidocanol and sodium tetradecyl) , osmotic (hypertonicsaline) and irritant (glycerin). The detergents can be converted into a foam solution which is currently the gold standard for sclerotherapy. These solutions can be formulated into different concentrations and, often times. multiple solutions and concentrations may be used during the treatment
Several agents for Sclerotherapy
There are several solutions that are commonly used in sclerotherapy. However, none are perfect and all have certain drawbacks. Sotradecol and more recently, Asclera (polidocanol), are both FDA approved for sclerotherapy. I chose to use these agents in my procedures because they are safe, effective, and cause the least amount of side effects. These agents produce better results and do not have the cramping or pain commonly associated with hypertonic saline (salt water). Some physicians also use glycerin for tiny vessels.
Sodium tetradecyl sulfate is the only currently the FDA-approved sclerosant. We have also used hypertonic saline in the past with mixed results and a a lot of pain. This new product works better and is less painful. I have used it for over 3 years with no complications.