Flashcards in Sclerotherapy of varicose veins Deck (79):
The aim of sclerotherapy is the transformation of a treated vein into a fibrous cord
Foam sclerotherapy is the method of choice for telangiectasia and reticular veins.
F Liquid sclerotherapy.
Liquid sclerotherapy is effective for the treatment of saphenous veins and tributaries. y.
F Foam sclerotherap
Larger diameter veins respond well to sclerotherapy.
Sclerotherapy is the treatment of choice for small-calibre varicose veins (reticular varicose veins, spider veins).
Severe systemic disease is an absolute contraindication to sclerotherapy.
Uncompensated leg oedema is an absolute contraindication to sclerotherapy.
F Relative CI.
Acute DVT is an absolute contraindication to sclerotherapy.
T As is Pulmonary embolism
Arterial occlusive disease of any stage is an absolute contraindication to sclerotherapy.
F Advanced disease only (stage III or IV). Stage II is relative CI.
Bronchial asthma is an absolute contraindication to sclerotherapy.
F Relative CI.
Late complications of diabetes are an absolute contraindication to sclerotherapy.
F Relative CI. Eg. polyneuropathy.
Marked allergic diathesis is a relative contraindication to sclerotherapy.
Pregnancy is a relative contraindication to sclerotherapy.
F Absolute CI.
Known asymptomatic patent foramen ovale is a relative contraindication to foam sclerotherapy.
Visual disturbances or neurological disturbances following previous foam sclerotherapy is a relative contraindication to foam sclerotherapy.
Sclerotherapy is generally performed in sequential order of leakage points, proceeding from the smaller to the larger varicose veins.
F Larger to smaller.
Aethoxysklerol, containing the active ingredient polidocanol, can be used for foam sclerotherapy.
T Liquid and foam sclerotherapy.
Severe pain during injection of liquid sclerosant may be indicative of perivascular injection.
Asclera injection contains the active ingredient polidocanol
T In concentrations 0.25/.5/1/2/3/4%
Immediately after injection of liquid sclerosant and removal of the cannula, local compression should be avoided.
F Should be performed along the course of the sclerosed vein.
Following liquid sclerotherapy, local compression can be removed the same evening or the next day.
After liquid sclerotherapy, the patient should remain immobile.
F Walking good (physical thrombophylaxis).
Medium sized varicose veins use 2-3% POL
T Large varicose veins should use 3% POL
Intensive sports activity, hot baths, saunas and strong UV radiation are not prohibited in the initial days after sclerotherapy.
F Should be avoided.
The use of duplex ultrasound in performing liquid sclerotherapy allows greater control with fewer complications and increased efficacy.
T Performed with the patient lying down.
Foam sclerotherapy involves the use of detergent-type sclerosants such as polidocanol
Hypopigmentation occurs more commonly after foam sclerotherapyr
F Hyperpigmentation and induration occu
Neurological disturbances are more frequent after foam sclerotherapy
T Eg migraine-like symptoms
Maximum foam volume per session should be 20mls in routine cases
After injection of foam the patient should rest supine for at least 5 mins
History of symptomatic patent foramen ovale is a contraindication for foam sclerotherapy
Intra-arterial injection of foam causes erythma
F Causes extensive necrosis
Matting; fine telangiectasia in the area of a sclerosed vein occurs in most patients
F Unpredictable individual reaction. Can occur after surgical removal of a varicose vein
Transitory phenomena after sclerotherapy includes phlebitis
Sclerotherapy is considered to be the standard treatment for intracutaneous varicose veins, allowing improvement of up to 90% to be achieved
The Monfreux technique of foam sclerosant production involves the use of negative pressure generated by drawing back the plunger of a glass syringe.
The Tessari technique of foam sclerosant production, involves the turbulent mixing of polidocanol with air in a sclerosant plus air ratio of 1 + 4 in two syringes linked via a connector.
F This is true for the double-syringe system technique.
The Puzzi technique of foam sclerosant production involves the mixing of liquid and air in two syringes connected via a three-way stopcock.
F True for the Tessari technique. There is no Puzzi technique.
When treating the long saphenous vein with foam sclerosant, it is recommended that the venous puncture be performed in the proximal thigh area when utilising a direct puncture method.
T Below the knee if long catheters are used.
When treating the short saphenous vein by direct puncture with foam sclerosant the venous puncture should be performed in the distal part of the lower leg.
F Proximal or middle part.
When treating perforating veins with foam sclerosant, the injection should ideally be made directly into the affected vein.
F This should be avoided.
The Tessari and Tessari/double syringe system methods are recommended for the generation of foam sclerosant for all indications.
Air should not be used as the gas component for the generation of foam sclerosant.
F Recommended for all indications.
The preferred ratio of liquid sclerosant and gas for the generation of a foam sclerosant is 1 + 2 (1 part liquid + 2 parts gas).
F 1 + 4.
The recommended maximum foam volume per leg and session (given in a single injection or in several injections) is 10mL.
Duplex ultrasound for foam sclerotherapy should be performed with the patient lying down.
F Standing up.
After foam sclerotherapy, the length of the occluded venous segment must be compared with the length of the incompetent venous segment that was to be occluded by sclerotherapy injection.
T Thus the segment to be treated is defined prior to the injection. This is important for checking whether the ‘whole vein’ is occluded after Rx.
Venous reflux can be assessed after sclerotherapy during a Valsalva maneuver or during distal compression/decompression
After foam sclerotherapy, the injected areas should be immediately compressed.
F This should be avoided.
After foam sclerotherapy, the use of ultrasound to monitor foam distribution improves the safety of the procedure
For foam sclerotherapy, highly viscous foam should be avoided.
F This improves safety.
After foam sclerotherapy, there should be no patient or leg movement for 2-5 minutes, no Valsalva maneuver, or other muscle movement.
After foam sclerotherapy, active muscle movement should be encouraged if a larger volume of foam is detected in the deep venous system.
Allergic reactions are a common complication in foam and liquid sclerotherapy.
Hyperpigmentation and induration occur more commonly after liquid sclerotherapy compared with foam sclerotherapy.
F More commonly after foam.
Neurological disturbances, including migraine-like symptoms, are more frequent after liquid sclerotherapy compared with foam sclerotherapy.
F More common after foam.
After injection with sclerotherapy, the patient should rest supine for at least 5 minutes.
A history of symptomatic patent foramen ovale is an absolute contraindication for foam sclerotherapy.
After successful foam sclerotherapy, there should be partial occlusion of the treated venous segment detectable by duplex ultrasound.
F Complete occlusion (non-compressibility), complete vein disappearance, or ‘fibrous cord’.
Allergic reactions following foam sclerotherapy occur in the form of allergic dermatitis, contact urticaria or erythema.
Anaphylactic shock is not an adverse reaction of sclerotherapy
.F Occurs very rarely.
Patent foramen ovale is proposed to be a contributing factor to the development of transient migraine-like symptoms following sclerotherapy.
Thromboembolic events may occur after sclerotherapy.
The risk of thromboembolic events is higher when large amounts of sclerosant are used, particularly in the form of liquid.
Previous history of thromboembolism or known thrombophilia is an absolute contraindication to sclerotherapy.
F Must weight risk vs. benefit and perform with caution.
Skin necrosis can occur following perivascular or intra-arterial injection of sclerotherapy.
T Described as ‘embolia cutis’.
Hyperpigmentation occurs following sclerotherapy in 0.3-10% of patients.
Matting, fine telangiectasia occurs universally following sclerotherapy.
F Unpredictable individual reaction.
Nerve damage can occur after perivascular sclerosant injection.
Transient phenomena that can occur after sclerotherapy include: intravascular clots, phlebitis, haematomas, disturbed sense of taste, feeling of chest tightness, pain at injection site, swelling, induration, mild cardiovascular reactions and nausea.
Patients with patent foramen ovale who undergo sclerotherapy should remain lying down for 1hr following the procedure.
F 8-30 minutes.
Patients with patent foramen ovale who undergo sclerotherapy should only have small volumes of foam (2mL) or liquid injected.
Patients with patent foramen ovale who undergo sclerotherapy should avoid Valsalva maneuvers.
Patients with patent foramen ovale who undergo sclerotherapy should have their leg elevated by 30cm.
Prior to foam sclerotherapy, it is necessary to perform specific investigations for patent foramen ovale.
Prior to foam sclerotherapy, it is necessary to perform specific investigations for thrombophilia.
Foam sclerotherapy is more effective than liquid sclerotherapy.
Sclerotherapy is considered to be the standard treatment for intracutaneous varicose veins (spider veins and reticular veins).
T Allows for improvement of up to 90%.