Clinical guidelines for sclerotherapy: implementation in actual practice
Open Access
- 16 January 2021
- journal article
- Published by Remedium, Ltd. in Ambulatory surgery: hospital-replacing technologies
- No. 3-4,p. 27-35
- https://doi.org/10.21518/1995-1477-2020-3-4-27-35
Abstract
Introduction. The simplicity of the sclerotherapy procedure, its high efficiency and low cost along with the possibility of performing the procedure on an outpatient basis stimulate the widespread use of the method.Objective of the study. Examine the current state of actual clinical practice regarding the treatment of patients with varicose veins using the sclerotherapy procedure.Materials and methods. An anonymous survey of 162 doctors, members of the professional community of specialists engaged in the treatment of venous diseases was performed. It comprised 15 questions concerning the features of the sclerotherapy procedure and following up of the patients.Results and discussion. The lack of clear-cut standardization for sclerotherapy in the regulatory documents contributes to the significant heterogeneity in the approaches of specialists to the performance of the procedure. The views on the use of sclerotherapy to remove perineal varicose veins (routinely performed only by 25.3% of physicians) and the upper extremity veins (less than 4%) turned out to be controversial. There were significant differences in the therapeutic approaches to the administration of anticoagulants by the patients (refusal in the procedure – 26.3% of respondents, discontinuation of drugs during sclerotherapy – 7.5%). Approximately a third of the respondents regularly exceed recommended 10 ml-volume of foam per session, there is no consensus on the choice of the needle diameter, drug concentration even in the similar clinical situations. About half of them have experience in using glucose as the sclerosant, every third – in using a transcutaneous laser, 5.6% – in using the mechanochemical obliteration techniques that are not currently certified in the Russian Federation. The use of compression therapy after sclerotherapy is not standardized; the regulatory documents provide contradictory durations of its use, which is due to the weakness of clinical research data on this issue. Up to 99% of physicians observe pigmentation, 83.2% – development of secondary telangiectasias and 60.2% – superficial necrosis in their practice. These circumstances arouse legal suspicion in relation to this type of treatment and the legal vulnerability of physicians. At the same time, physicians need to be more informed about the current requirements for some issues.Conclusion. The current legislation regulating the practical aspects of the sclerotherapy considers it largely through the lens of medicine, ignoring a significant cosmetic component. It is necessary to work out the provisions describing the specifics of cosmetic manipulations performed by the phlebologists, and the need for more detailed familiarization with the regular updates of the guidelines.Keywords
This publication has 12 references indexed in Scilit:
- Sclerotherapy. Step by step. TelangiectasiaAmbulatory surgery: hospital-replacing technologies, 2019
- Sclerotherapy for Reticular Veins in the Lower LimbsJAMA Dermatology, 2017
- Randomized clinical trial comparing surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy for the treatment of great saphenous varicose veinsBritish Journal of Surgery, 2016
- A review of randomised controlled trials comparing ultrasound-guided foam sclerotherapy with endothermal ablation for the treatment of great saphenous varicose veinsPhlebology: The Journal of Venous Disease, 2015
- Five-year results of a randomized clinical trial of conventional surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy in patients with great saphenous varicose veinsBritish Journal of Surgery, 2015
- Clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins: results from the Comparison of LAser, Surgery and foam Sclerotherapy (CLASS) randomised controlled trialHealth Technology Assessment, 2015
- Role of compression stockings after endovenous laser therapy for primary varicosisJournal of Vascular Surgery. Venous and Lymphatic Disorders, 2014
- European guidelines for sclerotherapy in chronic venous disordersPhlebology: The Journal of Venous Disease, 2013
- Foam Sclerotherapy: Investigating the Need for Sterile AirDermatologic Surgery, 2011
- Duplex ultrasound and efficacy criteria in foam sclerotherapy from the 2ndEuropean Consensus Meeting on Foam Sclerotherapy 2006, Tegernsee, GermanyVasa, 2008