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The role of sclerotherapy in abnormal varicose hand veins
D M Duffy1, C Garcia, R E Clark
1University of California, Los Angeles, School of Medicine, USA. www.drdavidmduffy.com.
Insights
Sclerotherapy effectively treats hand varicose veins. Higher concentrations of polidocanol (3%) achieved a 95% success rate, while lower concentrations failed in 80% of cases.
Area of Science:
- Vascular Surgery
- Dermatology
- Cosmetic Procedures
Background:
- Prominent, tortuous hand veins are a common cosmetic concern.
- Sclerotherapy is a potential treatment for these visible veins.
Purpose of the Study:
- To evaluate the efficacy of sclerotherapy for varicose veins on the dorsum of the hand.
- To compare outcomes using different concentrations of sclerosing agents.
Main Methods:
- 100 female patients with hand varicose veins were treated.
- Group A (20 patients) received low-concentration sclerosing agents (0.5% sodium tetradecyl sulfate or 1.5% polidocanol).
- Group B (80 patients) received high-concentration polidocanol (3%). Post-treatment compression was used for all patients.
Main Results:
- Low-concentration sclerotherapy (Group A) failed in 80% of patients.
- High-concentration polidocanol (3%) in Group B resulted in successful vein elimination in 95% of patients.
- Common adverse events included pain, edema, and bruising; one case of transient nerve injury occurred. Neovascularization (matting) was observed in 14.5% of successful treatments.
Conclusions:
- Low sclerosing agent concentrations are ineffective for hand varicose veins.
- High-concentration polidocanol (3%) is effective, achieving high success rates.
- Compression sclerotherapy with appropriate concentrations is a safe and effective treatment for hand varicose veins, with manageable side effects.
Abstract:
Large, tortuous veins involving the dorsa of the hands often become more prominent with the passage of time and are a common source of patient dissatisfaction. The objective was to evaluate the results of sclerotherapy in the management of unsightly varicose veins of the dorsum of the hand. From January of 1987 to August of 1998, 100 healthy, ambulatory female patients with a mean age of 56.5 years (range, 35 to 78 years) underwent sclerotherapy treatment for abnormally dilated veins on the dorsum of the hands. Patients were divided into two groups: group A consisted of 20 patients treated with 0.5% sodium tetradecyl sulfate (Sotradecol Elkins-Sin, Inc., Cherry Hill, N.J.) or 1.5% polidocanol (Aethoxysklerol Kreussler, Chemische-Fabrik, Wiesbaden, Germany). Group B consisted of 80 patients treated with 3% polidocanol. Postsclerotherapy compression was utilized in all cases. Failure was observed in 16 patients (80 percent) in group A. Successful elimination of varicose veins was obtained in 76 of 80 patients (95 percent) in group B. The diameter of treated vessels ranged from 1 to 6 mm (mean, 3 mm). Adverse events observed included pain, ecchymosis, various degrees of edema, and thrombosis of the treated veins. One patient (1 percent) developed transient neuropraxia of the superficial branch of the radial nerve following treatment of vessels located on the thenar web. Eleven of the 76 patients (14.5 percent) treated successfully with higher concentration developed microscopic neovascularization (matting). In conclusion, (1) low concentrations of sclerosing agents were associated with a high incidence of failure (80 percent); (2) the use of higher concentrations of polidocanol (3%) produced good results in 95 percent of treated patients; (3) adverse events common to sclerotherapy were observed in 90 percent of the treated patients-there were no serious adverse events; and (4) when appropriate sclerosant concentrations were employed, compression sclerotherapy proved to be an effective method of treatment for varicose veins involving the dorsum of the hand.