Polidocanol in Sclerotherapy for Lymphovenous Disorders: Mechanisms, Clinical Uses, and Future Prospects

Polidocanol is a widely recognised drug for its effectiveness as a sclerosant in the treatment of lymphovenous disease. The versatility and minimal invasiveness of polidocanol make it a favoured treatment modality for chronic venous disease (CVD) and other venous and vascular disorders. Especially, polidocanol foam sclerotherapy achieves high closure rates and efficiency compared to thermal ablation, in cases of venous hypertension affecting small tributary veins of the peripheral venous system. The underlying pathophysiology of these venous disorders is multifactorial. Elevated venous hypertension and related microcirculatory barriers lead to cellular damage. Additionally, CVD manifestations are typically limited to the lower legs because venous return is hindered by anatomical and gravitational forces, especially around the ankle. In addition, clinical severity tends to increase with procedures that occlude venous exit sites, further distorting circulatory dynamics. Genetic influences on the integrity of collagen and elastin contribute importantly to venous wall strength. It also became apparent that the actual primary pathological cause is not valve malfunction but venous wall weakness. Polidocanol addresses this by targeting venous wall instability, highlighting that varicose (dilated) veins are a symptom, not the disease itself. It has a superior safety profile compared to agents like sodium tetradecyl sulphate and hypertonic saline and hence is a preferred choice for treating haemorrhoidal disease, oesophageal varices, telangiectasias, lymphovenous malformations, and CVD. Polidocanol use is associated with a very low incidence of complications, and the development of foam formulations has further enhanced its efficacy by improving retrograde flow dynamics. During sclerotherapy, forceful injection of polidocanol can cause intervention with plasma proteins, increasing its foam stability and therapeutic effectiveness.