Hyperosmolar versus detergent sclerosing agents in sclerotherapy. Effect on distal vessel obliteration

Sclerosing agents produce local endothelial destruction extending to the adventitia of the vessel wall while producing minimal thrombosis formation. They are rapidly inactivated in order to prevent damage far beyond the injection site. It has been stated that detergent sclerosants may have more distal sclerosing capabilities than hyperosmolar sclerosants.

The present study compares the in vivo relative potential of polidocanol (POL.), a detergent sclerosing agent, and hypertonic saline (H.S.), a hyperosmolar sclerosant in their effects on distal vessel obliteration.

Symmetrical Class III reticular vessels of 2-3-mm diameter were injected with equal amounts (0.5 cc) of sclerosing solutions: 0.5% POL. in the left leg and 23.4% H.S. in the right leg. Distance of vessel sclerosing effect was calibrated from the inferior patellar tendon employing a calibrated measuring window. Standard compression (20-30 mm Hg) was employed for 72 hours after each treatment session. Patients were examined at 2-, 4-, 6-, 8-, 10-, and 16-week intervals for vascular sclerosing resolution effect.

The mean distance of vessel sclerosis utilizing 23.4% H.S. was 6.24 cm vs 6.34 cm utilizing 0.5% POL. The mean duration of time to clinical disappearance of treated vessels was 6.4 weeks for the H.S.-treated extremity vs 6.2 weeks of the POL.-treated extremity. The difference of both parameters in terms of distance of sclerosing effect and time interval to achieve this effect were not statistically significant for either variable utilizing POL. or H.S.

Hyperosmolar and detergent sclerosants such as POL. and H.S. in comparable concentrations for given vessel diameter may provide equal degrees of vessel obliteration clinically over equivalent periods of time in vivo. Other factors such as minimal sclerosant concentration, hypersensitivity/complication profile, patient discomfort, sclerosant availability, and physician experience are other important factors in choosing a sclerosing agent for a given clinical setting.