POLIDOCANOLO (Sclerotherpy)
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Monday, 19 May 2008

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 Polidocanol is commonly used because it does not cause burning with injection and is less likely than other agents to cause skin ulceration or pigmentation changes. The maximum dosage is 2 mg/kg/d. Dilutions are 2% for midsized vessels (2-4 mm), 1% for small vessels (1-2 mm), and 0.25-0.75% for telangiectasias. Regarding adverse effects, polidocanol may cause an allergic reaction.

Sclerotherapy


Treatment of telangiectasias and reticular veins may greatly improve their appearance. Treatment may also improve the associated painful symptoms. These vascular abnormalities are common. Telangiectasias are present in up to 28.9% of men and 40.9% of women (Engel, 1988).Etiology: Genetics and individual behavior patterns are important factors in the development venous disorders. Familial inheritance is reported in 15-40% of cases. Caucasians are most commonly affected. Pregnancy, prolonged standing, or prolonged walking also predisposes people to venous disease (Parsons, 2004).IndicationsThe major indications for sclerotherapy are to improve the cosmetic appearance and to reduce the associated pain and burning.Relevant Anatomy and ContraindicationsRelevant Anatomy: A thorough review the lower extremity venous system is essential before treatment is administered. The lower extremity has both a superficial and a deep venous system. The deep venous system includes the femoral and popliteal veins. The superficial system includes the saphenous system. Several communicating vessels are present between the systems called perforating veins. Also, telangiectasias may communicate with the deep system.Contraindications: Contraindications to sclerotherapy include pregnancy, thrombophlebitis, pulmonary emboli, hypercoagulable states, and allergy to the sclerosing agents.Work Up


Imaging Studies:
  • Duplex ultrasonography is the diagnostic method of choice for diagnosing venous disease

Author: Laurence Z Rosenberg, MD, Staff Physician, Department of Surgery, Division of Plastic Surgery, University of Alabama at Birmingham Hospital

Coauthor(s): Jorge de la Torre, MD, FACS, Associate Professor of Surgery and Physical Medicine & Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics; Gary D Monheit, MD, Associate Professor, Department of Dermatology, University of Alabama at Birmingham; John D Kayal, MD, Consulting Dermatologist, NW Georgia Dermatology and Skin Cancer Specialists, LLC

Laurence Z Rosenberg, MD, is a member of the following medical societies:Alpha Omega Alpha, and Phi Beta Kappa

Editor(s): Shahin Javaheri, MD, Chief, Department of Plastic Surgery, Martinez Veterans Affairs Outpatient Clinic; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Mark E Krugman, MD, Assistant Professor of Plastic Surgery & Clinical Professor of Oto/Head, Division of Plastic surgery & Department of Oto-Head and Neck Surgery, University of California at Irvine School of Medicine; Nick Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center; and Jorge de la Torre, MD, FACS, Associate Professor of Surgery and Physical Medicine & Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics.

Introduction

Sclerotherapy remains the primary treatment for small-vessel varicose disease of the lower extremity. These small vessels include telangiectasias, venules, and reticular veins. Telangiectasias are flat, red vessels smaller than 1 mm in diameter. Venules and reticular veins are blue and smaller than 2 mm, whereas reticular veins are 2-4 mm. Large varicosities do not respond as well as small varicosities to sclerotherapy.