AVF Workshop: Sclerotherapy Agents, Technique, and Perforator Care

Sclerosing Agent Selection and Dosing

Polidocanol (Asclera) and sodium tetradecyl sulfate are the two FDA-approved detergent sclerosants, used as liquid or foam limited to fifteen milliliters per treatment. Smaller reticular veins require diluting the stock solution. Hypertonic saline and chromated glycerin are older off-label alternatives causing more pain and a higher risk of tissue necrosis if extravasated.

Injection Technique and Visualization Pearls

Presenters emphasized small-gauge needles, slow injection rates, and watching for vessel blanching as the endpoint rather than overfilling. A two-handed technique that stretches the skin, plus aspirating for blood return, helps confirm placement. Vein-light transillumination and infrared vein viewers make target vessels easier to see, and tumescent anesthesia improves comfort and keeps the vein collapsed.

Perforator Vein Sclerotherapy and Laser Alternatives

Pathologic perforator veins near a venous ulcer bed can be treated with ultrasound-guided foam sclerotherapy or thermal ablation to support wound healing. A long-pulsed 1064 nanometer laser was also presented as a non-injection option for reticular veins and telangiectasias, penetrating deeply enough for darker skin types.