Fellows Course: Sclerotherapy Agents, Technique and Pitfalls
Choosing a Sclerosing Agent
Faculty generally preferred polidocanol for small telangiectasias and sodium tetradecyl sulfate, often diluted to about 0.5 percent, for larger reticular and varicose veins, noting hypertonic saline can cause allergic reactions and pain despite being effective on small vessels.
Foam Technique and the Tessari Method
For larger varicosities, presenters favored foam using the Tessari method, mixing sclerosant and air at roughly a 1 to 4 ratio and agitating 10 to 20 times, using fine gauge needles so patients barely feel the injection.
Pigmentation Risk Near the Ankle in Older Patients
A case of an older patient with fragile skin injected near the ankle showed extravasated sclerosant causing worsening pigmentation that took months to heal, reinforcing caution in that area and with darker skinned patients prone to visible pigmentation.
Post-Procedure Compression and Learning Technique Safely
Faculty noted a Cochrane analysis found compression duration has little effect on outcomes, recommended micro thrombectomy for trapped coagulum to reduce pigmentation, and advised fellows to learn sclerotherapy by practicing on consenting friends or family rather than patients.
