Sclerotherapy for leg varicose veins - Institute of Health Economics

Sclerotherapy for leg varicose veins
bandaging techniques on patients (>15 years of age) referred to a surgical outpatient
clinic or primary care practitioner’s office that had symptomatic and/or cosmetic
varicose veins. Children presenting with varicose veins of the leg and patients with
venous ulcers were excluded. A comparison of surgery versus sclerotherapy was
outside the scope of this review.
The reviewers found very limited evidence on which to assess the relative merits of
sclerotherapy as a treatment for leg varicose veins. The methodological quality of most
of the twelve included RCTs was considered questionable. The main problems
appeared to be in the randomisation process and in blinding of the patient and/or
observer to the treatment. Most RCTs dated back to the 1980s.
There were no RCTs comparing injection sclerotherapy with simple observation. Also
no RCTs comparing sclerotherapy for thread veins with laser treatment were found.
One RCT published in 1973 compared sclerotherapy (using 0.5 ml STD injection) to
graduated compression stockings in pregnancy (in 101 patients with primary or
recurrent varicose veins). The reported results showed that sclerotherapy was more
effective in terms of symptomatic improvement and cosmetic appearance (RR 1.61 [95%
CI 1.19-2.18]).
Results reported by the other reviewed RCTs indicated that the type of sclerosant, local
pressure dressing, degree and length of compression have no significant effect on the
outcomes. Comparisons of STS to alternative sclerosants indicted no significant benefit
from using alternative sclerosants to STS. The addition of local anaesthetic to the
sclerosant reduced the pain from injection. Comparison of two pressure dressings
showed no difference in their effect on erythema or the success of the sclerotherapy.
The degree and duration of compression (elastic) had no significant effect on recurrence
rates, cosmetic appearance or symptom improvement. Short-term bandaging was
found to be better tolerated than more prolonged bandaging.
The Cochrane Reviewers found that for symptomatic varicose veins, there was no
objective evidence to support or not support the continued use of sclerotherapy. They
concluded that the reviewed evidence supported the place of sclerotherapy in modern
clinical practice, which was limited to the treatment of recurrent varicose veins
following surgery and thread veins. However, they recommended consideration of
their results in conjunction with findings from an ongoing Cochrane Review (by
Michaels and Kendall) that will assess RCTs comparing surgery to sclerotherapy and
help determine the overall place for sclerotherapy as a procedure for treating varicose
veins.
Tisi recently produced a Clinical Evidence summary 1 on the effects of treatments such
as surgery, compression stockings and injection sclerotherapy in adults with varicose
veins. The review (using Clinical Evidence search and critical appraisal, July 2003) was
focused on uncomplicated varicose veins and excluded treatments for chronic venous
Alberta Heritage Foundation for Medical Research
Health Technology Assessment
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