Editing Varicose veins (section)

==== Sclerotherapy ====
A commonly performed non-surgical treatment for varicose and "spider leg veins" is [[sclerotherapy]], in which medicine called a sclerosant is injected into the veins to make them shrink. The medicines that are commonly used as sclerosants are [[polidocanol]] (POL branded Asclera in the United States, Aethoxysklerol in Australia), sodium tetradecyl sulphate (STS), Sclerodex (Canada), hypertonic saline, [[Glycerol|glycerin]] and chromated glycerin. STS (branded Fibrovein in Australia) liquids can be mixed at varying concentrations of sclerosant and varying sclerosant/gas proportions, with air or CO<sub>2</sub> or O<sub>2</sub> to create foams. Foams may allow more veins to be treated per session with comparable efficacy. Their use in contrast to liquid sclerosant is still somewhat controversial{{Medical citation needed|date=April 2022}}, and there is no clear evidence that foams are superior.<ref name="CD001732">{{cite journal | vauthors = de Ávila Oliveira R, Riera R, Vasconcelos V, Baptista-Silva JC | title = Injection sclerotherapy for varicose veins | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 12 | pages = CD001732 | date = December 2021 | pmid = 34883526 | pmc = 8660237 | doi = 10.1002/14651858.CD001732.pub3 }}</ref> Sclerotherapy has been used in the treatment of varicose veins for over 150 years.<ref name="Goldman" /> Sclerotherapy is often used for telangiectasias (spider veins) and varicose veins that persist or recur after vein stripping.<ref>Pak, L. K. et al. "Veins & Lymphatics," ''in'' Lange's ''Current Surgical Diagnosis & Treatment'', 11th ed., McGraw-Hill.{{page?|date=November 2023}}</ref><ref>{{Cite journal |last1=de Ávila Oliveira |first1=Ricardo |last2=Riera |first2=Rachel |last3=Vasconcelos |first3=Vladimir |last4=Baptista-Silva |first4=Jose Cc |date=2021-12-10 |title=Injection sclerotherapy for varicose veins |journal=The Cochrane Database of Systematic Reviews |volume=2021 |issue=12 |pages=CD001732 |doi=10.1002/14651858.CD001732.pub3 |pmc=8660237 |pmid=34883526}}</ref> Sclerotherapy can also be performed using foamed sclerosants under ultrasound guidance to treat larger varicose veins, including the great saphenous and small saphenous veins.<ref>{{cite book | vauthors = Thibault P | date = 2007 | chapter = Sclerotherapy and Ultrasound-Guided Sclerotherapy | title = The Vein Book | pages = 189–199 | veditors = Bergan JJ | doi = 10.1016/B978-012369515-4/50023-5 | isbn = 978-0-12-369515-4 }}</ref><ref>{{cite journal|vauthors=Padbury A, Benveniste GL |title=Foam echo sclerotherapy of the small saphenous vein|journal= Australian and New Zealand Journal of Phlebology|volume=8|issue=1|date=December 2004}}</ref>

There is some evidence that sclerotherapy is a safe and possibly effective treatment option for improving the cosmetic appearance, reducing residual varicose veins, improving the quality of life, and reducing symptoms that may be present due to the varicose veins.<ref name="CD001732" /> There is also weak evidence that this treatment option may have a slightly higher risk of deep vein thrombosis. It is not known if sclerotherapy decreases the chance of varicose veins returning (recurrent varicose veins).<ref name="CD001732" /> It is also not known which type of substance (liquid or foam) used for the sclerotherapy procedure is more effective and comes with the lowest risk of complications.<ref name="CD001732" />

Complications of sclerotherapy are rare, but can include blood clots and ulceration. [[Anaphylaxis|Anaphylactic]] reactions are "extraordinarily rare but can be life-threatening," and doctors should have resuscitation equipment ready.<ref>Finkelmeier, William R. (2004) "Sclerotherapy", Ch. 12 in ''ACS Surgery: Principles & Practice'', WebMD, {{ISBN|0-9748327-4-X}}.</ref><ref>{{cite journal |vauthors=Scurr JR, Fisher RK, Wallace SB |title=Anaphylaxis Following Foam Sclerotherapy: A Life Threatening Complication of Non Invasive Treatment For Varicose Veins |journal=EJVES Extra |volume=13 |issue=6 |pages=87–89 |year=2007|doi=10.1016/j.ejvsextra.2007.02.005|doi-access=free }}</ref> There has been one reported case of [[stroke]] after ultrasound-guided sclerotherapy when an unusually large dose of sclerosant foam was injected.<ref>{{cite journal |last1=Forlee |first1=Martin V. |last2=Grouden |first2=Maria |last3=Moore |first3=Dermot J. |last4=Shanik |first4=Gregor |title=Stroke after varicose vein foam injection sclerotherapy |journal=Journal of Vascular Surgery |date=January 2006 |volume=43 |issue=1 |pages=162–164 |doi=10.1016/j.jvs.2005.09.032 |pmid=16414404 |url=https://www.jvascsurg.org/article/S0741-5214(05)01704-0/fulltext |access-date=8 October 2024}}</ref>