Sclerosing agents not only results embolization of the
target vein, but also disrupt its endothelium limiting
proliferation and collateralization.[
3] Although earlier
studies suggested that hypertonic solutions might
cause fewer side effects (i.e. hyperpigmentation) than
chemical agents,[
4] recent data suggests that sclerosing
agents are superior to placebo in terms of efficacy and
patient satisfaction.[
5] A recent prospective randomized
study showed no superiority of hypertonic saline
solution over polidocanol and also a higher rate of pain
during its injection.[
6] Currently, sclerotherapy with
sclerosing agents is regarded as the choice of therapy
in treating spider and reticular veins.[
7] According
to a report from England, the number of patients
requesting for sclerotherapy increased by 300% over
seven years, although number of patients presenting
with varicose veins declined by 34%.[
1]
Complications related to sclerotherapy are
extremely rare[2,8] and may not only be dependent on chemical irritation or iatrogenic factors; however,
they also be related with patients related factors
such as hypercoagulable state.[9] There have been a
number of case reports in the past about development
of sclerotherapy-related severe life threatening
complications including acute ischemic stroke in a
73-year-old woman,[10] myocardial infarction in a
61-year-old patient with foramen ovale,[11] arterial
occlusion due to intra-arterial injection in a 59-year-old
woman,[12] middle cerebral arterial embolism,[13] and
visual loss in a 66-year-old woman.[14] It is likely that
foam sclerotherapy in elderly may rarely cause serious
complications, while related complications are usually
mild, transient and underreported.
Our histopathological assessment supports the
concept that sclerosing agent not only resulted in
thrombus formation within the vein lumen, but
also induced a substantial structural damage to the
vessel wall. We observed that vein endothelium was
irreversibly eroded and tunica media was almost
completely disappeared in focal sectional areas. Such
changes should be regarded as the natural consequence
of the treatment. Presence of both inflammatory and
necrotic cells in histopathological specimen is likely
to explain why the patient has been suffering from
pain and sensitivity despite using topical medications.
Our patient had no further complications such as
ascending thrombophlebitis which occurred previously
in a 48-year-old patient undergoing foam sclerotherapy.
The authors reported that the patient presented with
some symptoms similar to ours after receiving foam
sclerotherapy for varicose veins at lower extremity.
That patient was eventually diagnosed with breast
cancer.[15]
Declaration of conflicting interests
The authors declared no conflicts of interest with
respect to the authorship and/or publication of this
article.
Funding
The authors received no financial support for the
research and/or authorship of this article.
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