ABSTRACT
Direct-vision sclerotherapy can be used to treat telangiectases, reticular veins and small varicose veins, usually on the lower limbs but also on the face, hands, breasts or trunk. Ultrasound-guided sclerotherapy can be used to treat primary or recurrent saphenous veins, perforators or tributaries as well as some malformations. Histology after foam applied to isolated saphenous vein segments during surgery demonstrates intimal destruction within two minutes and intimal separation by 15–30 minutes. Intra-arterial injection can occur with any major artery adjacent to a treated vein, and aberrant veins are at high risk. Many practitioners prefer to preserve forearm veins for possible later medical use, though there is no reason not to attempt judicious sclerotherapy in selected patients. Minocycline can lead to blue–grey pigmentation after sclerotherapy, and histology shows haemosiderin deposition in the dermis and pigmented macrophages within the sub-endothelial layer of the vein wall.
