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Sclerotherapy: rare but sometimes severe adverse effects

Injecting sclerosing agents into veins exposes patients to rare but severe adverse effects, generally disproportionate to the desired outcome of treatment.

When varicose or spider veins on the leg are considered ugly or embarrassing, patients are sometimes offered sclerotherapy. This relatively simple technique however is not harmless.

In September 2013 the sclerosing agents used in France were lauromacrogol 400 (alias polidocanol), sodium tetradecylsulfate, chrome alun + glycerol, and quinine-urea.

Lauromacrogol 400 liquid or foam is commonly used to treat varicose veins in the lower limbs. It is known to expose patients to severe adverse effects, including anaphylaxis, strokes, transient ischaemic attacks, migraine and visual and cardiac disorders, deep vein thrombosis and peripheral arterial thrombosis.

Three French follow-up studies on patients who had been given lauromacrogol 400 revealed cases of deep vein thrombosis, one transient ischaemic attack, visual disorders sometimes combined with headaches.

The harms associated with liquid or foam lauromacrogol 400 are the best known, but all sclerosing agents are potentially implicated. These harms are generally disproportionate to the aims of treatment. They should be taken into account in the harm-benefit balance for varicose vein sclerotherapy.

©Prescrire 1 March 2014

"Venous sclerotherapy with lauromacrogol 400: thrombosis, ischaemia" Prescrire Int 2014; 23 (147): 70-71. (Pdf, subscribers only).
Download the full review.
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Venous sclerosants:
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Prescrire Int 2011;
20 (117): 155.
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