A COMPARATIVE EVALUATION OF SCLEROSANTS USED IN THE MANAGEMENT OF VARICOSE VEINS

Abstract

Background: Varicose veins, a manifestation of chronic venous insufficiency, often result from perforator vein incompetence (PVI). Sclerotherapy, which uses agents such as sodium tetradecyl sulfate (STS) and polidocanol, offers minimally invasive management. This study aimed to compare the efficacy and safety of STS and polidocanol in treating perforator incompetence in the lower extremities.

Methods: This prospective, hospital-based comparative study evaluated the efficacy and safety of STS and polidocanol foam sclerotherapy in treating perforator incompetence in the lower extremities. Fifty patients with varicose veins and perforator incompetence were randomly assigned to receive either STS (Group 1, n=50) or polidocanol (Group 2, n=50) foam sclerotherapy. Patients were assessed at baseline and followed up at 2-, 4-, 8-, and 12-weeks post intervention. The primary outcome was anatomical success, defined as complete or partial obliteration of the treated perforator vein, without reflux. The secondary outcomes included clinical success, wound healing, and adverse events.

Results: Both groups were comparable in terms of age, sex, comorbidities, CEAP grade, diabetes duration, and HbA1c levels (P > 0.05). Group B showed significantly better wound healing (68% vs. 52% complete healing, P = 0.025), greater vein closure (72% vs. 36% complete closure, P = 0.0007), and reduced reflux (16% vs. 44%, P = 0.002). Adverse events were more frequent in Group A, including higher rates of hyperpigmentation (32% vs. 12%), paraesthesia (20% vs. 8%), skin necrosis (8% vs. 0%), and superficial vein thrombosis (12% vs. 4%). No anaphylactic shock was reported, and symptomatic DVT occurred only in Group A (4%).

Conclusion: Polidocanol foam sclerotherapy demonstrated superior efficacy and safety over STS for treating perforator incompetence, with better healing, higher closure rates, and fewer complications than STS.