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Phlebology 2009;24:98-107
doi:10.1258/phleb.2009.009010
© 2009 Royal Society of Medicine Press

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A-Z Series

Venous disease A-Z series: no. 10

Catheter-directed sclerotherapy

K Parsi 

Department of Dermatology, St Vincent's Hospital, Sydney; Vascular Birthmark Unit, Sydney Children's Hospital, Australia

Correspondence: Dr Kurosh Parsi FACD FACP, Suite 2102, Level 21, Westfield Tower 1, 520 Oxford Street, Bondi Junction 2022, Australia. Email: kparsi{at}ozemail.com.au

Background: Catheter directed sclerotherapy (CDS) involves the use of a long catheter to deliver a sclerosing agent into a target vessel (saphenous trunks or venous malformations) under ultrasound guidance.

Aims and Methods: This article reviews the history, current techniques and devices and the evidence as it relates to these procedures.

Results: CDS was developed to increase the safety and efficacy of ultrasound-guided sclerotherapy (UGS). With the advent of foam sclerosants and tumescent anaesthesia, the procedure has enjoyed a higher primary success rate. CDS has a better safety profile when compared with UGS with virtually no risk of intra-arterial injection or sclerosant extravasation. Compared with endovenous laser (EVLA) and radiofrequency ablation (RFA), CDS is a quicker procedure with less associated pain. Some balloon catheters, however, have been found to force the sclerosant down the perforators causing femoral vein occlusion. Based on the current level of evidence, no firm conclusion regarding the efficacy of CDS techniques can be drawn in comparison with EVLA or RFA, but the primary success rate is probably higher than the standard UGS.

Conclusion: CDS ensures a safe intraluminal delivery of the sclerosing agent into the trunk of the saphenous veins using a single access point. This procedure preceded EVLA and RFA, and remains a safe alternative for the treatment of saphenous incompetence and venous malformations.

Key Words: sclerotherapy • ultrasound-guided sclerotherapy • catheter-delivered foam • varicose vein • saphenous vein


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