Sclerotherapy: A Brief History

What is sclerotherapy?

Sklerosis: Greek - a hardening or induration of a tissue or part.

Therapeia: Greek - treatment of disease or disorder as by some remedial or restorative process.

Sclerotherapy is a somewhat broad term that describes injecting medication into a vein for the purpose of shutting down and eliminating it. Typically this is done to alleviate the typical symptoms such as pain, heaviness, aching, cramps, itching or burning. Alternatively, they are treated for purely for cosmetic purposes.

Sometimes referred to as injection sclerotherapy or compression sclerotherapy, this technique was originally developed for the treatment of varicose veins but later evolved into the treatment of choice for spider veins (telangiectasia). More recently, the use of this technique in treating larger varicose veins is making a resurgence.

Varicose veins in ancient times

While varicose veins have almost certainly existed since the dawn of man man, the first historical documentation thereof dates to the writings on papyrus scrolls by the ancient physician Ebers in the year 1550 BC. Since that time several major discoveries or inventions have led to the many refinements that bring us to the present day techniques.

Certainly, sclerotherapy has at times been used as an alternative to surgery which was initially very primitive and later simply not as effective as one would have hoped. Presently, sclerotherapy and surgery coexist as complimentary modes of treating the total vein problem.

The first documented treatment of venous disease was found in the historical annals around 400 BC in the form of offerings to the gods as supplication seeking relief. Hippocrates, around 460 BC, wrote of introducing a slender instrument of iron through multiple punctures into the veins to induce thrombosis. This concept of inserting a foreign substance into the vein was most likely the precursor to sclerotherapy itself.

Great things evolved from these unlikely beginnings. Events that changed the procedure dramatically include the first injection of distilled plantain water via an enema syringe into a branch of the crural vein by Sigismund Eisholtz in the mid-1600′s.

The lachymal syringe, compression and ultrasound

The introduction of the lachrymal syringe by Anel in 1713 led to the development of the hypodermic syringe by Rynd in 1845 and its subsequent modification by Pravaz. At this point, experimentation with many varied types of medication including absolute alcohol (1840), ferric chloride (1851), iodine (1906), mercury (1920), sodium morrhuate (1930), sodium tetradecyl sulfate (1946), polidocanol (1966) became the norm.

Compression therapy was recognized early on as an important adjunct starting first with Hippocrates, then the use of leather straps by Roman soldiers, plaster bandages and ultimately the mechanically-engineered graduated-pressure compression stockings of today.

The 1970s saw the refinement of ultrasound as a medical tool that gave rise to use in venous disease treatments. The use of duplex ultrasound in conjunction with the development of thick foam-like medications (some are now the consistency of toothpaste) allowed the skilled physician to place by injection (with great precision) measured doses of sclerosant medications directly into the incompetent or refluxing vein.

Sclerotherapy has in many ways evolved enormously, yet in other ways has changed little. Today, it is the industry standard treatment of choice for spider veins in the legs. It is also used to treat veins in the arms, back, breasts and other areas. And recently, the use of ultrasound and foam has opened up fantastic possibilities in the treatment of varicose veins, perforator veins and in some cases, even the great saphenous vein.

Reviewed February 16, 2017

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