Answers

Replied on 10/20/2009

By: VeinSolutions - Austin  |  Emery W. Dilling, M.D.
Jeffrey M. Apple, M.D., F.A.C.S.
Austin, TX

There are many solutions available for sclerotherapy. Hypertonic saline is still available, but most physicians use polidocanol, sodium tetradecyl sulfate, or glycerine. There is no mercury in these solutions to my knowledge.

Replied on 10/19/2009

By: Vein Center of Tampa Bay
Featuring Stunning Looks Medi Spa  |  Jeffrey A. Hunt, D.O., R.V.S.
Christopher J. Schaffer, M.D.
Tampa, FL

We use Sotradecol for spider veins. The only common side effects of this treatment can be temporary injection-site bruising and redness.

Replied on 10/15/2009

By: Laser Lipo and Vein Center  |  Thomas Wright M.D. F.A.C.P.
St. Peters, MO

The classic saline solution used for sclerotherapy was hypertonic saline, with no mercury or other additives. The problem with saline is that it burns tremendously, so it is no longer used by most. The current agents we use are called Sotradecol or Polidocanol, both of which have been used for many, many years with excellent results, and much less discomfort as compared to saline. There is no mercury in either compound, and the side effects are generally mild, and consist of bruising, mild tenderness, hyper pigmentation or mild discoloration, which slowly fades over time. The most significant potential, but rare, side effect could be a small surface skin ulcer, which usually heals very well over time.

Replied on 10/15/2009

By: Vein Specialists at Royal Palm Square  |  Joseph G. Magnant, M.D., F.A.C.S.
Fort Myers, FL

There are a variety of solutions used for injection sclerotherapy, but only one which is FDA approved: sodium tetradecol sulfate or STS. Hypertonic saline solution is not commonly used by today's practicing Phlebologists or vein specialists. I am not aware of any solutions used for sclerotherapy which contain mercury, and the commonly used solutions are generally used in such small amounts that there is little chance of minor complications andalmost no risk of more serious, long term complications. THE use of air mixed in with the solution to create "foam' has been advocated by some vein specialists as a more effective treatment for veins larger than spiders or reticular veins, noting that the foam creates more 3-D contact with the vein wall rather than the liquid solution layering along the dependent surface of the vein. There are 2 camps of thought on this topic and my recommendation is that you have a discussion with your vein specialist and have your
questions answered to your satisfaction.

Replied on 10/13/2009

By: California Vein Specialists  |  J. Michael Leary M.D., FACEP
Newport Beach, CA

Saline is high concentration of salt. Usually 23% or 20%. Saline is not a very effective sclerosant because it gets very diluted when injected. Saline can cause staining which is a brown stain over the vein that was injected. Saline can also cause significant necrosis of
the skin. There are much more effective and much safer sclerosants available and sclerosants that are not as prone to staining, we do not use hypertonic saline at California vein specialists for this reason. We use detergents that are safer and more effective. I am not aware of mercury in any sclerosants.

Replied on 10/13/2009

By: Vein Centers for Excellence of Kansas City  |  Craig I. Schwartz, D.O., FACOS, FICS
Kansas City, MO

The classic saline solution used for sclerotherapy was hypertonic saline, with no mercury or other additives. Problem with saline is that it burns tremendously, so it is no longer used by most. The current agents we use are called Sotradecol or Polidocanol, both of which have been used for many, many years with excellent results, and much less discomfort as compared to saline. There is no mercury in either compound, and the side effects are generally mild, and consist of bruising, mild tenderness, hyper pigmentation or mild discoloration, which slowly fades over time. The most significant potential, but rare, side effect could be a small surface skin ulcer, which usually heal very well over time.

Replied on 10/13/2009

By: Novi Vein  |  Jeffrey H. Miller, M.D.
Novi, MI

Saline compared to other solutions for sclerotherapy is more painful and less effective. Saline is notorious for causing cramps during injection. Potential side effects for sclerotherapy: blood trapped in veins injected, blood clot (very rare), allergic reaction, migraine headache, skin ulcer, darkening of skin, new veins. Overall, sclerotherapy is very safe however.

Replied on 10/12/2009

By: Vein Specialty Medical Clinic, Inc.  |  Khalil Fattahi M.D.
Board Certified, American Board of Phlebology
Campbell, CA

Saline comes in three different forms, and only one of them is used by some doctors (not by most vein specialists) in treating unwanted legs veins. When saline is made with its salt equal to our body salt concentration in body fluids, it is called isotonic. isotonic saline
has no effect on vessels and is used to mainly to expand the patients fluid volume, such as in dehydrated patients. Salt content of isotonic saline is 0.9%. Hypotonic saline has less than 0.9% saly content, and used in specific situations to balanc fluid and
electrolyte imbalance where more water is required than salt.

Hypertonic saline (much thicker concentration of salt in water than our blood) with salt concentration of 23.4% is used to cause damage to the inner ayer of unwanted veins and scar these vessels from within. It should be noted that Hypertonic saline is NOT approved by FDA for treatment of spider veins or varicose veins. The only solution that is FDA-approved for this use is Sodium Tetradecyl Sulfate , commercially known as Sotradecol, Sotradecol is used in many different concentrations depending what size and where is the target varicose vein or spider veins.

Furthermore, sclerotherapy should only be done by a doctor with proper training and experience in its use, evaluation and treatment of vein related problems. In my
experience of 17 years of doing sclerotherapy, I have noted, generally speaking, that those physicians who perform sclerotherapy as a side job (once in a while) and not a full-time ficus of their career, produce much less desirable results. Treatment of varicose and spider veins should not be trivialized in any way.

Replied on 10/12/2009

By: Bella MD Laser Vein and Aesthetic Center  |  David A. Engleman MD, FACC
Dallas, TX

When saline is used for sclerotherapy then it is only saline. No other chemicals. The high concentration is what makes it damaging to the veins. Other chemical or solutions can also be used but none would contain any Mercury unless there was a contamination issue.

Typical side effects include bruising and redness in addition to some degree of skin hyperpigmentation.

Replied on 10/12/2009

By: Mountain View Dermatology Cosmetic Surgery and Vein Center in Boulder, CO  |  Richard Levine, M.D.
Boulder, CO

Saline is just a salt solution. There is no mercury.

Some temporary inflammation and possible minor bruising can occur.

Replied on 10/12/2009

By: Idalis Cosmetic Laser and Vein Center  |  Samuel Coor, D.O.
Lacey, WA

The only chemicals in the saline solution are salt and water. It contains no mercury. Hypertonic saline for sclerotherapy can only be used for small vessels. The main side effects are irritation of the skin and some skin ulcers. There are no associated allergic reactions from it since it is only salt and water.

Replied on 10/12/2009

By: Makris MD Interventional Radiology Center  |  Angelo N. Makris, M.D.
Oak Brook, IL

The saline solution is a hypertonic saline and does not contain mercury. Side effects are the same for other sclerotherapy solutions; staining, bruising, phlebitis, and possible ulceration.

Replied on 10/12/2009

By: Innovative Vein  |  Paul Cheatum, M.D.
Wichita, KS

There are several different commonly used sclerotherapy solutions. Hypertonic saline is used frequently. I personally do not use it. We use Sotradecol at our clinic. Hypertonic saline is a high salt content water that should not have additional elements.

Side effects are typically burning and irritation at the injection site. Sometimes there can be staining which is usually temporary. Rarely there is a more significant side effect of tissue necrosis where there is some skin damage. Again, fortunately, this doesn't happen often.

Replied on 10/12/2009

By: Vein Specialists Institute  |  Kenneth H. Jesser, M.D.
Palm Desert, CA

Saline solution for vein treatments is concentrated salt water (sodium chloride). There is no mercury in it. Any side effects would consist of local irritation of the treated veins. Risks of sclerotherapy include infection, bleeding at injection sites, darkening of the injected veins, and
small risk of blood clots. Generally sclerotherapy is safe and uncomplicated.

Replied on 10/12/2009

By: The Vein Treatment Center of NJ  |  Dean H. Wasserman, MD, FACS, RVT, FACPh
Paramus, NJ

Saline, when used for vein sclerotherapy, is very high in salt concentration and the salt is composed of sodium and chloride. Although "saline" makes up almost 60-70% of our own body components and thue sounds "natural", the body saline is less than 1% salt, while it is prepared super concentrated over 26% salt for vein injection use.

While saline is among the least expensive agents of the many available for sclerotherapy, it is also associated with significant pains, and has a higher rate of pigmentation that preparations designed for this use

The pain is due to the saltiness and could be compared with "rubbing salt into a wound". For thie reason. when saline is used for sclerotherapy, many Phleboligists add intravenous numbing lidocaine into the mixture. This additive has the potential of acting on the
heart in large enough volumes.

It is also interesting that saline is not FDA approved for sclerotherapy leg vein injections. There is no mercury involved.

Replied on 10/12/2009

By: Vein and Laser Specialist  |  Edward G. Mackay, M.D.
St. Petersburg, FL

Most of the time when people say they are treating spider veins with saline they mean sodium chloride. There may be a preservative added but it is not mercury. The main sclerosant used though in Sotradecol. Here is a link to the package insert:
http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/EnforcementActivitiesbyFDA/WarningLettersandNoticeofViolationLetterst
oPharmaceuticalCompanies/ucm054378.pdf

This drug has been used for sclerotherapy for over 50 years and is verysafe. Saline or Sodium chloride is very safe as well. Of course both have upper limits of safe use in a sitting.

Replied on 10/12/2009

By: General Vascular Surgery Group  |  Michael D. Ingegno, M.D.
San Leandro, CA

I don't use saline solution, never have, but it is a solution which has been available for many years. It is just a concentrated salt solution. Generally most people in the US use Sotradecol these days, it is FDA approved for sclerotherapy, and works quite well. As far as I know there is no mercury in this solution or any other solution used for sclerotherapy. Some possible unlikely side effects include, pigmentation, allergic reaction, skin ulceration (very rare), matting (recurrent tiny veins)

Replied on 10/12/2009

By: VeinSolutions - Minneapolis  |  Christopher F. Roland, M.D., F.A.C.S.
William R. Omlie, M.D., F.A.C.S.
Timothy Jon Gavin, M.D., F.A.C.S.
C. Phifer Nicholson, M.D., F.A.C.S.
Howard L. Saylor III, M.D., F.A.C.S.
Edina, MN

We do not use saline anymore. We have two different solutions that we use. The first is sodium tetradecyl sulfate, it is mixed with air to become a "foamed" solution. The second is glycerin mixed with lidocaine. Side effects can include some irritation, discoloration or ulceration (very seldom) at the injection sites.

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