polidocanol

Polidocanol, also known as lauromacrogol 400, is a sclerosant used in sclerotherapy to treat varicose veins, reticular veins, and spider veins. It is available in liquid form and as a foam, with foam versions designed to enhance contact with the vein endothelium. Liquid polidocanol is typically used in concentrations ranging from about 0.5% to 3%, depending on the size and location of the vein, while foamed preparations allow treatment with smaller volumes.

Mechanism and effects

Polidocanol works primarily by damaging the endothelial lining of targeted veins. This endothelial injury triggers inflammation, coagulation, and eventual fibrosis, leading to occlusion of the treated vein. The foam form increases the surface area in contact with the endothelium and helps achieve closure of larger or incompetent veins with greater efficiency.

Clinical use

Polidocanol is employed in the treatment of varicose veins, including insufficiencies of superficial and some deep venous segments, as well as certain spider and reticular veins. It is also used in the management of internal hemorrhoids in some clinical settings. The procedure is usually performed by trained clinicians, often under ultrasound guidance for larger veins, and may involve multiple injections or staged sessions.

Safety and side effects

Common adverse effects include transient injection-site pain, redness, swelling, and local crusting or pigmentation at the treatment site. More serious but rare risks include allergic reactions, tissue necrosis from extravasation, deep vein thrombosis, pulmonary embolism, and, with foam sclerosants, rare neurologic events. Proper technique and patient selection are essential to minimize complications.

Overview

Polidocanol is a widely used sclerosant in vascular and hemorrhoidal sclerotherapy, valued for its availability in liquid and foam forms and its balance of efficacy and safety when administered by trained professionals.