Hypertonic saline is the solution which has been most widely used in the past. It is simply a very concentrated saline (salt) solution which irritates the tiny veins in which it is injected and subsequently closes them. Hypertonic saline is used widely and is very effective. It is also very inexpensive, which means that physicians who use it may be able to charge a little less for their services. Furthermore, allergic reactions do not occur with this solution. However, there are disadvantages to hypertonic saline. The most important disadvantage is that it is very painful when injected. Hypertonic saline must be injected directly in the vein where it often causes an intense burning sensation. To help ease the pain, physicians sometimes mix lidocaine in the solution or give their patients valium or a pain reliever, but this rarely makes the burning go away entirely. Furthermore, there are risks. If the physician misses the vein, the saline can cause severe pain and even ulceration at the injection site.
The remaining two solutions are sodium tetradecyl sulfate which is known by its trade name Sotradecol and polidocanol which is also known by its trade name Asclera or Aethoxysklerol. They are very similar to one another. Both are widely used, but are expensive, so physicians using these solutions usually have to charge a bit more in order to provide a more comfortable experience. Both are detergent-like solutions that work by interfering with the cells that make up the inner lining of the vein. The vein wall is then essentially sealed shut and closes. The solutions can also work by causing clotting of the tiny spider veins, causing them to eventually disappear.
Sotradecol (sodium tetradecyl sulfate) and Asclera (polidocanol) are advantageous over hypertonic saline for various reasons:
- They are generally painless when injected. Even when injected around the vein rather than in the vein, they rarely cause any reaction or ulceration. For this reason, patients generally prefer one of these detergent solutions over hypertonic saline.
- Because these two solutions are “detergents”, they can be formulated as “foam” which allows the physician to inject larger veins.
- They are just as effective as hypertonic saline but are far less painful when injected.
Sotradecol and Asclera or Aethoxysklerol are competing products and are both FDA approved. Patients will find information on the internet which claims that one is superior to another. These studies are usually funded by one company or the other. However, in many independent studies, no definitive advantage has been found between sodium tetradecyl sulfate, polidocanol, and hypertonic saline.
At the San Francisco Vein Center, Dr. Aquino usually uses sodium tetradecyl sulfate (Sotradecol) for sclerotherapy.