Extravascular Effects of Sclerosants in Rabbit Skin: A Clinical and Histologic Examination

Abstract

Sclerotherapy refers to the injection of a material for the purpose of obliterating a blood vessel. During this procedure a small quantity of sclerosing solution may be unintentionally injected into the tissues surrounding the vessel, either by missing the vessel or leakage of sclerosant upon withdrawal of the needle. Occasionally, the sclerosant may be intentionally injected into an extravascular site in the hope of reducing telangiectatic mats (best described as multiple, grouped, extremely fine telangiectatic vessels). The various sclerosants in use appear to vary in their potential to cause necrosis of perivascular tissues as a complication. This study examines the clinical and histologic effects of the intradermal injection of 0.1 ml of 0.25, 0.5, and 1.0% Aethoxysklerol (AES); 0.5% Sotradecol (SOT); and 23.4% hypertonic saline (HS) in rabbit skin. All three agents produced some clinical necrosis with intradermal injection. AES in all three concentrations produced the least clinical necrosis, no histologic necrosis, and resolved faster than SOT or HS.

Postsclerotherapy Hyperpigmentation: A Histologic Evaluation

“…This phenomenon probably occurs when red blood cells extravasate into the dermis following the rupture of treated vessels 14 . Although Cacciatore 4 has reported a significantly decreased incidence of hyperpigmentation with the use of AES, one of us (DMD) has found the incidence of postsclero‐therapy pigmentation to be approximately equal for SOT, AES, and HS.…”

A Comparison of Sclerosing Agents: Clinical and Histologic Effects of Intravascular Sodium Tetradecyl Sulfate and Chromated Glycerin in the Dorsal Rabbit Ear Vein

“…Superficial necrosis has been reported to occur frequently at the higher concentration 6,7 . Experimental intradermal injection of 0.5% STS in rabbit skin has also been found to produce epidermal and dermal necrosis both clinically and histologically 8 …”

Subcutaneous injection of liquid and foamed polidocanol: extravasation is not responsible for skin necrosis during reticular and spider vein sclerotherapy

“…Goldman et al. 7 showed that the intradermal injection of 0.1 mL of polidocanol liquid (0.25–1.0%) into the rabbit skin does not produce clinical necrosis. This is consistent with our finding that 0.5 mL is the lowest volume capable of inducing skin necrosis.…”

“…Such deeply situated extravasation is nowadays probably a very rare event considering the ultrasound guidance of sclerosant injection into deeper intrafascial vessels. Goldman et al 7 showed that the intradermal injection of 0.1 mL of polidocanol liquid (0.25-1.0%) into the rabbit skin does not produce clinical necrosis. This is consistent with our finding that 0.5 mL is the lowest volume capable of inducing skin necrosis.…”