Venous Segment Preparation

Sclerotherapy of telangiectatic veins should be performed with the patient in the supine position and the phlebologist comfortably seated. The surface of the injection site should first be drenched with 70% isopropyl alcohol. This not only cleanses the site, but it also enhances visualization of the telangiectasia(s) because alcohol changes the index of refraction of the skin causing it to become more transparent. Additionally, the alcohol may also cause vasodilatation of the telangiectasias [2]. Alternative techniques used to enhance visualization include wiping the skin with a solution composed of 70% isopropyl alcohol and 0.5% acetic acid, recommended by Sadick who found this solution to better improve the angle of refraction than alcohol alone, and by rubbing a very small amount of the sclerosing solution into the skin, as practiced by Scarborough and Bisaccia [2]. These phlebologists also use Aethoxysklerol (polidocanol),which contains alcohol [2].Magnifying devices with a 2+ or 3+ diopter should also be used to further enhance visualization of the telangiectasia(s) (Table 8.7). The use of a lamp, or any other source of direct lighting, over the injection site should be avoided because this will produce a glare.Visualization is maximized with indirect, shadow-free lighting.

Table 8.7. Sclerotherapy supplies and distributors   Supplies       Distributors   Magnifying glasses       Clip-on Loupes: Almore International Portland, OR 97225, USA Opticald: Edroy Products Co., Inc. Nyack, NY 10960, USA   Headband-mounted simple binocular magnifiers       Mark II Magni-Focuser: Edroy Products Co., Inc. Nyack, NY 10960, USA Optivisor: Donegan Optical Company 15549 West 108th Street Lenexa, KS 66219, USA   Simple binocular loupes       Multidistance Headband Loupe: Edroy Products Co., Inc. Nyack, NY 10960, USA Precision Binocular Loupe: Almore International Portland, OR 97225, USA   Binocular loupes       Design for Vision New York, NY 10010, USA N1064 Oculus: Storz Instrument Company St. Louis, MO 63122, USA Westco Medical Corporation San Diego, CA 92138, USA See Better Loupe: Edroy Products Co., Inc. Nyack, NY 10960, USA   Syringes       Luer Lok or non-Luer Lok: Becton-Dickinson & Company Rutherford, NJ 07070, USA Plastipak Eccentric Syringe: Becton-Dickinson & Company Rutherford, NJ 07070, USA   Material for foam generation       Injekt syringe with Luer-Lock (green) 10 ml, for foam generation; No. 4606728 B, BRAUN,Melsungen Combidyn adapter, f/f, for the safe connection of the syringes during foam generation; No. 5206634 B, BRAUN,Melsungen Omnifix syringe with Luer-Lock 10 ml, for foam generation; No. 4617100 B, BRAUN,Melsungen www.bbraunusa.com/ 824 Twelfth Ave., Bethlehem, PA 18018, USA   Material for sterile filtration of ambient air       Sterifix 0.2 µm sterile filter no. 4099206 B, BRAUN,Melsungen www.bbraunusa.com/ 824 Twelfth Ave., Bethlehem, PA 18018, USA   Compression hosiery       Camp: Camp International, Inc. P.O. Box 89 Jackson, MI 49204-0089, USA Jobst: The Jobst Institute, Inc. P.O. Box 652 Toledo, OH 43694, USA JuZo: Julius Zorn, Inc. (JuZo) P.O. Box 1088 Cuyahoga Falls, OH 44223, USA Legato: Freeman Manufacturing Co. 900W. Chicago Rd. Sturgis, Michigan 49091-9756, USA Medi: Medi USA (American Weco) 76 W Seegers Rd. Arlington Heights, IL 60005, USA Sigvaris: Sigvaris P.O. Box 570 Branford, CT 06405, USA Venosan: Freeman Manufacturing Co. 900 W Chicago Rd. Sturgis, Michigan 49091-9756, USA   Foam pads       Reston: 3M Health Care St. Paul, MN 55144-1000, USA or: D-46325 Borken, Germany STD Pharmaceutical Field Yard, Plough Lane Hereford HR4 0EL,UK   Color-duplex scanner       Apogee 800: Advanced Technology Laboratories Solingen, Germany   Needles   21-, 23-, or 25-gauge butterfly   Abbott Hospitals, Inc. 25-gauge North Chicago, IL 60064, USA butterfly Surflo Winged Infusion Set: Terumo Corporation Tokyo, Japan       26- or 27-gauge   Allergy: Becton-Dickinson & Company Ft. Lauderdale, FL 33314, USA Yale: Becton-Dickinson & Company Ft. Lauderdale, FL 33314, USA       30-gauge   Acuderm: Acuderm, Inc. Ft. Lauderdale, FL 33314, USA Delasco: Dermatologic Lab and Supply, Inc. Council Bluffs, IA 51503, USA Precision Glide: Becton-Dickinson & Company Rutherford, NJ 07070, USA       33-gauge   Delasco: Dermatologic Lab and Supply, Inc. Council Bluffs, IA 51503, USA Hamilton: Hamilton Company Reno,NV, USA (800) 648-5950   Tape dressings   Localized pressure   Coban Tape: Medical Surgical Division/3M St. Paul, MN 55144, USA Medi-Rip Bandage: Conco Medical Company Bridgeport, CT 06610, USA       Minimal pressure   3M Microfoam Surgical Tape: Medical Surgical Division/3M St. Paul, MN 55144, USA Tubigrip Tubular Support Bandage: Seaton Products, Inc. Montgomeryville, PA, USA

To distend the diameter of vessels that appear to be too small for injection, either the patient stands for 5 min and is then placed in the Trendelenburg position or a blood pressure cuff is inflated to approximately 40 mmHg proximal to the injection site while the patient is supine.