A study to compare outcomes of Sodium tetra-decyl sulphate and Polidocanol in the treatment of varicosities due to incompetent tributaries of superficial vein of leg: a randomized controlled trial

Jitendra K. Kushwaha, Akshay Anand, Abhinav A. Sonkar, Rajni Gupta


Background: Various options for treatment of varicosities of tributaries are mini-phlebectomy, hook phlebectomy, Trivex and sclerotherapy. Sodium tetra-decyl sulphate (STD) and polidocanol (POL) are most commonly used sclerosants. Adverse events caused by sclerosants are pain, thrombophlebitis, hyperpigmentation, allergy, anaphylactic shock, cutaneous necrosis, deep venous thrombosis, headache, visual disturbances and chest tightness. Foam sclerotherapy has been considered to be better than liquid sclerosant. In this study we have compared foam prepared by STD versus POL in the treatment of varicosities of tributaries of superficial vein of Leg.

Methods: Patients treated for SFJ or SPJ incompetency post their primary admission and management were attended and evaluated in outpatient department. Patients having varicosities were enrolled for study and treated in OPD by foam sclerotherapy. Patients were randomized to two groups - A or B. Patients were followed up for one month and various clinical outcomes were analyzed.

Results: In group A (STD) out of n=20 patients pain, hyperpigmentation and skin necrosis was present in n1=18 patients, n2=14 patients and in n3=2 patients respectively on the first post-operative day while in group B (POL) out of 24 patients it was present in n1=14, n2=8 and n3=1 patient respectively. Post sclerotherapy at one month follow up, in Group A pain and hyperpigmentation decreased to n1=08 and n2=04 patients respectively but skin necrosis was persisting in all n3=02 patients. In-group B pain and hyperpigmentation was present in patients each n1= n2=02 and skin necrosis was present in n3=01 patient.

Conclusions: Polidocanol is better than Sodium tetra-decyl sulphate for foam sclerotherapy in terms of better cosmetic outcomes.



Foam sclerotherapy, Incompetent tributaries, Polidocanol, Sodium tetra-decyl sulphate, Varicose vein

Full Text:



Callam MJ. Epidemiology of varicose veins. Br J Surg. 1994 81(2):167-73.

Burleva EP, Tiurin SA, Smirnov OA, Faskhiev RR. Comparative 3-year results of phlebectomy and thermal ablation for lower limb varicose veins. Angiol Sosud Khir. 2018;24(2):82-91.

Puggioni A, Kalra M, Carmo M, Mozes G, Gloviczki P. Endovenous laser therapy and radiofrequency ablation of the great saphenous vein: analysis of early efficacy and complications. J Vasc Surg. 2005;42(3):488-93.

Lam YL, Lawson JA, Toonder IM, Shadid NH. Eight-year follow-up of a randomized clinical trial comparing ultrasound-guided foam sclerotherapy with surgical stripping of the Great saphenous vein. Br J Surg. 2018;105(6):692-8.

Zolotukhin IA, Seliverstov EI, Zakharova EA, Kirienko AI. Short-term results of isolated phlebectomy with preservation of incompetent great saphenous vein (ASVAL procedure) in primary varicose veins disease. Phlebol. 2017;32(9):601-60.

Pittaluga P, Chastanet S, Locret T, Barbe R. The effect of isolated phlebectomy on reflux and diameter of the great saphenous vein: a prospective study. Eur J Vasc Endovasc Surg. 2010;40(1):122-8.

Bunke N, Brown K, Bergan J. Foam sclerotherapy: techniques and uses. Perspect Vasc Surg Endovasc Ther. 2009;21(2):91-3.

Bergan J, Pascarella L, Mekenas L. Venous disorders: treatment with sclerosant foam. J Cardiovasc Surg (Torino). 2006;47(1):9-18.

Yiannakopoulou E. Safety Concerns for sclerotherapy of telangiectases, reticular and varicose veins. Pharmacol. 2016;98:62-9.

Subbarao NT, Aradhya SS, Veerabhadrappa NH. Sclerotherapy in the management of varicose veins and its dermatological complications. Indian J Dermatol Venereol Leprol. 2013;79(3):383-8.

Smith CP. Sclerotherapy and foam sclerotherapy for varicose veins. Phlebology. 2009;24(6):260-9.

Uncu H. Sclerotherapy: a study comparing polidocanol in foam and liquid form. Phlebol. 2010;25(1):44-9.

Willenberg T, Smith PC, Shepherd A, Davies AH. Visual disturbance following sclerotherapy for varicose veins, reticular veins and telangiectasias: a systematic literature review. Phlebol. 2013;28(3):123-3.

Whiteley MS, Smith VC. Exacerbation of alopecia areata: A possible complication of sodium tetradecyl sulphate foam sclerotherapy treatment for varicose veins. SAGE open medical case reports. 2017;5:2050313X17712643.

Chang YY, Lu PH, Yang CH. Anaphylactic shock after injection of foamed sodium tetradecyl sulfate. Dermatol Surg. 2017;43(6):887-8.

Leach BC, Goldman MP. Comparative trial between sodium tetradecyl sulfate and glycerin in the treatment of telangiectatic leg veins. Dermatol Surg. 2003;29(6):612-4.

Goldman MP. Treatment of varicose and telangiectatic leg veins: double-blind prospective comparative trial between aethoxyskerol and sotradecol. Dermatol Surg. 2002;28(1):52-5.

Rao J, Wildemore JK, Goldman MP. Double-blind prospective comparative trial between foamed and liquid polidocanol and sodium tetradecyl sulfate in the treatment of varicose and telangiectatic leg veins. Dermatol Surg. 2005;31(6):631-5.