By Jill Buterbaugh RN, MSN, CRNP, FNP-BC
Varicose vein treatments have been around for a long time. The first documented records were from Hippocrates time over 2000 years ago. Statues still standing in the Acropolis in Athens, Greece show depictions of varicose veins. Ancient treatments such as blood letting are found in scripts of Hippocrates who also described traumatizing the veins with instruments to cause the blood in the vein to clot. The procedures of stripping and cauterization were first described by Celsus around 30 BC to 30 AD. Vein ligation was attributed to Galen in the second century AD and Paulus of Aegina, 660 AD was documented to perform stripping and ligation procedures. William Harvey is given credit for discovering the true physiology of circulation and it was then felt those procedures were considered more problem causing than problem solving so treatment practices were rejected for a period of time.
The modern history of varicose vein treatment really started after the concepts of sterile procedures and using anesthesia began in the late nineteenth century. Compression therapy was initially attributed to the Roman soldiers who used leather straps to wrap their legs. This was thought to increase the endurance in their legs for long marches. There are other documented therapies such as plaster bandages and laced leather sheaths wrapped on the legs to treat wounds. Some of the instructions noted that if the compression devices were applied correctly, the leg should look cyanotic (blue in color from decreased blood supply and oxygen) when horizontal then turn pink when standing.
The first documented sclerotherapy or injections to treat veins was in the early 1600’s. Some of the documented solutions included plantain water, acid, nitric acid, alcohol, ferric chloride, iodine, tannin and perchloride of mercury. Unfortunately, many patients died from these early treatments. Later it was discovered that a side effect of Luargol solution, which was used to treat syphilis caused scarring of the veins and further experiments found that salicylate of soda worked the best.
The first pharmacologically manufactured sclerosant agent was a mixture of saline and procaine in Germany. This triggered many experiments using many different agents across the world to see what worked the best. Many different compounds were used including grape sugar, mercury biiodide, sodium salicylate, sodium nitrate, sodium chloride, bichloride of mercury, calorose, quinine sulfate, and urethane. These solutions were used across the world but resulted in many side effects and even deaths. The first successful, safe treatment was documented in 1939 and the research and development and research is continual to this day.
There are still a small variety of substances used for sclerotherapy today including glycerine, hypertonic saline, sodium tetradecyl and polidocanol. Sodium tetradecyl and polidocanol are the only two approved for sclerotherapy by the FDA. They are only active in the body for a few seconds and work on contact where they are injected. They have an excellent safety profile. For more information on varicose vein treatment and sclerotherapy, please visit us at altoonavein.com
*Historical information referenced from: Goldman, M.P. & Bergan, J.J. 2001. Sclerotherapy Treatment of Varicose and Telangiectatic Leg Veins, Third Edition. St. Louis, MI: Mosby.