[Contra indications of sclerotherapy, update 2005].

BACKGROUND: Modern sclerotherapy, using ultrasound guidance and foam sclerosants, is a reference treatment of varices of the lower limbs. Like all other techniques it should be employed in the safest, precisely described and reproducible conditions. Therefore, its contra indications must be clearly known.

METHODS: Contra indications of sclerotherapy can be defined in legal notices provided by the manufacturers in compliance with regulatory standards, developed empirically, extrapolated from theoretical mechanisms, or analyzed from controlled studies.

RESULTS: Contra indications can be patient-, method-, or sclerosing agent-related. Legal notices (France) are different for the different available sclerosing agents, and often outdated. We can note principally: hypersensitivity, fever, phlebitis, childhood, and pregnancy. Chromated glycerin should be avoided in patients with chronic renal insufficiency. Intra-arterial injections are prohibited (obviously), and the treatment of huge veins as well. Association with disulfirame is contra indicated. We must of course add: bed rest, severe systemic diseases, poor patient understanding, needle phobia, short life expectancy, late stage cancer, known allergy to the sclerosing agent, and treatment with tamoxifen. Previous medical history of deep vein thrombosis and thrombophilia could be theoretical contra indications and are currently under evaluation. Oral anticoagulation is not a contra indication provided the situation is stable and the causal disease is not a contra indication in itself. Pregnancy is not usually a period when sclerotherapy is useful or urgent, according to some authors it can be carried out anyway. In children, sclerotherapy of venous malformation is now a reference treatment. Thanks to progress in ultrasound guided sclerotherapy with foam, the size of the veins is no more an issue, neither is a difficult access to the varix.

CONCLUSIONS: Sclerotherapy is now based on seriously documented evidence. It is safe and efficient. Its contra indications are exceptional, usually non-specific. It can be used safely for fragile or elderly patients.