Sequential Injection of 3% Sodium Tetradecyl Sulfate and 20% Sodium Chloride in the Treatment of Refractory Varicosity of the Greater Saphenous Vein

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Abstract
American practitioners of sclerotherapy are limited by United States Food and Drug Administration (FDA) restrictions. The strongest FDA-approved sclerosant is sodium tetradecyl sulfate. In the United States, when a varicose vein is refractory to treatment with this drug, there are no effective FDA-approved pharmaceutical alternatives. A method of sequential injection of sodium tetradecyl sulfate followed immediately by sodium chloride is described. We have theorized that this drug combination should be more effective than equivalent doses of either drug alone. The injections are done under ultrasonic guidance. Sodium tetradecyl sulfate is injected first. After the vessel goes into spasm, a second injection of sodium chloride is made through the same needle. In the majority of varicose veins that had been refractory to repeated large doses of sodium tetradecyl sulfate alone, a single sequential injection treatment has brought about sclerosis and rapid atropy. This method should be considered for any case in which sclerotherapy is indicated, if it is known or anticipated that sodium tetradecyl sulfate alone will be ineffective or inefficient.

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