Extensive tissue necrosis following high-concentration sclerotherapy for varicose veins

BACKGROUND. Tissue necrosis after sclerotherapy has been observed, but is u nexplained. OBJECTIVE. To present the complication of extensive tissue necrosis followi ng high-concentration sclerotherapy for varicose veins. METHODS. Cases coming to the attention of the authors are presented briefly with commentary and discussion to explain the mechanisms of tissue destruc tion. RESULTS. Although the complication of extensive tissue necrosis has been as cribed to intra-arterial injection, in fact, careful study of the cases des cribed here shows that intravenous injection was present in each case. A th eory of distribution of the sclerosant into the arterial arborization is pr oposed. This theory would explain the distribution of sclerosant into the a rterial tree and would also explain the causation of extensive tissue necro sis. Mention is made of experimental work in which intraarterial injection was not the mechanism of causation of tissue necrosis. CONCLUSION. Extensive tissue necrosis following high-concentration scleroth erapy may be rare, but its occurrence is serious and its treatment may be i ncomplete.