Serious and atypical complications of sclerotherapy

Sclerotherapy is a safe and effective treatment for telangiectasias and varicose veins. Although the safety profile is favorable, life-threatening complications may occur after sclerotherapy in very rare and atypical cases. This article aims to compile serious and uncommon complications related to sclerotherapy. Clinical presentation, pathophysiology, treatment, and key points for prevention and early recognition are included. We conducted a narrative review of the literature published between 2000 and 2022, available in PubMed and Cochrane Library. The following MeSH terms were used: "Varicose veins," "Sclerotherapy," "Adverse effects," "Mortality," and "Complications." Sixty articles met eligibility criteria and were included in the review. The SANRA guidelines for narrative reviews were followed. Serious complications are classified ac-cording to severity (major or minor) and organ system compromise (local or systemic). Two percent of major systemic complications correspond to neurological complications, with intra-arterial injection as the most fatal complication. Deep vein thrombosis may be underestimated due to subclinical presentation. For minor complications, telangiectatic mats and residual pigmentation present in up to 15-24% and 6.1-28.6%, respectively. Transient general effects commonly occur, with pain and vasovagal reflex as the most common events. International guidelines recommend a rapid response algorithm for prompt recognition and treatment. Sclerotherapy is generally safe and well tolerated. Despite reports of low incidence, undesirable complications can occur. Vascular centers with performance of sclerotherapy should have an established standard-ized algorithm to address acute adverse events. Practitioners should be appropriately trained to perform the treatment and recognize and manage its complications.