Which Concentration?

What concentration and when?

‘One of the most important concepts in sclerotherapy is that of achieving optimal destruction of the blood vessel wall with the minimum concentration of sclerosant necessary for a clinical result. Too high a concentration leads to adverse sequelae’.

Goldman & Bergan – Sclerotherapy. Treatment of varicose and telangiectatic leg veins 2001 

Concentration guidelines

Below is a guide to the appropriate concentration of Fibrovein to use for a given size of vein. The guide is approximate since the effect will vary slightly from patient to patient and according to technique. Too high a concentration can lead to adverse effects such as pain, necrosis and pigmentation. Spider and thread veins are best treated with 0.1-0.2% Fibrovein.

Vein diameter Fibrovein concentration
< 0.5mm 0.1%
0.5-1.0mm 0.2%
1-2mm 0.3%
2-3mm 0.5%
3-5mm 0.75%
+5mm 1-3%

NB These guidelines are for injections of liquid. After Thibault 1999 & 2001

Diluting Fibrovein

To make non standard concentrations of Fibrovein the following is recommended:-

  1. The recommended diluent is sterile water (water for injection). Normal Saline (sterile) is satisfactory but not necessary.
  2. It is recommended that the above dilutions be made in the syringe and unused material is discarded.
  3. Do not store diluted Fibrovein between treatment sessions. This is dangerous because the bactericide (Benzyl Alcohol) has also been diluted.

Comparison with polidocanol

Fibrovein is an anionic detergent whereas polidocanol is a cationic detergent; by and large the anionic detergents are the more powerful surface active agents. Fibrovein is more surface active than polidocanol and therefore should be used at lower concentration. Where practitioners have previously used polidocanol then caution should be exercised when they start to use Fibrovein. They should use Fibrovein at half to one third the strength of polidocanol for the same size vein. Using too high a concentration of Fibrovein can result in increased incidence of adverse sequelae such as pigmentation and necrosis.

Vein diameter Fibrovein concentration Approx Polidocanol concentrtation
< 0.5mm 0.1% 0.25%
0.5-1.0mm 0.2% 0.5%
1-2mm 0.3% 0.75%
2-3mm 0.5% 1%
3-5mm 0.75% 2%
+5mm 1-3% 3-5%

After Thibault 2001