Paraplegia after sclerotherapy of varicose leg veins

We would like to present the case of paraplegia due to venous spinal ischaemia, which occurred after sclerotherapy of leg veins and subsequent to previous venous surgery. After exclusion of other pathogenetic causes such as surgery, tumescent local anaesthesia or neurological, infections, cardiological and haemosteaseological causes, this complication must be regarded as a consequence of sclerotherapy. Sources in literature describe shunts (shortened connections) between the leg veins and the venous spinal system, thus enabling minutest particles from sclerotherapy to enter the veins and possibly have a cytotoxic or microembolic effect with spinal ischaemia.

Paradoxical embolism, stroke and sclerotherapy

Sclerotherapy has been associated with 13 published cases of stroke since 1994. Four earlier reports implicated liquid sclerosants while nine recent cases have followed foam sclerotherapy. This adverse event represents a very rare complication of a very popular procedure. Ten of the 13 reported patients recovered completely with no long-term sequelae. A right-to-left shunt and in particular a patent foramen ovale (PFO) was the most consistent risk factor. Paradoxical gas emboli were observed in the brain-supplying or the intra-cranial arteries of five patients with an immediate onset of stroke after foam sclerotherapy. Paradoxical clot embolism was suspected in three patients with a delayed onset of stroke and concurrent venous thrombosis. In the remaining five cases, which included two cases with an immediate onset after liquid sclerotherapy, no specific cause was identified. Patients with a past history of cryptogenic stroke or a long life history of recurrent classic migraine attacks (with aura) have a higher risk of neurological adverse events and may benefit from preoperative screening and percutaneous closure of PFO.