Treatment of varicose veins and other manifestations of superficial vein incompetence. 2. Sclerotherapy and compression bandaging

Abstract

This chapter describes the treatment of varicose veins and other manifestations of superficial vein incompetence. The treatment of simple varicose veins caused by superficial vein incompetence is always by the removal or obliteration of the pathway of superficial vein incompetence and the more completely this is done the more effective and lasting the treatment will be. Injection sclerotherapy sets out to cause a chemically induced reaction that will eventually obliterate the pathway of incompetence. Injection of a sclerosing agent, such as sodium tetradecyl sulfate, damages the intima and will be followed by a repair process that can, in favorable circumstances, seal the interior of the vein with fibrous tissue binding the luminal surfaces together and effectively destroying the lumen. Compression sclerotherapy is much more effective in obliterating peripheral varicosities than in giving lasting occlusion to the principal superficial veins from which usually arise the saphenous veins. It is found that the source vein may remain open, continually seeking to establish renewed connections with the low pressure areas below the musculovenous pumps. The elimination of the visible outlying varicosities for at least several years may be all that is required, and this is the basis of widespread successful use of the injection method and eradication of the origin is on far less secure ground.