Ultrasound-Guided Sclerotherapy (USGS) of Perforating Veins in Chronic Venous Insufficiency

Publisher Summary This chapter presents the review of a nonsurgical treatment option for incompetent perforating veins, ultrasound-guided sclerotherapy, which combines the precision of surgical approach with minimal invasiveness of an injection. Recent development of new treatment options for reflux in the superficial venous system have established a new standard where patients can be treated in the office without a need for general anesthesia, can ambulate immediately after treatment, have insignificant postoperative pain, and have almost no negative impact on quality of life immediately after treatment. When venous stripping was the only choice for patients with saphenous insufficiency, surgical interruption of perforating veins, either by subfascial endoscopic surgery (SEPS) or through small incisions, was considered minimally invasive. In a new clinical environment, invasiveness and wound complication risk of these surgical techniques exceeds that of the treatment of saphenous veins. Achieving this goal theoretically should convert the patient into being asymptomatic, eliminate or reverse existing signs, and prevent progression to more advanced stages of venous disease. Practical challenges that face the surgeon who will treat a patient with chronic venous disease include selection of which vein to treat and which technique to employ.