Compression Sclerotherapy: Theory, Method and Practice

In compression sclerotherapy, reverse flow in the perforating veins between the deep and superficial veins is located. The veins at these sites are then obliterated permanently by the injection of a sclerosant, which initiates controlled thrombosis, and by the application of continuous pressure. The technique relies on the restoration of the pumping capacity of the multiple muscle pumps of the foot, calf and thigh, rather than on the eradication of superficial varices or the opening up of proximal obstruction. Advantage is also taken of the fact that not all incompetent valves are injured permanently. Valves may be incompetent because the vein containing them is dilated (secondary incompetence); they can regain normal function when the vein reduces in size after the efficiency of the pumps is restored and normal ambulatory venous pressure achieved. It is unnecessary to be so radical as to strip out superficial veins, or to thrombose them along their entire length by indiscriminate multiple injections. The proximal half of the LSV is one of the best “spare parts” that human beings carry, and it should not be stripped out without good reason.