Sclerotherapy and Ultrasound-Guided Sclerotherapy

Publisher Summary Varicose veins are a degenerative disease of the venous system where there is a defect in the strength of the vein wall with associated valvular dysfunction resulting in reflux (reverse) flow in affected areas of the superficial venous system of the legs. Sclerotherapy for varicose veins associated with great saphenous vein (GSV) and small aaphenous vein (SSV) incompetence traditionally has been relegated to treating residual varicose veins following surgical stripping or varicose veins associated with isolated perforator vein incompetence. Duplex ultrasound has become the gold standard in the investigation of lower-limb venous disease. As an independent investigation, duplex scanning has unrivalled relevance in the clinical decision-making process as well as being used in the serial assessment of disease progress and effectiveness of treatment. Ultrasound guidance of sclerosant injections is a logical extension of the pretreatment evaluation and gives sclerotherapy the potential to rival other ablative methods in effectiveness in the treatment of varicose veins. Ultrasound-guided sclerotherapy (UGS) has become the preferred management of postsurgical recurrent varicose veins. There are four common sources of reflux associated with recurrence of varicose veins after surgical ligation and stripping—recurrence of reflux at the SFJ or SPJ because of neovascularization or inadequate ligation, incompetent thigh or calf perforating veins, incompetent gastrocnemius veins, and persistent varicose tributaries or duplication of the GSV in the thigh, with these medial thigh veins receiving reflux from pelvic tributaries.