2005 Volume 16 Issue 4 Pages 267-274
[Aim] Instead of conventional stripping, a partial stripping with sclerotherapy was designed for the purpose of decreasing operative wounds and invasion. We carried out sclerotherapy using venography to confirm the inflow of sclerosants into varicose veins. Sclerosants were injected while proximal compression was performed if insufficient perforator interruption was achieved by subfascial endoscopic perforator surgery (SEPS). Flow ofsclerosants into the proximal superficial veins was inhibited by compression, but the contrast medium entered the popliteal vein in many cases. As a result, we reviewed the compression method and pressure that could inhibit the flow of sclerosant into the proximal superficial veins and deep veins. [Subjects and Methods] A combined procedure including sclerotherapy under venography was performed in consecutive 67 recent patients with great saphenous varices’ Sclerosants (hypertonic saline and foam aethoxysklerol) were injected into the great saphenous trunk after performance of retrograde saphenous venography with isotonic contrast medium (Iopamiron 150). The spread of contrast medium and sclerosant was compared under two different compression pressures of 60 and 300 mmHg, which were applied by using a femoral air tourniquet. [Results] At a compression pressure of 60 mmHg, contrast medium that entered the crural varices flowed out into popliteal vein, and the peripheral extension of contrast medium and sclerosant were not observed. At a pressure of 300 mmHg, however contrast medium showed little flow into the popliteal vein. and both the contrast medium and sclerosant entered vessels peripheral to the crural varices. [Discussion and Conclusion] For adequate sclerotherapy of varicose veins, it is important to inhibit the outflow of sclerosant into normal veins and to confine the sclerosing agent into the varicose veins. Sclerosants were effectively confined to crural varices by a proximal femoral tourniquet at a pressure of 300 mmHg, which prevented drainage of sclerosants into the deep venous system.
