Duplex ultrasound enhances the precision and therefore, both the efficacy and safety of saphenous vein sclerotherapy when performed by experienced practitioners. While awaiting long-term follow-up to document the progressive recurrence rate over time, our results at 2 years are superior to those after conventional sclerotherapy, and compare favorably with those after surgical interruption.

Larger doses of STS are required to induce vasospasm in older patients, males, and those with larger veins. Regardless of gender and age, larger veins are more likely to recanalize, but are not necessarily associated with clinical recurrence. Although older patients and males tend to have larger veins, their recanalization rates are similar to younger patients and females when sufficiently higher STS doses are used to induce vasospasm. Ambulatory patients of all ages and either gender may be good candidates for UGS if vasospasm is used as the treatment endpoint. Contrary to prevailing opinion, large vein caliber is not an absolute contraindication for UGS.

RLS is common in patients with both saphenous and nontruncal varicose vein disease, and can respond frequently and rapidly to sclerotherapy. This subpopulation of RLS sufferers should be considered for phlebological evaluation and possible treatment before being consigned to chronic drug therapy.

Using our UGS protocol to treat saphenous junctional incompetence, 2 mL SIV was less effective than 1 mL SIV, and was associated a minor adverse effect. The larger SIV did not induce more rapid vasospasm, and therefore did not lead to a reduction in the number of injections per treatment. The maximum safe STS dose/session is unknown, and deserves scientific study.

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