A Reappraisal of the Injection Treatment of Varicose Veins

Emerson, Edward C.

doi:10.1177/000331976301400102

Cited by 4 publications

(2 citation statements)

References 3 publications

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“…8. Obese patients tend to develop painful reictions and perivenous inflammations after the injections, because it is impossible to apply a ;ufficient pressure bandage.…”

Section: Disadvantages Of Surgerymentioning

confidence: 99%

The Modern Conception of Therapy of Varicose Veins

1964

Angiology

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“…8. Obese patients tend to develop painful reictions and perivenous inflammations after the injections, because it is impossible to apply a ;ufficient pressure bandage.…”

Section: Disadvantages Of Surgerymentioning

confidence: 99%

The Modern Conception of Therapy of Varicose Veins

1964

Angiology

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“…In humorous fashion, Orbach quotes mutually contradictory statements from Emerson (3), who proposed that &dquo;the injection method of treatment be completely abandoned and that all varicose veins requiring treatment be dealt with surgically,&dquo; and from Sigg (4), expressing the view that &dquo;if one sees patients after vein operations with ugly scars and recurrences, one can only regret each surgical intervention.&dquo; Orbach himself believes that the truth lies somewhere in between, and Leu agrees that no statement could be more true. In the light of Orbach's and Leu's reasoning, however, one cannot avoid drawing the conclusion that the truth, in their view, does not in fact lie somewhere &dquo;in between,&dquo; but a good deal closer to sclerotherapy than to surgery.…”

mentioning

confidence: 99%

Surgery or Sclerotherapy?

Hæger¹

1967

Vascular Surgery

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Recently Orbach (1) and Leu (2) discussed the advantages and disadvantages of sclerotherapy and operation, respectively, in the treatment of varicose veins. In humorous fashion, Orbach quotes mutually contradictory statements from Emerson (3), who proposed that &dquo;the injection method of treatment be completely abandoned and that all varicose veins requiring treatment be dealt with surgically,&dquo; and from Sigg (4), expressing the view that &dquo;if one sees patients after vein operations with ugly scars and recurrences, one can only regret each surgical intervention.&dquo; Orbach himself believes that the truth lies somewhere in between, and Leu agrees that no statement could be more true. In the light of Orbach's and Leu's reasoning, however, one cannot avoid drawing the conclusion that the truth, in their view, does not in fact lie somewhere &dquo;in between,&dquo; but a good deal closer to sclerotherapy than to surgery. It is, however, somewhat difficult to understand Orbach's position. He recommends sclerotherapy in primary varicose veins with normal valves, and in residual varices after complete operation. In this latter case, even a surgeon would agree with him, though with certain reservations. Where, however, primary varicose veins are concerned, it is questionable whether these in fact can occur where the valves are intact. If a varicosity is treated by injection, thrombosis of the vein, with total or subtotal closure, takes place. Phlebographic examination after injection (5), and even direct observation of veins (6) which have been removed by operation in cases treated earlier with sclerotherapy, show that re-canalization takes place after a short time. At this stage, if not earlier, the valves are permanently damaged. In other words, the sclerotherapist himself creates the valvular insufficiency, which should not be found if he is to consider his therapy indicated at all! It must be noted that even Orbach (as well as Leu) is aware of this development: &dquo;To sclerose veins by injection will produce immediate satisfactory post-injection results:however, it will only be short lived in cases of venous hypertension, since due to the vis a te~°go, recanalization will take place after a few months.&dquo; Having made this point, Orbach further limits his indications for sclerotherapy, including only &dquo;convoluted varices which cannot be stripped and which can only be resected through large incisions.&dquo; Since most varicose veins may be resected even from short and later indiscernible incisions it is hard to understand that in Orbach's opinion there would be any indications at all left for sclerotherapy.Leu reviews indications and contraindications for surgery and sclerotherapy,

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