Combination sclerotherapy for exceptionally large varicose veins: One method of preserving the greater saphenous vein for future grafts

Abstract

The aim of this study was to demonstrate that sclerotherapy of exceptionally large varicose veins, i.e., >2.0 cm in diameter, is achievable, and should be the method of choice if one wishes to preserve the greater saphenous vein as a source for future bypass grafts. There is an increasing propensity toward microphlebectomy when treating varicose veins in America today. And, there is a corresponding reluctance to perform sclerotherapy, especially when dealing with the larger varices. The following are possible reasons for these decisions: 1. Unsatisfactory sclerotherapy results obtained by the clinician; 2. A belief that sclerotherapy is not useful for large veins; 3. A belief that only ligation and stripping or microphlebectomy can eliminate these huge veins; 4. Unsatisfactory scarring from stripping procedures; and/or 5. Difficulty in obtaining third-party reimbursement for sclerotherapy. Once deep vein pathology has been ruled out, sclerotherapy can be a successful treatment for any large vein. The second caveat is that significant saphenofemoral junction (SFJ) reflux (>1 second) must be eliminated prior to sclerotherapy; the author feels this should be accomplished surgically, not with sclerotherapy. With large varices, if the SFJ is competent then there is most likely a responsible perforator that must either be ligated and/or injected with sclerosant. Less frequently the short saphenous may be involved, and in these cases there are several alternatives, i.e., sclerotherapy or ligation and stripping of the short saphenous vein. Finally, but of great importance, ligation and stripping the greater saphenous vein in order to eliminate the varices that are merely branches of it, creates an unacceptable loss of potential bypass grafts for future CAD patients. This, alone, is reason enough to promote sclerotherapy for very large varicose veins. The author presents two enormous varices that were successfully treated with combination sclerotherapy, with a detailed description of the method utilized. </hea