Pulmonary Embolism Following the Injection Treatment of Varicose Veins

Abstract

Numerous authors report a low incidence of serious complications following the injection therapy of varicose veins. McPheeters 1 has reported seven deaths in a series of 53,000 cases. Four of these were due to embolism. Silverman 2 collected nineteen cases of embolism from the literature and added one case of his own. In his series there were fifteen deaths and five recoveries. Kettel3 reported ten deaths due to embolism in a series of 60,000 cases. Westerborn 4 has recently reported eleven deaths from embolism in a series of 30,000 cases; he also mentions fifty-three additional cases of embolism. Probstein5 reported two cases of anaphylaxis and three of embolism with no deaths. Kilbourne 6 collected a series of twenty deaths due to emboli and other causes. An occasional death from allergy has been reported.7We believe that embolism is the most common cause of death following the injection treatment of varicose veins. Its occurrence is one of the most dreaded catastrophes in surgery. The patient who has felt well suddenly complains of severe pain in the chest, air hunger and the fear of impending death. Respirations are rapid and shallow. Pallor or cyanosis with engorgement of the superficial veins of the neck soon appears. The pulse is rapid and thready. Death may ensue in a few minutes. Most emboli develop from six to ten days after the injection. There are on record, however, three cases in which embolism occurred within a few minutes after the veins were injected.8The etiologic factors in embolus formation include bed rest and infection. It is probable that continuous bed rest predisposes to most of the emboli, the danger of bed rest being that it favors the development of venous stasis and a resultant thrombophlebitis from which most emboli are thought to arise. The role of infection in embolism has been pointed out by de Takats.9 Kilbourne°emphasizes the necessity of employing a sterile technic for the injections. He also believes that bactericidal solutions should be used and points out that eleven of the twenty patients with embolism in his series were injected with nonbactericidal solutions. Westerborn,4 on the other hand, shows that in some cases emboli develop when bactericidal solutions are used. Sodium morrhuate and most of the other fatty acid preparations in use today are only weakly bactericidal. Occasionally an embolus will develop even though the patient has remained ambulatory after the injections and in spite of the fact that no evidence of phlebitis exists,10 indicating that there are other etiologic factors than bed rest and infection. Silverman 2 believes that the use of a large volume of sclerosing solution is the cause of most emboli. report of two cases A recent survey of the last 600 cases of varicose veins treated at the University Hospitals revealed that two deaths had resulted from embolism after injection therapy: Case 1.-A white woman aged 68 was admitted to the University Hospitals for treatment of large varicose veins which had been present in both lower extremities for twenty ye...