SCLEROTHERAPY - CONTINUOUS-WAVE DOPPLER-GUIDED INJECTIONS

BACKGROUND. The usual method of injection of sclerosing agents is based simply oil clinical recognition and visualization of the varicose vein. OBJECTIVE. The authors present an original technique for sclerosing injections, named Doppler sclerotherapy. The purpose is to allow more accurate sclerotherapy in situations where varicose veins (usually greater than 4-5 mm) are not palpable in the supine position, but palpable when standing. METHODS. This technique consists of injecting the sclerosing agent using an uncomplicated continuous wave Doppler, a syringe, and a needle, according to a method consisting of four well-defined steps ensuring avoidance of arterial vessels and constant appreciation of the varicose vein to be treated, even during the injection. It requires no assistants and allows the treating physician's gaze to remain at the injection site while listening for very specific Doppler sounds of aspiration and injection. RESULTS. In our multicenter study of 220 patients (approximately 1,400 injections) all but 18 injections were successful for intravascular localization. No serious complications were noted. CONCLUSIONS. The principal indication is the treatment of varicose veins that are palpable while standing but impalpable in the supine position. In addition varicose veins in the groin region, lower third of the thigh, and along the axis of the small saphenous vein may be treated with this technique. In these situations it is a more accessible, faster, and economical technique, although it does not replace duplex ultrasound-guided injections.