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A logical approach to the injection treatment of varicose and "spider" veins.

The incurable nature of varicose veins mandates a re-evaluation of excisional surgery both as appropriate therapy and as the gold standard against which to judge alternative treatments. An injection techniques has been developed which enables synchronous in situ obliteration of all varicose veins and superficial venous ectasia, regardless of their size or extent, and eliminates the need to identify incompetent perforators. The results of 742 patients (1,425 legs) were evaluated retrospectively from two to 12 years following initial therapy. All patients experienced total relief of painful symptoms and 95% were very pleased with the final appearance. Some residual brown pigmentation or a scar from an injection ulcer were the reasons for less than total satisfaction in the remaining 5%. None regretted having undergone the procedure. Because of the difficulty in sustaining compression in the inguinal area, 6% of patients required a concomitant sapheno-femoral disconnection under local anesthesia immediately prior to injection therapy, but none required stripping. The results repudiate the generally held belief that injection therapy is only of value for treating postsurgical recurrences, or for eliminating small varicosities and superficial capillary ectasia (spider veins) for cosmetic improvement.