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THE ADVANTAGES OF COMPRESSION SCLEROTHERAPY
In the large-scale treatment of any disease, the choice between different types of therapy yielding similar end-results must be based upon factors such as ease of application, time involvement, and expense.
If the technique of compression sclerotherapy, as described in the preceding chapters, is rigidly followed, and satisfactory clinical results are obtained, we believe that the adoption of this technique as the standard method of treating insufficiency offers considerable advantages to the individual patient, to the practitioner, and to the community at large. If the desirable clinical end-results and satisfactory follow-up figures are not obtained, despite the fact that the practitioner may feel he is using the technique correctly, he would be well advised to discard this form of treatment. The resurrection of sclerotherapy as a treatment for varicose veins, unless rigidly adhered to as laid down by us, would be a retrograde step in the treatment of venous insufficiency.
Advantages to patient
1. Absence of mortality. In the treatment of approximately 16,000 cases by compression sclerotherapy no deaths have occurred as a complication of the technique. Venous insufficiency is a condition in which direct fatal complications, such as exsanguination due to rupture of the varix, are exceptional, and therefore it is not permissible to advocate a method of treatment which carries even a small chance of mortality while an alternative method which reduces this risk is available. There is no doubt that compression sclerotherapy is safer for the patient than any other recognized therapeutic approach. With any other form of treatment in the number of patients attending the clinic we could reasonably have expected sixty deaths. Unfortunately the prevention of sixty deaths does not make the same impact as the saving of sixty lives.
2. Diminished morbidity. A small number of patients treated by compression sclerotherapy suffer from minor discomfort following the injections. The various causes of discomfort have already been discussed in Chapter VI. All of these results from errors in technique and, apart from the rare instances of sensitivity, can be avoided by proper attention to the placing of the injections, the localization of the sclerosant and the correct bandaging of the limb. Patients treated by compression sclerotherapy, including those with ulceration, are expected to continue their normal life during the course of their treatment. This is rarely possible with any other method of treatment as practised at present.
3. The avoidance of hospitalization. The routine treatment of patients as out-patients offers obvious advantages to them. The domestic upheaval, possible expense, and loss of earnings brought about by hospitalization are avoided.
4. Lack of interruption of employment. Patients treated by compression sclerotherapy do not have to obtain sick leave from their employment. It is our policy in the Dublin clinic to arrange for male patients to be seen in the evenings so that even short absences from work are unnecessary.
5. The absence of scars. Frequently surgical ligation or excision of varicose veins is marked by the development of unsightly scars at the sites of incision. While these may not appear to be an important factor to be considered in the choice of treatment, they frequently are a source of irritation and embarrassment to some patients, especially to those in whom the appearance of their legs may be important in their occupations.
6. Immediate treatment. The use of compression sclerotherapy enables a team of medical personnel to deal with much larger numbers of patients than they could reasonably care for by any other method, apart from palliative bandaging and dressing of ulcerated legs. Thus patients who otherwise would be relegated to a waiting list can expect to receive positive treatment quickly.
7. Further treatment. In the event of the development of further incompetent perforating veins or superficial varicosities in a patient being treated with compression sclerotherapy, all that will be required is a further course of injections. On the other hand a patient being treated by operative methods must be subjected to the risks of a second anaesthetic and operation and the inconvenience of a further period of hospitalization.
Advantages to the doctor
1. Absence of a waiting list. As stated above, large numbers of patients can be dealt with quickly and efficiently by this method. Thus is should be possible for any doctor to clear even a large list of patients waiting for treatment. However, a word of caution is necessary. Personnel who adopt compression sclerotherapy as a routine measure in the treatment of varicose veins frequently find that they are not only clearing their own waiting list, but also those of several of their colleagues. There is a tendency among many practitioners to treat varicose veins either as a nuisance, or with studied neglect, and naturally patients tend to gravitate towards those who offer them immediate and positive therapy.
2. Alleviation of the 'bed problem'. Most general hospitals in Ireland and Britain have an ever-present problem in providing hospital beds for those for whom hospitalization is essential. The treatment as out-patients of patients with varicose veins immediately removes a very substantial burden from the hospital bed situation.
3. Time saving. By compression sclerotherapy patients can be treated more rapidly than by any other technique. As a result, time is spared which can be usefully employed for other purposes.
4. Improved results. Even if the results of compression sclerotherapy were only to compare reasonably with those of other techniques, the advantages enumerated above would strongly support the case for its general adoption. However, we believe (see Chapter VIII) that properly practised compression sclerotherapy can be expected to produce better end-results, in terms of relief of symptoms as well as disappearance of obvious varicosities, than those generally obtained by surgery.
Advantages to the community
These are, in the main, economic. The use of compression sclerotherapy (i) saves doctors' time, (ii) saves nurses' time, (iii) saves hospital beds and their attendant expenses, (iv) reduces loss of earnings due to absence from work, (v) does not cause dislocation of industry due to absence of key operators, (vi) does not cause disruption of home life.