CONTENTS NEXT HOME FEEDBACK SEARCH
I wrote this book in 1967 after 16 years hard work and research on varicose veins. I have many times been asked to rewrite it. Recently it was used as a basis for a seminar I held in America. It was so useful that reprinting is essential.
As a result the urgent need for copies does not allow time to complete the rewrite and update. There is, in fact, little need to rewrite the principles of the technique, they are the same today as they were 25 years ago. To communicate these essentials to a new generation of doctors is now important.
I will stress that the secret of success is the importance of exactly following the technique, and all the modifications suggested by others have had some sorry results.
The seven pillars of good sclerotherapy are still the same:
If these seven essentials are observed then a wall to wall fibrous union occurs and the undesirable endothelial prolifications and thrombus formation is avoided.
The chapter on histology makes it clear that the object of the injection is the total stripping of the intema of a three inch segment of vein which ideally should include an incompetent perforator connection. Unless the vein is stripped of endothelium the fibroblast will not cross the lumen to unite with its fellow on the opposite side; unless the amount of blood in the lumen is kept to a minimum the endothelium from the adjacent uninvolved vein will reline the segment.
Empty vein injection is necessary to allow destruction of the intema. Isolation is necessary to control the reaction. Compression, together with walking, is necessary to reduce to the minimum the content of the vein, i.e. external compression and internal decompression (walking).
Walking as well as reducing the volume and pressure of blood in the superficial veins also stimulates fibrosis. Standing is detrimental in that it encourages the build up of interliminal thromba.
In the inadequately or non-compressed vein the endothelial proliferation from wither end of the injected segment together with proliferation of undestroyed islands of intema grow and split to form sinuses as the thrombus reacts, thus allowing the recanalization of the segment. In the segment of vein totally stripped of endothelium and adequately compressed the wall to wall fibrosis union which results is of hard scar tissue which will never recanalize any more than a surgical wound with perfect apposition and which has properly healed will never reopen.
Thrombus formation and recanalization are racing neck and neck with fibroblastic development. Short term results from both will appear satisfactory. However, only the fibroblastic reaction will produce the long-lasting scar tissue that will provide permanent occlusion of the injection segment.
GEORGE FEGAN
Lamu, Kenya
April 1990