Advanced sclerotherapy treatment of varicose veins with duplex ultrasonographic guidance

Advanced sclerotherapy of varicose veins is described in this article using duplex ultrasonographic guidance in three phases of the process. In the presclerotherapeutic stage, patency and competency of the deep venous system are evaluated, location and morphology of the highest point of reflux are determined, luminal and parietal diameters of the target vein, venous compressibility, leaflets of the incompetent valve, and the degree, extent, and velocity of reflux are assessed. In the sclerotherapeutic stage, ultrasonographic guidance is helpful when the anatomy is intricate and points of reflux would otherwise be inaccessible. In the postsclerotherapeutic stage, duplex ultrasonography is indispensable for determination of the extent of the sclerosing reaction, measurement of luminal and parietal diameters, and to elucidate luminal content and its degree of adherence to the venous wall. Duplex ultrasonography provides a sound basis for clinical decision making and thereby enhances the precision and safety of advanced sclerotherapy.