Abstract
Chronic venous insufficiency is a progressive disease, which may require surgical intervention to prevent complications. This study was done to determine the usefulness of a high ligation with sclerotherapy to prevent the return of symptoms. Duplex scanning was used to locate incompetent veins. There was no evidence of incompetent perforating or deep veins in the 322 patients who had 483 high ligations of the greater saphenous vein. Multiple phlebectomies and limited vein stripping were done for large (> 20 mm) varicose veins. The clinical, etiologic, anatomic and pathophysiologic (CEAP) score evaluated the severity of venous dysfunctions. Symptoms of leg aches, ankle edema, night cramps or ulceration were evaluated after 1–3 months, and then at 6–12 month intervals. Sclerotherapy of the saphenous vein, using a sodium tetradecyl sulfate solution from 0.1–3.0%, was done if there was no significant improvement of a non-healing ulcer or the recurrence of symptoms. Compression hose, 30–40 mm Hg, was prescribed unless contraindicated by arterial occlusive disease, acute deep vein thrombosis or severe congestive heart disease. After the high ligation, symptoms improved in 212 limbs, were unchanged in 187 limbs and became worse in 84 limbs. After sclerotherapy in 264 limbs, 237 limbs improved, 21 remained unchanged and six became worse. Patients who have varicose veins from superficial venous incompetence can achieve a good long-term outcome with the high ligation procedure. However, it is important to control venous reflux and the related symptoms with sclerotherapy as needed.
