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Questions and answers for patients Questions and answers for medical professionals From sclerotherapy to T.R.A.P. |
The problem of the Doppler"In treating varicose veins, the most important
therapeutic The problem of the Doppler is clearly expressed in an emblematic photograph by M.P. Goldman in the book Sclerotherapy, 2nd Ed. Mosby, 1995, Fig. 2/27. (Goldman deserves appreciation for the frankness of the image, inserted, without comment, for the few who are able to understand it. However, I wonder why the Americans write books on sclerotherapy when they don’t even have a decent sclerosing solution). The figure legend reads: " Duffy type2 (mixed telangiectasia and varicose veins with no direct ccommunication with the saphenous system) in a 54-year-old woman. There was no evidence (venous Doppler) of incompetence of the saphenofemoral or saphenopopliteal junction or of perforating veins". Observe the photograph carefully! According to the Doppler image, the patient displays no pathology. This is absurd and shows the poor diagnostic capability of the Doppler. The varicose veins and spider naevi shown in Goldman’s Fig. 2/27 are the result of a large number of small incontinent perforating veins that are not visible on Doppler imaging. Every vein, every telangiectasia that you see is the effect of underlying valve insufficiency. To eliminate the effect, it is always necessary to treat the cause. The most effective diagnostic/therapeutic tool remains the syringe, which enables us to understand that a small, 2 mm telangiectasia is the manifestation of a dilated underlying perforating vein.
ReferencesM.P Goldman: Sclerotherapy,Ed. Mosby, 1995 |
Three-dimensional Regenerative Phlebotherapy Fleboterapia tridimensional Regenerativa |
