In these cases, if saphenofemoral incompetence can be shown, distal injection therapy with compression is combined with Trendelenburg's saphenofemoral disconnection under local anesthesia. The patient requires no hospitalization and remains ambulatory and active. As with surgery, isolated varices will recur, requiring treatment. Simple injections suffice if new varices are detected early, and compression may not be necessary. Injection therapy has few complications.
Allergic reactions are rare.
If both legs are to be treated, it is best to allow a few hours for the solution to be excreted from the first leg before treating the second leg. Extravascular injection can cause the overlying skin to slough, with subsequent scarring. Deep vein thrombosis with embolism is rare. Commonly cited indications for surgery include pain, recurrent thrombophlebitis, skin changes, and cosmetic reasons. Since the advent of bypass grafting of coronary and peripheral arteries, every effort is made to preserve the saphenous veins.