Foam sclerotherapy and eccentric compression

Digressive compression of 20 mm Hg does not modify the diameter of saphenous varicose veins in a standing position. This explains the results of Dr Hamel-Desnos’ study, which demonstrated that there was no significant benefit to the use of this compression after treatment with foam sclerotherapy of the Great Saphenous Vein. Dr. Zarca will confirm, few years later, these same results with a compression of 30 mm Hg.

So how can we explain the recommendations of many authors who suggest that we must use an eccentric compression?

This can be explained by the Laplace’s Law which explains that the more the surface is plane, the lower the transmitted pressure is. This is also explained by the physical law of pressure transmission according to the density of the compressed tissues: the suppler the surface is, the lower the transmitted pressure is.

This is obviously the case for the medial part of the thigh where we would like to compress the GSV and for the posterior part of the calf for the SSV compression. These surfaces are flat and the tissue is supple and depressible. Digressive compression loses in these cases all its efficiency. On the other hand, eccentric compression allows us to concentrate the pressure, with denser material, on a specific area, to promote healing, fibrosis and control inflammation. Under no circumstances, it plays a role in venous return. It favours varicose vein treatments during the short healing period, possibly in addition to digressive compression.

Eccentric compression is often put in place by the doctor and cannot be replaced by the patient. Moreover, this compression is artisanal and the applied pressure is not measurable.

We have thus studied a new device that corresponds to a standardisation of the eccentric compression that the patient can put over his clothes and reposition whenever he wants, according to his sensations. Our study shows that this eccentric compression allows the reduction of varicose vein diameter and therefore the volume of the saphenous veins and superficial varicose veins decrease up to 70%. Blood is the public enemy of all our treatments, thus, as the volume of blood is reduced in the treated varicose veins we reduce haematomas after surgery, we limit blood carbonisation around the thermal probe and we decrease the volume of foam injected.

Maintaining this compression 48 hours after these treatments would enable us to have a more harmonious fibrosis, in addition to reduced side effects related to excessive inflammation (redness, intravenous blood traps, hematomas, localized pain, pigmentation). We could also consider treating larger varicose veins with this eccentric compression, without increasing the volume of foam injected.