SCLEROTHERAPY FOR VARICOSE-VEINS OF THE LOWER LEGS IN PATIENTS WITH DYSPLASMINOGENEMIA

Sclerotherapy combined with ligation has become a widely accepted trea tment for varicose veins; however, it is associated with some risk of the serious complications of deep vein thrombosis (DVT). We investigat ed the incidence of thrombophilia in 164 consecutive patients undergoi ng treatment for varicose veins and determined the activities of antit hrombin-In, protein C, and plasminogen. Of the 164 patients, 10 were d iagnosed as having dysplasminogenemia (DPG), showing an incidence of 6 .1%, in accordance with previous reports. DVT was not found to be caus ed by DPG in any patient, and no difference was found between patients with and those without DPG, suggesting that DPG is not a risk factor for varicose veins. We also investigated the activation of coagulation by measuring the thrombin-antithrombin III complex (TAT). The activat ion of coagulation after sclerotherapy was inhibited when ligation was performed 1 month prior to sclerotherapy, whereas it was increased wh en sclerotherapy and Ligation were performed simultaneously. Of the 10 patients with DPG, 5 were treated uneventfully, and their TAT level i ncreased to 4.0 mu g/l, which was comparable to the level after sclero therapy and ligation. These findings indicate that sclerotherapy can b e performed safely in the majority of patients with DPG, and that the temporal separation of sclerotherapy and surgery is an alternative for these patients to prevent the activation of coagulation.