Communications that I have received show that sloughs following the injection treatment of varicose veins are occurring with more frequency than one would suppose from case series reported. These sloughs, if not properly treated, may cause prolonged disability. The literature on the subject is not only disappointing but actually misleading—disappointing because it gives no adequate guidance to those so unfortunate as to have incurred these accidents, and misleading because, as I shall show, it contains misstatements partly responsible for the sloughs.
An absolute diagnosis cannot be made at the time of injection. As has been frequently stated, some injection fluids, if they escape outside a vein, cause an immediate burning pain at the site of injection; but the converse statement does not hold true. An immediate pain at the site of injection does not necessarily mean an extravascular escape of fluid. Many perfect injections give pain at the site
KILBOURNE NJ. THE VARICOSE VEINS SLOUGH. JAMA. 1930;95(11):787-789. doi:10.1001/jama.1930.02720110023007