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INTRODUCTION

Lower extremity telangiectasias, reticular and varicose veins develop as a result of venous system impairment.

EPIDEMIOLOGY

Incidence: very common and the incidence increases with age. Reticular veins can occur in up to 10% of children 10 to 12 years old. The incidence of varicose veins in the seventh decade is 72% in women and 43% in men

Age: more common in adults and elderly

Sex: more common in women

Precipitating factors: familial predisposition, pregnancy, static gravitational pressures, dynamic muscular forces, hormonal influences

PATHOPHYSIOLOGY

Venous pathology develops when venous return is impaired for any reason.

It can develop from venous obstruction (thrombotic or nonthrombotic) or from venous valvular incompetence.

PHYSICAL EXAMINATION

Lower extremity telangiectasias are red to violaceous in color and up to 2 mm in diameter. Reticular veins are blue to blue-green in color and up to 4 mm in diameter. Varicose veins are blue to blue-green in color with a diameter greater than 3 to 4 mm.

LABORATORY DATA

Dermatopathology

Dilated vascular channels in the dermis.

Vascular Studies

Doppler ultrasound and/or duplex scanning are indicated in the following clinical scenarios:

  • Asymptomatic varicosity greater than 4 mm in diameter

  • Symptomatic veins

  • Reticular, perforating, and/or varicose veins

  • Signs of venous insufficiency or stasis changes

  • Prior history of deep vein thrombosis or thrombophlebitis

  • Prior history of sclerotherapy with recurrences or bad outcome

MANAGEMENT

Sclerotherapy (Figs. 37.137.3)

Figure 37.1

(A) Sclerotherapy of spider veins. The needle is bent at a 45-degree angle and the vessel is canalized. (B) Immediate vessel blanching seen after injecting the sclerosant agent

Figure 37.2

(A) Spider veins, prior to treatment with sclerotherapy. (B) Marked resolution of the spider veins after sclerotherapy treatment

Figure 37.3

(A) Lower leg telangiectasias at baseline. (B) Marked resolution of the telangiectasias 1 month after one sclerotherapy treatment. Note the development of slight telangiectatic matting superior to the treated area

Sclerotherapy is the treatment of choice for lower leg telangiectasias and reticular veins. It should be repeated at 6 to 8 week intervals. Patients may require two to six sclerotherapy sessions to achieve the greatest treatment benefit.

Sclerosing agents

An ideal sclerosing agent causes complete local endothelial destruction of the vessel wall with secondary fibrosis and lumen obliteration, with no systemic toxicity. ...

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