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INTRODUCTION

Utilized in ancient Greece to alleviate painful leg varicosities, sclerotherapy, the therapeutic injection of sclerosant into veins, has been successfully practiced for thousands of years. Sclerotherapy is the treatment of choice for telangiectasias and reticular veins of the legs. The technique has undergone significant advancements in the development of foamed solutions to improve its efficacy and side-effect profile. It provides a rapid, effective, and safe treatment alternative that is particularly attractive for patients with extensive networks of small abnormal veins.

The appearance of telangiectatic vessels may be so disturbing to patients that they curtail their activities and modify their lifestyles to avoid situations in which their legs are visible. They may avoid the pool and the beach, as well as wearing shorts or skirts. Besides causing cosmetic embarrassment, spider veins can also produce symptoms of pain, burning, and fatigue. These symptoms may be worsened by prolonged standing or sitting and can be relieved by wearing support hose or by elevation of the legs.1 Vein size alone does not predict the presence of symptoms. Vessels causing symptoms may be smaller than 1 mm in diameter.2 Sclerotherapy not only offers remarkably good cosmetic results, but has also been reported to yield an 85% reduction in symptoms.3 Many different techniques have been used in the treatment of small veins, but certain basic principles are universal and will be outlined later.4–8

CLASSIFICATION AND ANATOMY

To diagnose and treat telangiectasias in a logical way, a classification scheme is helpful (Table 44-1). A discussion of the classification of leg veins includes telangiectasias (tiny red vessels <1 mm), venulectasias (small dark red or purple veins 1–2 mm), and associated reticular veins (light blue vessels 2–4 mm). For the purposes of discussion of sclerotherapy of spider veins (types I–III), it will be assumed that the major primary varicose veins of types IV and V have already been eliminated or are absent.

TABLE 44-1Classification of Veins9

Telangiectasia from Axial Reflux

Telangiectatic webs may be the result of axial reflux due to junctional or large perforator incompetence.7 It is ...

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