Doppler ultrasound findings in reticular veins of the thigh subdermic lateral venous system and implications for sclerotherapy.

Abstract

Treatment of varicose veins is directed towards eliminating sources of reflux causing venous hypertension in the superficial venous system. Doppler ultrasound is routinely used to localize sources of reflux prior to treatment of large varicose veins. To assess the value of Doppler ultrasound in localizing reflux in subcutaneous reticular veins associated with groups of lateral thigh telangiectases. Seven hundred patient records in which Doppler ultrasound was performed on thigh reticular veins were reviewed. Patients with reflux of the saphenofemoral junction, saphenopopliteal junction, or major saphenous system perforators were excluded. Audible reflux upon distal calf compression release was noted in thigh subcutaneous reticular veins of 618 out of 700 patients (88%). These incompetent reticular veins were associated with groups or webs of telangiectases and/or venulectases on the lateral thigh in almost all cases. Reflux was loudest just distal to the lateral femoral condyle. In 20 patients Doppler ultrasound was performed on a reticular vein while a telangiectasia associated with the reticular vein was injected with sclerosing solution. In 15 patients a clearly audible flow signal was heard in the reticular vein during injection. These findings indicate an association of telangiectatic veins with reticular veins on the thighs. Furthermore, this study underscores the value of Doppler in determining sources of reflux in smaller veins and implies that sclerotherapy of reticular veins is necessary for treatment of thigh telangiectatic webs.