Reticular Veins Research Articles

THE APPLICATION OF CUTTING-EDGE TECHNOLOGIES IN THE TREATMENT OF THE EARLY STAGES OF CHRONIC VENOUS DISEASES

Background. The vascular network of the legs presents a significant and complex issue that still lacks a reliable solution. Cosmetic defects, such as unwanted or unsightly vessels, are commonly observed in individuals with chronic venous diseases as well as in those without these conditions. According to global guidelines, sclerotherapy is considered the "gold standard" treatment for reticular veins and telangiectasias. However, the high incidence of hyperpigmentation (11-80%) and matting (5-75%) has prompted the exploration of new methods to eliminate these vessels. The goal of this study is to explore the effectiveness of combining percutaneous laser coagulation and sclerotherapy for the treatment of reticular veins and telangiectasias in the lower extremities. Materials and methods. Since 2017, we have utilized the CLaCS technique (cryo-laser, cryo-sclerotherapy) to address the vascular network of the legs. The treatment involves a neodymium laser with a wavelength of 1064 nm (Fotona XP Dynamis), a VeinViewer (Christie Medical, USA), a Syris 900v polarized light 4x forehead loupe, and a Zimmer Cryo 6 cryocooler. Protocol for treating reticular veins: spot size – 6-9 mm; fluence – 50 J/cm²; pulse duration – 35-50 ms; ethoxysclerol 0.3% injections; visualization with a thermal imager and cooling using the cryocooler (-20 °C). Protocol for treating telangiectasias: spot size – 4-2 mm; fluence – 160-360 J/cm²; pulse duration – 5-10 ms; cooling with a cryocooler (-20 °C). Following each procedure, patients are prescribed a class 2 compression stocking for one day. From November 2017 to June 2023, we performed 5,535 procedures (4,146 errors) using a combination of CLC and sclerotherapy to treat reticular veins and telangiectasias. We followed up with 3,875 cases to assess the final results, which were evaluated using a Likert scale. Results. 5 points were found in 1782 (46%) patients, 4 points in 1434 (37%) patients, 3 points in 465 (12%), 2 points in 116 (3%), and 1 point was assessed in 78 (2%) patienys. For patients with 2 and 3 points, reticular varicose veins were initially significantly pronounced, requiring more than two sessions (3-5). Six months after the second session, a decision was made to schedule additional CLaCS sessions. In patients with a score of 1 point, reflux in the superficial veins was detected via ultrasound duplex scan. These patients were offered procedures for vein elimination, including endovenous laser treatment or radiofrequency ablation. Conclusions. The use of percutaneous laser coagulation with a neodymium laser significantly reduces the volume and concentration of sclerosant, as well as the number of side effects (such as pigmentation and matting). Eliminating reticular veins is crucial for the success of treating telangiectasias. All patients should undergo ultrasound examination. If reflux is detected in the superficial veins, the first step is to perform endovenous laser treatment or radiofrequency ablation to correct phlebohemodynamics.

Treatment of lower limb telangiectasias with Nd: Yag 1064 nm laser with and without tumescent anesthesia - TTL technique.

Transdermal laser is an option for varicous veins treatment, yet it may be painful. In this study, we will present a technique for performing tumescent anesthesia associated to transdermal laser (TTL) to reduce pain during treatment. The study compares pain during treatment of telangiectasias in lower limb with and without tumescent anesthesia to offer a less painful procedure. 50 CEAP C1 patients with bilateral telangiectasias on thighs underwent transdermal laser treatment, using tumescent anesthesia on one side and standard technique on the other. Pain was assessed via the Visual Analogue Scale. The outcomes were compared with Student's t-test. Significance was set at p < .05. Laser treatment without tumescent anesthesia resulted in a VAS pain score of 7.9, versus 0.0 with anesthesia, showing a significant statistical difference. Tumescent anesthesia and transdermal laser (TTL) is capable of reducing pain in laser treatment of telangiectasias and reticular veins.

Intense pulsed light is a promising way for telangiectasias / reticular veins treatment: from pathogenesis to pronounced clinical outcomes

Varicose veins are the most common pathology of peripheral vessels. A broader concept is the term chronic venous insufficiency (CVI), which, in addition to varicose veins, includes telangiectasias and reticular veins. Sclerotherapy is considered as the basis of treatment for reticular veins. However, the procedure has its drawbacks and side effects, which indicates the importance of implementing safer treatment methods. An alternative treatment for reticular veins is intense pulsed light. To illustrate the effectiveness and safety of IPL treatment for reticular veins, we present a clinical case of a patient aged 73 years with complaints of dark purple and bluish vessels. After clinical evaluation, diagnosis of reticular veins/telangiectasias was made (C 1 according to the CEAP 2020 classification). Due to the patients’ refusal to undergo sclerotherapy, it was decided to perform IPL procedures (M22, Lumenis). The patient’s reticular veins and telangiectasias were almost completely leveled out after the second session of IPL therapy; there was also no progress of CVI. No side effects were noted. The pathogenetic application of intense pulsed light in the treatment of reticular veins can be explained by decreasing the inflammatory process, integrating extracellular matrix, as well as inhibition of mast cell degranulation.

A comparative study between cryo-laser cryo-sclerotherapy and sclerotherapy in the treatment of telangiectasia and reticular veins: A randomized controlled trial

ObjectiveTelangiectasias, characterized by dilated venules, are frequently observed in the lower extremities. Sclerotherapy stands out as the predominant treatment of these vascular lesions. The integration of laser therapy with a mild sclerosing agent, serving as an osmotic sclerosant, presents an enhanced cosmetic treatment approach, aiming to optimize outcomes and minimize potential adverse effects. This study sought to evaluate the feasibility, efficacy, and safety of cryo-laser and cryo-sclerotherapy (CLaCS) and compare it with injection sclerotherapy for the treatment of telangiectasia and reticular veins. MethodsIn this randomized controlled trial, individuals expressing concerns about telangiectasia and reticular veins were recruited for aesthetic treatment. The enrolled patients were prospectively randomized according to the chosen treatment technique. Group A included patients undergoing CLaCS with 70% dextrose, focusing on a single area measuring 20 cm by 20 cm. Group B included patients receiving polidocanol injection sclerotherapy for a single area of the same dimensions. ResultsGroup A comprised 195 patients and group B comprised 197 patients. The rates of complete lesion elimination after the first, second, and third treatment sessions were 64.6%, 86.2%, and 100% in group A and 50.3%, 74.1%, and 85.3% in group B, respectively. Group A exhibited a significantly higher complete elimination rate compared with group B at the conclusion of the study (P < .001). Furthermore, group A demonstrated a statistically significant lower incidence of postprocedural pigmentation and other complications compared with group B (P < .001). These findings underscore the enhanced efficacy and safety profile associated with the CLaCS technique using 70% dextrose compared with injection sclerotherapy with polidocanol. ConclusionsCLaCS, combining cryo-laser and cryo-sclerotherapy, demonstrated superior efficacy and safety compared with traditional polidocanol sclerotherapy for treating telangiectasia and reticular veins.

Long-pulsed 1064nm Nd:YAG laser in the treatment of leg veins: Systematic review.

Long-pulsed 1064nm Nd:YAG laser can damage vessels with higher diameters and penetrate to a deeper level than other laser therapies. We aim to analyze outcomes of the treatment of leg veins with long-pulsed 1064nm Nd:YAG laser regarding intervention protocol, technical success, clinical success, and side effects. A research of the published literature was conducted, using PubMed and Embase databases, in April 2022. The key words used were telangiectasia, reticular veins, neodymium YAG laser, clearance, satisfaction, and treatment. PRISMA guidelines were followed. We included twenty-six articles, twenty-three prospective and three retrospective studies, with a total of 1991 patients. The articles were organized in different sections according to the control group. The four outcomes were analyzed in each section. These studies showed that the long-pulsed 1064nm Nd:YAG laser is a safe and very good option for the treatment of leg veins measuring up to 3mm in diameter. Studies comparing long-pulsed 1064nm Nd:YAG laser therapy and sclerotherapy showed similar clearance rates with no significant differences. However, sclerotherapy seemed to be less painful and to have faster clinical improvements. In two articles, Nd:YAG laser had better outcomes in the treatment of smaller vessels with less than 1mm in diameter, than sclerotherapy alone. Treatment with polidocanol microfoam and Nd:YAG laser had better clearance rates than Nd:YAG laser alone in three studies. In the comparison of 1064nm Nd:YAG laser therapy with other lasers and light sources, the studies had contradictory results. Long-pulsed 1064nm Nd:YAG laser is a valid therapeutic option for leg telangiectasia and reticular veins with great aesthetic outcomes and minor side effects. Nd:YAG laser therapy could be combined with sclerotherapy or other laser therapies or IPL in order to achieve better results. Serious side effects are rare, but the procedure is almost always accompanied by moderate tolerable pain.

A Study of Blood Viscosity and Inflammatory Biomarkers’ Levels in Bilateral Primary Varicose Veins/Reticular Veins as Predictive Markers

Objectives Cross-sectional data was collected for a period of 1 year to assess the biomarkers of inflammation, and blood viscosity as predictive markers in patients with primary bilateral varicose veins or reticular veins that might progress to varicose veins. Material and Methods A sample of 40 participants, 20 controls and 20 patients aged 18–65 years falling under the reticular veins and symptomatic varicose veins (C1, 2s), primary etiology (Ep), superficial veins (As), reflux pathology (Pr) categories of Clinical, etiologic, anatomic, Pathophysiologic (CEAP) classification with the exception of telangiectatic veins, were included in the study. Blood viscosity was measured using a Capillary Viscometer. Evaluated inflammatory markers were tissue Plasminogen Activator (tPA), Plasminogen Activator Inhibitor-1 (PAI-1), and fibrinogen. Analysis was done using Statistical Package for the Social Sciences (SPSS) software and Chi-square, Fisher’s, Bonferroni, and Analysis of Variance (ANOVA) tests were applied. Results There was a statistically insignificant relationship between occupation and different study groups. Standing hours and serum fibrinogen levels had a significant difference in different study groups. Serum tPA, Serum PAI-1, and blood viscosity had an insignificant difference between different study groups. It was revealed that the pairwise group comparisons of study group C2 vs. control group C0, study group C1 vs. control group C0 and study group C2 vs. study group C1, and study group C2 vs. control group C0 each were significantly different pairwise. Conclusion Blood viscosity, tPA and PAI-1 cannot be used as predictive markers in patients with bilateral (B/L) primary varicose veins/reticular veins. Serum fibrinogen levels can be used as predictive markers for the development of B/L primary varicose veins and in our particular study with a predictive range of 189.4–327.9 mg/dL but not for B/L reticular veins. Prolonged standing, irrespective of the occupation of the patient, is associated with the development of B/L reticular veins and B/L varicose veins.

Interventional and device treatment of the periocular area

Growth in the research, innovation, and development of laser and energy-based technologies over the past few decades has led to dramatic increases in treatment options for dermatologic and cosmetic concerns of the periorbital area. We highlight recent treatment options using laser and energy-based devices for the clearance of periocular pigmented lesions, including solar lentigines and nevus of Ota; vascular lesions, including port-wine birthmarks, infantile hemangiomas, superficial telangiectasias, and reticular veins; laser ablation of benign tumors, such as xanthelasma; cosmetic rejuvenation; treatment of infraorbital dark circles and festoons; laser removal of eyebrow and eyeliner tattoos; and device-based treatment of chronic dry eyes.

Effect of life cycle and venation pattern on the coordination between stomatal and vein densities of herbs.

Life cycle (annual vs perennial) and leaf venation pattern (parallel and reticular) are known to be related to water use strategies in herb species and critical adaptation to certain climatic conditions. However, the effect of these two traits and how they influence the coordination between vein density (vein length per area, VLA) and stomatal density (SD) remains unclear. In this study, we examined the leaves of 53 herb species from a subtropical botanical garden in Guangdong Province, China, including herbs with different life cycles and leaf venation patterns. We assessed 21 leaf water-related functional traits for all species, including leaf area (LA), major and minor VLA, major and minor vein diameter (VD), SD and stomatal length (SL). The results showed no significant differences in mean SD and SL between either functional group (parallel venation vs reticular venation and annual vs perennial). However, parallel vein herbs and perennial herbs displayed a significantly higher mean LA and minor VD, and lower minor VLA compared to reticular vein herbs and annual herbs, respectively. There was a linear correlation between total VLA and SD in perennial and reticular vein herbs, but this kind of correlation was not found in annual and parallel vein herbs. The major VLA and minor VD were significantly affected by the interaction between life cycle and leaf venation pattern. Our findings suggested that VLA, rather than SD, may serve as a more adaptable structure regulated by herbaceous plants to support the coordination between leaf water supply and demand in the context of different life cycles and leaf venation patterns. The results of the present study provide mechanistic understandings of functional advantages of different leaf types, which may involve in species fitness in community assembly and divergent responses to climate changes.

Neodymium long-pulse laser as a monotherapy for unaesthetic vessels of various locations: a series of clinical observations

The article presents a series of clinical cases describing the successful use of the long-pulse neodymium laser in removing unaesthetic reticular veins and telangiectasia of various locations. The first two cases demonstrated reticular varicose veins of the lower limbs in female patients with a fear of injections, which were treated without compression garments and ecchymoses with excellent effect. The outcome of treatment was comparable with that of classical sclerotherapy. The third case showed a successful laser removal of large telangiectasias on the hands, which developed following the long-term use of injection narcotic drugs as part of trophovegetoneurosis. Such pathology is rare for medical practice and approaches to its treatment have not been developed. The fourth case showed large telangiectasias of the buccal and zygomatic regions A good effect after the use of a large diameter spot in that area was demonstrated. The fifth case demonstrated the treatment of the veins in the buccal region, including the vein curving over the mandibular angle. The outcome of the treatment allowed to evaluate not only the aesthetic effect of the procedure, but also the severity of side effects in that area. In the sixth case, the periorbital vein, which divides into two branches, was investigated. The treatment was successful despite the different structure of the vein wall and depth of occurrence. The seventh case demonstrated the removal of large temporal veins. The outcome of treatment was presented on the following day, reflecting the degree of visual discomfort in the early post-procedure period. The final outcome a month after treatment was also demonstrated. In conclusion, the eighth case demonstrated the effectiveness of the treatment of scattered small red telangiectasias on the face using a long-pulse neodymium laser.

Percutaneous laser coagulation of dilated intradermal veins: from theory to practice

Review authors consider the current possibilities of percutaneous laser coagulation for telangiectasias and reticular veins, which are the most common cosmetic defects of vascular genesis, occurring in more than 80% of women of different age groups. This vascular pathology constituting an aesthetic defect and causing local physical discomfort is one of the most common indications for phlebosclerosing therapy and percutaneous laser coagulation. The authors present the most effective and safe guidelines for percutaneous laser coagulation based on analyses of a large volume of specialized literature. Due to the use of state-of-the-art Nd:YAG lasers, percutaneous laser coagulation is increasingly used in patients with various types of intradermal vein lesions and, owing to high efficiency and safety, has advantages over compression sclerotherapy by several criteria. Nd:YAG lasers can be divided into long- and short-pulse ones according to their technical characteristics. Long-pulse lasers provide coagulation of the target vessel due to a single pulse with a high energy density (fluence), while short-pulse lasers, on the contrary, generate a series of pulses to the target vein with a running time of fractions of a millisecond, which ensures the conversion of hemoglobin into methemoglobin with a ten-fold increased ability to absorb laser energy and convert it to heat. As the duration of the pulses generated by the device is a priori shorter than the thermal relaxation time, the risk of burns to the skin and paravasal structures almost completely disappears. The authors provide clinical examples of the application of Aerolase Neo device that utilizes MicroPulse technology to confirm the effectiveness and safety of shortpulse Nd:YAG lasers.

Effects of long-pulsed 1064-nm Nd:YAG laser on telangiectasias and reticular veins: a human in-vivo histological study.

Telangiectasias and reticular veins are associated with aesthetic disorders. Sclerotherapy is the gold standard treatment, but long-pulsed 1064-nm Nd:YAG laser (LP1064 laser) is also used. No data on the human histological effects of these lasers are reported. The objective was to test different LP1064 laser parameters and their histological effects on the dermis, collagen, telangiectasias, and reticular veins. This was a single-center, prospective, single-arm, case-control, human study. During surgery (dermolipectomy), the abdominal section of 10 female patients was irradiated with 6 different transdermal LP1064 laser parameters after anesthesia. Ten pieces with areas of varying irradiation were evaluated according to the characteristics of the vessels identified by area. In each piece, two irradiation areas were performed per group, totaling 12 irradiation areas per piece, with 120 regions later analyzed at the end of the ten samples. After removing the surgical product, histological sections were extracted, and the dermis, telangiectasias, and reticular veins were analyzed. Histological analysis showed that exposition to six different parameters from LP1064 laser led to significant dermal layer separation and collagen alterations. The effects were inconsistent on the loss of endothelial cells, intravascular thrombus formation, and fusion of vascular walls for both telangiectasias and reticular veins. In reticular veins, effects on intravascular thrombus formation and vascular wall fusion were not observed. The LP1064 laser in monotherapy with fixed settings did not lead to a consistent vascular lesion to promote immediate occlusion in telangiectasias and reticular veins. This strategy may not work as monotherapy for small vein treatment, but the possible late response to the LP1064 laser cannot be ruled out and require further investigation.

Enhanced Perception of Deoxygenated Hemoglobin for the Visualization of Lower-Extremity Reticular Veins.

Enhanced Perception of Deoxygenated Hemoglobin for the Visualization of Lower-Extremity Reticular Veins.

Periprocedural management of sclerotherapy in patients with telangiectasias of the lower extremities

Objective — to reveal the effect of certain medicinal and non­medicinal factors that can be applied before and after the sclerotherapy procedure on the final result of the treatment. Materials and methods. The study included 104 patients aged 18 to 60 years who underwent sclerotherapy for the treatment of telangiectasias and reticular varicosities of the lower extremities. Patients were divided into subgroups depending on the appointment of phlebotonics and external means after the procedure. Results were evaluated 1, 3, and 6 months after treatment. Results and discussion. According to the self-assessment of patients, the best cosmetic result was achieved in the subgroup that used phlebotonics in combination with external therapy with heparin sodium gel, compared to the subgroups in which phlebotonics were not prescribed (p &lt; 0.01). In the subgroup where only phlebotonics were used, the result was also better compared to the subgroups in which phlebotonics were not prescribed (p = 0.03; p &lt; 0.01). Self-administration of sodium heparin gel did not provide a statistically significant improvement when comparing the subgroups (p = 0.26). No statistically significant difference in disease recurrence was found between the subgroups (p = 0.729). Conclusions. Ultrasound Doppler mapping with a detailed definition of the feeding sources of the reticular veins and telangiectasias allows determining the optimal stages of treatment to prevent the recurrence of the disease. The appointment of phlebotonics in the post­procedure period has a positive effect on the cosmetic result of sclerotherapy, especially in combination with external therapy with heparin sodium salt gel (p &lt; 0.01). The use of phlebotonics and gel with heparin sodium salt does not affect the number of relapses of the disease (p = 0,729), which is probably due to the technical impossibility of detecting feeding sources in the pre­procedural period.

Hyperpigmentation after sclerotherapy: modern possibilities for prevention and treatment

Sclerotherapy is one of the most popular and most common techniques for the removal of delated reticular veins and telangiectasias on the lower limbs. Despite the vast pooled experience, this procedure can be accompanied by a number of undesirable side effects, of which post-injection hyperpigmentation, which frequency reaches 80%, is the most unpleasant one. The development of postsclerotherapy hyperpigmentation (PSHP) is associated with extravasation and destruction of red blood cells, which results in transformation of haemoglobin into hemosiderin pigment. PSHP is, by definition, a variant of post-traumatic hemosiderin pigmentation. The likelihood of occurrence and persistence of PSHP is determined by a number of hard controllable factors, including the calibre and location of the target veins, the type, concentration and physical form of the sclerosing agent, the sclerotherapy technique, the method and duration of post-procedural compression, patients’ ethnicity, iron metabolism disorders, concomitant use of a number of drugs, a menstrual cycle phase in women, etc. Hyperpigmentation significantly decreases the patients’ quality of life, which determines the need for the prevention and treatment of this undesirable side effect of phlebosclerosing treatment. Recommendations for prevention of PSHP include a detailed history taking aimed at identifying potential risk factors, in the presence of which it is advisable to use various systemic and topical drugs in the post-procedural period in order to prevent the skin hemosiderin deposition, as well as to apply the extended-cycle compression. In the case of PSHP, procedures aimed at the destruction and utilization of hemosiderin, such as Q-Switched laser and IPL therapy, as well as various peeling options intended to speed up the replacement of pigmented skin with normal, can be applied. For the PSHP prevention and treatment, the use of Contractubex containing cepalin onion extract in combination with allantoin and heparin is a matter of interest. Contractubex is a drug originally intended to optimize wound healing and prevent the formation of hypertrophic scars. At the same time, there is ample publications discussing the possible use of this drug for the management of post-traumatic hyperpigmentation due to the combined action of its components. Our clinical experience confirms the effectiveness of Contractubex in the treatment of PSHP, which determines the feasibility of conducting full-fledged clinical trials and accumulating more pooled experience in this area.

Variation in leaf vein traits of Pinaceae plants on the eastern Qinghai-Tibet Plateau, China.

To explore the adaptative strategies of single-veined plants along the environmental gradient, we collec-ted leaves of 57 Pinaceae species (including Abies, Larix, Pinus and Picea) from 48 sites along a latitudinal gradient (26°58'-35°33' N) on the eastern Qinghai-Tibet Plateau. By measuring three traits of leaf vein, including vein length per leaf area, vein diameter, and vein volume per unit leaf volume, we analyzed the trade-off between vein traits and their relationship with environmental changes. The results showed no significant difference in vein length per leaf area among different genera, but significant difference in vein diameter and vein volume per unit leaf volume. There was a positive correlation between vein diameter and vein volume per unit leaf volume for all genera. There was no significant correlation of vein length per leaf area with vein diameter and vein volume per unit leaf volume. With the increases of latitude, vein diameter and vein volume per unit leaf volume significantly decreased. In contrast, vein length per leaf area did not show a latitudinal trend. Mean annual temperature was the main factor driving the variation in vein diameter and vein volume per unit leaf volume. The relationships between vein length per leaf area and environmental factors were relatively weak. These results indicated that the single-veined Pinaceae plants have a special adaptative strategy to environmental changes through adjusting vein diameter and vein volume per unit leaf volume, which is quite different from complex vein structures such as reticular veins.

Treatments for symptomatic class I patients in CEAP classification with saphenous vein reflux: A pilot study

BackgroundFor patients with telangiectasia or reticular veins (CEAP [clinical, etiologic, anatomic, pathophysiologic] class C1), less invasive endovenous (EV) treatments have emerged. However, no prospective studies have compared compression stockings (CSs) and EV ablation treatment for C1 symptomatic refluxing saphenous veins. The present prospective study compared the therapeutic results of the two treatment modalities. MethodsFrom June 2020 to December 2021, 46 patients with telangiectasia or reticular veins (<3 mm; class C1) with axial saphenous reflux and venous congestion symptoms were prospectively enrolled. The patients were assigned to CS (n = 21) or EV treatment (n = 25), according to patient preference. Complications, clinical improvement scales (eg, the venous clinical severity score [VCSS]), and quality of life, including the Aberdeen varicose vein symptom severity score (AVSS) and venous insufficiency epidemiological and economic study – quality of life/symptoms (VEINES-QOL/Sym), were evaluated and compared between the two groups at 1, 3, and 6 months after treatment. ResultsNo major complications occurred in either group. The median VCSS was 2.0 (interquartile range [IQR], 1.0-2.0), 1.0 (IQR, 0.5-2.0), 1.0 (IQR 0.0-1.0), and 0.0 (IQR 0.0-1.0) at baseline and 1, 3, and 6 months after treatment in the CS group, respectively. The corresponding VCSSs were 3.0 (IQR, 1.0-3.0), 1.0 (IQR, 0.0-1.0), 0.0 (IQR, 0.0-0.0), and 0.0 (IQR, 0.0-0.0) in the EV group. The median AVSS was 4.4 (IQR, 3.0-5.5), 2.1 (IQR, 1.3-4.6), 1.0 (IQR, 0.0-2.8), and 0.0 (IQR, 0.0-1.8) at baseline and 1, 3, and 6 months after treatment in the CS group, respectively. The corresponding scores were 6.2 (IQR, 3.8-12.3), 1.6 (IQR, 0.6-2.8), 0.0 (IQR, 0.0-2.6), and 0.0 (IQR, 0.0-0.4) in the EV group. The mean VEINES-QOL/Sym score was 92.7 ± 8.1, 100.4 ± 7.3, 104.3 ± 8.2, and 106.0 ± 9.7 in the CS group at baseline and 1, 3, and 6 months after treatment, respectively. The corresponding scores were 83.6 ± 8.0, 102.9 ± 6.6, 107.9 ± 3.9, and 109.6 ± 3.7 in the EV group. Both groups showed considerable improvement in the VCSS, AVSS, and VEIN-SYM/QOL scores, and no significant between-group differences were observed for ≤6 months. Among the severely symptomatic patients (pretreatment VEINES-QOL/Sym score ≤90), the EV group exhibited more marked improvement (P = .029 for the VCSS and P = .030 for the VEINES-QOL/Sym score). ConclusionsBoth CSs and EV treatment provided clinical and quality of life improvement in symptomatic C1 patients with refluxing saphenous veins, with no significant between-group differences. However, a subgroup analysis revealed that EV treatment provided statistically significant improvement in the severe symptomatic C1 group.

Fate of minor lower limb varicosities after Endovenous Thermal Ablation in patients with lower limb Varicose veins with incompetent Sapheno-femoral Junction

Objectives This was an open-label randomized comparative two arms study to assess the efficacy and clinical outcome of endovenous thermal ablation on reticular veins and telangiectasias in patients with lower limbs varicose veins with incompetent Sapheno-femoral Junction. Patients and methods A total of 40 patients [15 (37.5%) males and 25 (62.5%) females] with reflux of the long saphenous vein were subjected to radiofrequency ablation (RFA). 20 patients had RFA alone while the other 20 patients underwent RFA and injection sclerotherapy. Then patients were followed up on 1 week after the procedure, 3 months, 6 months, and 1 year by duplex and clinically using venous clinical severity score. Results There were 37.5% males and 62.5% females. There was a statistically significant difference in both groups regarding patients’ symptoms (pain, heaviness, and swelling) before and after serial times of follow-up, which was assessed by the VCSS, denoting marked improvement of patients’ symptoms. Also, there was a statistically significant difference (P&lt;0.001) concerning duplex results regards the reflux before and following RFA. Reticular veins follow-up, we found that in group A they were present among 35% of patients on 1-week follow-up. This increased to reach 70% after 1 year of follow-up, however, in group B they were absent among all patients on 1 week follow-up. They were present among 15% of patients after 1 year of follow-up. Conclusion RFA with concomitant sclerotherapy for the associated minor veins have proved to be safe, cost-effective and more patient satisfaction than RFA without concomitant sclerotherapy.

Frequency of lipoedema in patients consulting a vein clinic for mild to moderate superficial venous disorder with symptoms: A retrospective analysis

Lower limb lipoedema is a chronic condition of the adipose connective tissue of the skin that affects women. Its frequency is not well known, hence the main objective of this study. Retrospective analysis of the records of phlebology consultations in private practice in a single center from April 2020 to April 2021. Inclusion criteria were: women aged 18 to 80 years, presenting with symptoms attributable to veins and the presence of at least one dilated reticular vein. The files of 464 patients were analyzed. 7.7% had lipoedema, 3.7% lymphedema, 3% stage 3 obesity. The 36 patients with lipoedema were 54.7 ± 16 years old (mean, Standard Deviation), with a Body Mass Index of 31.3 ± 5.5. Leg pain was the major symptom (32/36) and no patient had a positive pitting test. Lipoedema is a frequent condition in phlebology consultations.

Nd:Yag laser combined with injection sclerotherapy in the treatment of reticular veins and telangiectasias (CLaCS method): A triple-blind randomized clinical trial comparing two sclerosing agents associated with same laser patterns.

Cryo-Laser & Cryo-Sclerotherapy (CLaCS) is a technique which combines thermal sclerotherapy and injection sclerotherapy. Telangiectasias and small varicosities are targeted by a transdermal laser and right after receive injection sclerotherapy. A cooling device blows -20°C air onto the skin and needle in a pre-, parallel-, and post-fashion. Our objective was to establish if there is a difference in result and complications by varying the sclerosing agent but keeping the same ND:Yag long pulse laser parameters in the treatment of small varicosities. Fifty five patients were enrolled prospectively and randomized to two groups; in the group 1 dextrose 75% was the sclerosing agent used in combination with the ND:Yag long pulse laser and, in the group 2, the same laser technique was used but the sclerosing agent was polidocanol 0.3% and dextrose 67%. The results were evaluated 30days after the treatment by the patients and for blinded evaluators using before and after standardized photos with and without augmented reality. In the patient's perspective and in the blinded evaluation of the regular photos, no differences between the groups were found. Both groups had low rates of hyperpigmentation and bruising with no statistical difference. Patients treated with polidocanol had less pain after the treatment and a better clearance rate in the photos with augmented reality. No major complications were found. The treatment of small varicosities with CLaCS using Dextrose 75% or polidocanol 0.3% and Dextrose 67.5% is a safe and effective procedure and both sclerosing agents can be used with similar results. Possibly, in the polidocanol group more nonvisible reticular veins were cleared, but the implication of this find is not clear.

35389 Polidocanol: A review of clinical uses

Polidocanol is a nonionic detergent sclerosant that disrupts the intimal lining of blood vessels by inducing a negative charge on endothelial surfaces. Ultimately, thrombotic occlusion at the site of endothelial damage gives rise to endovascular fibrosis and effective obliteration of the target vessel. Polidocanol is FDA-approved for the treatment of uncomplicated spider veins and reticular veins in the lower extremity. Despite its limited indication, there are numerous reports of polidocanol’s use for a variety of off-label conditions. The purpose of our study was to describe the dermatologic clinical uses of polidocanol and to characterize efficacy and adverse effects associated with its various applications. In a review of literature searchable on PubMed from 2004 to 2020, polidocanol has shown efficacy in the treatment of varicose veins, hemangioma, mucocele of the minor salivary gland, pyogenic granuloma, lymphangioma circumscriptum, digital mucus cyst, mixed skin ulcer, cutaneous focal mucinosis, seroma, glomovenous malformation, acne cyst, and lymphocele. Commonly reported complications of polidocanol therapy include pain, edema, ecchymosis, ulceration, tissue necrosis, and thrombosis of the treated vein. Although not always first-line therapy, polidocanol may be chosen as a treatment method for off-label conditions due to its low cost, ease of use, and adaptability to difficult anatomic locations.