Spider Veins Research Articles

Percutaneous foam sclerotherapy for venous leg ulcers

The technique of foam sclerotherapy directed at the distal most vessels, draining the ulcer bed was first described in 2010, with excellent penetration into the underlying venous network possible with this technique. Thirty-five patients have now been treated with this technique as the initial treatment at Midwest Vein Laser, USA. There have been no complications with this technique and rapid healing occurred within 4-8 weeks after the initial treatment in 90% of the patients, and all ulcers were healed at 4 months. Here we present the representative case of a 67-year-old man treated with a modified technique that used a percutaneous approach via reticular or spider veins at the margin of the ulcer bed.

Facial skin lesions in male patients with liver cirrhosis: role of serum sex hormones and correlation with impaired liver function

To investigate the relationship between serum sex hormone levels, liver function, and pathogenic mechanisms related to cutaneous lesions involving the facial skin in male patients with liver cirrhosis. Fifty male cirrhotic patients with facial skin lesions, including spider angiomas, angiotelectasis and special type rash, (mean age: 48.1 +/- 12.2 years) were randomly selected for study and enrolled as the case group. Thirty cirrhotic male patients without facial skin lesions (mean age: 44.5 +/- 11.7 years) were enrolled as the control group. Serum levels of luteinizing hormone (LH), follicular stimulating hormone (FSH), prolactin (PRL), estradiol (E2), progesterone (PRGE), and testosterone (T) were detected and compared between cases and controls by the t-test. All patients were sub-categorized according to severity of cirrhosis (Child-Pugh classification) and comparisons between cases and controls were carried out by single factor analysis of variance. Logistic regression modeling was used to evaluate whether the presence of skin lesions is related to changes in markers of liver impairment, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), serum albumin (Alb), prothrombin time (PT-SEC), creatinine (CREA), platelet count (PLT), and alcoholism. In the cases with spider veins, LH level was significantly elevated (t = 2.01) and T level was significantly decreased (t = -2.20) (both, P less than 0.05 vs. controls). In the cases with telangiectasia, the LH level (t = 3.76, E2 (t = 2.08) and E2/T ratio (t = 2.98) were significantly elevated and T level was significantly decreased (t = -3.77) (all, P less than 0.05 vs. controls). In the cases with special type rash, FSH level was significantly elevated (t = 2.03) and T level was significantly decreased (t = -2.01) (both, P less than 0.05 vs. controls). In the case group, E2 levels decreased as severity of liver damage increased, while in the control group, E2 levels increased as severity of liver damage increased; however, the difference in average E2 values of the two groups did not reach statistical significance (P more than 0.05). In both cases and controls, the T levels were decreased as the severity of liver damage increased (F = 3.70, P less than 0.05). Multivariate logistic regression analysis showed that increased incidence of facial skin lesions is associated with alcoholism (odds ratio (OR) = 4.46, 95% confidence interval (CI) = 1.45-13.7, P less than 0.05) and elevated serum levels of AST (OR = 11.87, 95% CI = 1.24-113.1, P less than 0.05). Alcoholism, impaired liver function, and perturbed levels of circulating sex hormones are associated with cirrhosis-related facial lesions and may play important roles in the pathogenesis of cutaneous lesions in patients with cirrhosis.

Management of Varicose Veins and Venous Insufficiency

Chronic venous disease, reviewed herein, is manifested by a spectrum of signs and symptoms, including cosmetic spider veins, asymptomatic varicosities, large painful varicose veins, edema, hyperpigmentation and lipodermatosclerosis of skin, and ulceration. However, there is no definitive stepwise progression from spider veins to ulcers and, in fact, severe skin complications of varicose veins, even when extensive, are not guaranteed. Treatment options range from conservative (eg, medications, compression stockings, lifestyle changes) to minimally invasive (eg, sclerotherapy or endoluminal ablation), invasive (surgical techniques), and hybrid (combination of ≥1 therapies). Ms L, a 68-year-old woman with varicose veins, is presented. She has had vein problems over the course of her life. Her varicose veins recurred after initial treatment, and she is now seeking guidance regarding her current treatment options.

Pooled safety analysis of diclofenac sodium topical solution 1.5% (w/w) in the treatment of osteoarthritis in patients aged 75 years or older

BackgroundThis study aimed to determine the safety of diclofenac sodium topical solution 1.5% (w/w) in 45.5% dimethyl sulfoxide (TDiclo) for the treatment of knee or hand osteoarthritis in persons aged 75 years or older.MethodsA pooled analysis of safety data from seven multicenter, randomized, blinded, Phase III clinical trials (4–12 weeks’ duration) of TDiclo was conducted. The analysis focused on a subset of patients (n = 280) aged 75 years or older with a primary diagnosis of osteoarthritis of the knee (six trials) or hand (one trial). Patients received one of three topical treatments: TDiclo (n = 138); placebo (2.33% or 4.55% dimethyl sulfoxide, n = 39); or control (45.5% dimethyl sulfoxide, n = 103). Treatment groups were compared using Chi-square analysis, Fisher’s Exact test, or analysis of variance.ResultsThe most common adverse events involved the skin or subcutaneous tissue, primarily at the application site. The incidence of dry skin was higher in the TDiclo (36.2%; P < 0.0001) and dimethyl sulfoxide control (18.4%; P = 0.0142) groups than in the placebo group (2.6%); the incidence of other skin or subcutaneous tissue adverse events was similar between the groups. Relatively few patients (<18%) experienced gastrointestinal adverse events, and group differences were not detected. In the TDiclo group, constipation (3.6%), diarrhea (3.6%), and nausea (3.6%) were the most common gastrointestinal adverse events. Cardiovascular and renal/ urinary adverse events were rare, and group differences were not detected. There was one case (0.7%) each of hypertension, spider veins, and vasodilation in the TDiclo group. Changes from baseline to the final visit in blood pressure and hepatic/renal enzyme levels were also similar between the groups.ConclusionTDiclo appears to be well tolerated for the treatment of osteoarthritis in persons aged 75 years or older.

Subcutaneous injection of liquid and foamed polidocanol: extravasation is not responsible for skin necrosis during reticular and spider vein sclerotherapy

Cutaneous necrosis is one of the most annoying complications of reticular and spider vein sclerotherapy. The precise incidence of the complication is not known, although various sources reported incidence between 0.2% and 1.2%. Among a few mechanisms proposed to explain it, extravasation of the sclerosant into the perivascular tissue has been cited as the major cause. The aim of the experimental study in rats was to examine the potential of various concentrations and volumes of polidocanol in both liquid and foam forms to cause cutaneous necrosis after superficial subcutaneous injection. Twenty-four female Sprague Dawley rats were injected subcutaneously different concentrations (0.5%, 1%, 2% and 3%) of polidocanol as well as different preparations of polidocanol (liquid vs. foam) and volumes (0.1-0.5 mL). The animals were sacrificed 10 days after injections and biopsy specimens were obtained. Cutaneous necrosis was not seen at volumes <0.5 mL regardless of the concentration or form of polidocanol injected. Foam preparation was shown to be less potent in inducing necrosis with a minimal strength being 2% in comparison with the liquid form where 1% was sufficient to produce overt cutaneous necrosis. This experimental study shows that extravasation of polidocal in usual circumstances of sclerotherapy of spider and reticular veins cannot be a significant cause of cutaneous necrosis rarely observed in this setting. It is particularly true for the foamed polidocanol where 1% strength seems safe if injected extravascularly in volumes up to 0.5 mL.

Sclerotherapy of Varicose Veins with Polidocanol Based on the Guidelines of the German Society of Phlebology

Sclerotherapy involves the injection of a sclerosing agent for the elimination of intracutaneous, subcutaneous, and transfascial varicose veins. To update guidelines for sclerotherapy of varicose veins. The guidelines for sclerotherapy of varicose veins of the German Society of Phlebology were updated and modified through a review of the available literature. Published clinical series and controlled clinical trials provide evidence to support the elimination of intracutaneous and subcutaneous varicose veins using sclerotherapy. Allergic skin reactions occur occasionally as allergic dermatitis, contact urticaria, or erythema. Anaphylaxis is rare. Transient migraine headaches present more frequently in patients treated with foam sclerotherapy than liquid sclerotherapy. Sclerotherapy is the method of choice for the treatment of small-caliber varicose veins (reticular varicose veins, spider veins). If performed properly, sclerotherapy is an efficient treatment method with a low incidence of complications.

Aktuelle Aspekte der Schaumverödungstherapie

SummaryFoam sclerotherapy is an efficient and safe technique for the treatment of chronic venous insufficiency. In Germany, the multiplicity of sclerosing agents of past decades has reduced to the agent Aethoxysklerol® (active ingredient: polidocanol). It has been shown that sclerosants are more efficient when administered as foam rather than in liquid form. Only for spider veins are liquid sclerosants equally, or more effective than their foam counterparts. Various techniques can be used to mix the sclerosant with a gas (generally normal room air, alternative: CO2) to produce a foam. The foam's advantage over the liquid form is that it completely displaces the blood from the venous segment to be treated and thereby considerably prolongs the contact time with the vein wall. The various sclerosants lead to marked damage of the vascular endothelium and possibly, the entire venous wall. If sclerotherapy is successful, the vein is ultimately converted into a thread of connective tissue. A sufficient volume of foam is crucial to the success of sclerotherapy of trunk varices, in order to ensure adequate filling of the vessel lumen. Foam sclerotherapy reaches its limit with varicosities of more than 8 mm in diameter, because the rate of thrombosis rises sharply with foam volumes above 10 ml. Foam sclerotherapy may also be used to treat angiodysplasias, vulvar, pudendal and periulcerous varicosities and is quite often the only therapeutic option. The main complications of sclerotherapy are pain in the region of sclerothrombi, haematoma, phlebitis, induration, pigmentation and a metallic taste. Other acute complications are vasovagal reactions, paraesthesias and nausea. Anaphylactic reactions, intra-arterial injections with the possible sequelae, migraine attacks with visual disturbances (scintillating scotoma) and transient neurological deficits have indeed been reported in individual cases, but are very rare.Consideration of the current literature shows that foam sclerotherapy is a safe and quite simple technique for all forms of varicosis. Based on the data now available, it can be stated that foam sclerotherapy is far more effective than liquid sclerotherapy.

Phenotypic categorization of genetic skin diseases reveals new relations between phenotypes, genes and pathways

Motivation: Systematic analysis of connection between proteins, their cellular function and phenotypic manifestations in disease is a central problem of biological and clinical research. The solution to this problem requires the development of new approaches to link the rapidly growing dataset of gene–disease associations with the many complex and overlapping phenotypes of human disease.Results: We analyze genetic skin disorders and suggest a manually designed set of elementary phenotypes whose combinations define diseases as points in a multidimensional space, providing a basis for phenotypic disease clustering. Placing the known gene–disease associations in the context of this space reveals new patterns that suggest previously unknown functional links between proteins, signaling pathways and disease phenotypes. For example, analysis of telangiectasias (spider vein diseases) reveals a previously unrecognized interplay between the TGF-β signaling pathway and pentose phosphate pathway. This interaction may mediate glucose-dependent regulation of TGF-β signaling, providing a clue to the known association between angiopathies and diabetes and implying new gene candidates for mutational analysis and drug targeting.Contact: grishin@chop.swmed.eduSupplementary information: Supplementary data are available at Bioinformatics online.

Treatment of varicose veins

Varicose veins (VVs) are the most common manifestation of chronic venous insufficiency, affecting 25% of women and 15% of men. Reticular veins and telangiectasias (spider veins) are found in more than 80% of the general population. VVs produce symptoms of pain, swelling, heaviness, fatigue, and pruritus and predispose patients to complications including bleeding, superficial thrombophlebitis, and ulcerations that interfere with activities of daily living and result in lost time from work. Current treatments for VVs include conservative measures, and when these are unsuccessful, more invasive surgical and endovenous interventions primarily aimed at reducing venous hypertension and preventing progression to chronic inflammation and ulcerations. Surgical procedures including saphenous vein stripping, ligation of the saphenofemoral junction, and ambulatory phlebectomy are effective in the treatment of VVs but are associated with a high complication rate and recovery time. Emerging endovenous therapies, including endovenous laser therapy, radiofrequency ablation, and endovenous foam sclerotherapy, have shown similar efficacy in the treatment of VVs compared with more invasive surgical procedures, with lower complication rates and less time lost from work.

Efficacy of Polidocanol Sclerotherapy for Capillary Malformation with Masked Venous Malformation

Previous studies have proposed the effectiveness of the long PDL and the long-pulse 1,064-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser. The 595-nm PDL is effective for the treatment of leg telangiectasia, spider veins, and vascular lesions that are less than 1.5 mm in diameter. The long-pulse 1,064-nm Nd:YAG laser has been used successfully to treat deeper, larger diameter vessels such as leg veins, but the effectiveness of long PDL is uncertain, and one study has shown that only three of 22 resistant capillary malformations improved with the long PDL in one treatment session.

Laser Ablation of Cutaneous Leg Veins

Patients presenting with lower-extremity telangiectasias, commonly known as spider veins, are a frequent presentation for vascular surgeons. The use of lasers in the treatment of lower-extremity spider veins has gained increased popularity during the past 5 years. This technology, driven by consumer demand, has been effective in treating vessels that are refractory to sclerotherapy treatment, vessels that arise from telangiectatic matting, and in patients who experience a phobia to needles. One laser wavelength per machine limits what the practitioner can do. That is, each type of vein responds best to a specific wavelength. Light skin is more forgiving to complications than dark skin. The devices are a complement to good sclerotherapy, not a substitute.

Aesthetic Treatment of Leg Veins

The author's preferred treatment for spider veins is sclerotherapy, a technique that uses irritants to obliterate the vessel lumen. She reserves laser treatment for vessels too small to sclerose, matting, and patients who refuse sclerotherapy. Treatment is initiated only after ruling out reflux in the larger superficial venous systems or through the perforators. For long lasting and satisfying results, the author recommends multiple treatments, using the lowest concentration of the most effective sclerosant to achieve vessel obliteration with minimal thrombus formation. She presents a guide to pretreatment evaluation, sclerosing solutions, injection technique, and posttreatment care.

Sclerotherapy of spider veins using the accurate depth-gauge collagen needle

Sclerotherapy of spider veins using the accurate depth-gauge collagen needle

The Effect Of Graded Compression Socks On Maximal Exercise Capacity And Recovery In Runners

The application of compresion socks in the clinical setting is well known, i.e. for the treatment of edema, lymph edema, phlebitis, varicose veins, spider veins and deep vein thrombosis. However, renowned international athletes have occasionaly worn compression socks during races, claiming that it improves their performance and reduce their recovery time. The rationale behind graded compression socks is that it may enhance venous return to the heart through a more efficient calf muscle pump, leading to increased endurance capacity. It is also claimed that muscles are kept more compact (causing less muscle damage), thereby minimizing muscle fatigue. None of the above claims have been studied in an athletic population. PURPOSE: To determine whether athletes improve their maximal exercise capacity and recovery when running with graded compression socks. METHODS: Ten healthy male students (age = 23 ± 1.9 years, height = 182 ±6.3 cm, body mass = 82 ± 11.4 kg) volunteered to participate in this study. All subjects completed two identical maximal exercise protocols, with and without compression socks, in random order and within seven days. Blood lactate concentrations were measured at rest, and at 2, 10 and 30 min after the exercise tests. Maximal exercise capacity was determined on a h/p/cosmos saturn treadmill using a standardized, incremental protocol to exhaustion. Physiological responses were measured with the Cosmed Quark b2 metabolic system. RESULTS: There were no statisticaly significant differences in maximal oxygen consumption, heart rate or minute ventilation between the two exercise tests (p > 0.05). Subjects did, however, show a faster lactate recovery rate after exercise when wearing the compression socks. CONCLUSIONS: Our study does not support the claims of some distributors of compression socks that it would enhance short-term, maximal exercise performance. The possibility that compression socks may improve recovery after strenuous exercise seems promising and warrants further investigation.

The new‐generation, high‐energy, 595 nm, long pulse‐duration, pulsed‐dye laser effectively removes spider veins of the lower extremity

Lower-extremity spider veins are a cosmetic problem that poses formidable clinical difficulty for laser removal. They are significantly harder to remove than facial telangiectasias. A new-generation, pulsed-dye laser (PDL), capable of administering pulses that clinically behave like true 40-millisecond pulses has been developed, by doubling the number of sub-pulses comprising each laser pulse. Fifteen subjects with Fitzpatrick skin types I-III were enrolled in the study and treated to 35 sites. Subjects were treated three times at 6-week intervals using an average fluence of 20.4 J/cm(2), a 3 x 10 mm spot, and a dynamic cooling device to protect the epidermis. Digital photographs were taken before initiating treatment and 8 weeks following the final treatment. Mean improvement scores using a 4-point scale as rated subjectively by the treating physician were 0.92 (<25%), 2.7 (approximately 40-50%), and 3.6 (approximately 65-75%), 6 weeks following 1st and 2nd treatments and 8 weeks following the 3rd and final treatment, respectively. Improvement was also determined by three physicians, rating digital photographs and blinded as to which photographs were pre- or post-treatment. They rated improvement as mild (0-25%) in 10.5% of photographs, moderate (26-50%) in 15.2%, marked (51-75%) in 38.1%, and excellent (76-100%) in 6.3%. There was no textural change in any treatment site. The new-generation, high-energy, 595 nm, long pulse-duration, PDL effectively removes lower-extremity spider veins in subjects with skin types I-III.

Mirror, Mirror, and: Sweeping Up, and: Envy, and: Covenant, and: Private Lives, and: The Gift, and: Trespass

Mirror, Mirror The body I strip in the bedroom mirror is my mother's body, the one I found so hopeless (she could read it in my face) when I was fifteen. True, the breasts are better, the gloating nipples still rosy and erect, but the stomach's the same tired pudding, and those spider veins on the thigh. Stand up straight. Tie your hair back. Don't give me that look. She was fifty, undressing; I was trying on her satin, chiffon, gold lamé America. That was the year I was a bookish girl from Russia who refused to wear lipstick. [End Page 77] Things are easier between us lately. She's not so carping. Is even willing to listen. One would almost think death has mellowed her. On my dresser, a photo of her at eighty, tilting her head, leaning forward – the better to see my life? Her assessor's eye is shrewd but genial. She has something crucial to tell me but she's taking her own sweet time. Sweeping Up The war is over, mama, and the field lies in a litter of aftermath – teacup and tablecloth, Nitrostat, lipstick, the new Danielle Steele, your misspelled DO NOT RESOSITATE, the ordinary disorder. I am your custodian, I am left to sweep up the leavings. I have given the sofa away, but the dishes are still in the basement, the rosebud dishes I'll never use. Your letters are fading in the interrogative light of day, a harsh light that bleaches like peroxide. [End Page 78] Tell me, mama: that amber ring you bestowed with such munificence – did you know it was glass? What if we'd talked about the life after tea – and – mandelbroyt, where would that have taken us? Did you ever find out if I was your child? Your floral nightgown, the one you hemmed in a hurry with crooked stitches – it fits, mama; I'm wearing it. I keep choosing to wear it. Tell me, mama, what have you taken with you that I might have used? Whatever it is, I keep looking. The way a broom reaches sideways under a sofa drags out the dusty small change. Envy And then Naomi died and became available to us. "But did she know?" We sit in a circle and take her life in our hands. The silky feel of her secrets: "She wanted a child, she even – ." [End Page 79] "Damned if I don't fight," she swore on the clanking machine of a bed. That oath had to hack its way out of her throat but I envied the way she said it. She wanted to run downstairs, pare an apple, dip her spoon in the sauce. She wanted to wipe her own ass and tie her shoelaces. And I, of sound body and greedy heart – I envied the way she said it. "Rub my shoulders with cologne?" She pointed at the ancient bottle of Jean Naté, citron yellow beside the purple asters, a little still life on the bedside table. I swabbed her with long sweet lemon strokes, a ritual washing of the body this side of death. When I finished, she looked almost happy. She had only a few wishes left by then, each one smaller than the last. [End Page 80] Covenant What we are given is too hot to touch. Live coal, glowing from the altar. I take it in the tongs of language so it won't burn. It does burn. I reach for it anyway. But slowly. Slowly. The poem is a miracle of perversity. It knows before I do how words give even as they take away. How they slake and inflame. How they salt every morsel they save. I leave a place at the table for the prophet who pressed that burning coal to my lips. Private Lives I know a man who...

Laser-Doppler Examination Shows High Flow in Some Common Telangiectasias of the Lower Limb

The accepted pathophysiology of telangiectasias is reflux from superficial or deep veins. There are physical signs and scientific findings that do not fit this theory but support the possibility of arteriovenous (AV) shunt origin. If there is a higher flow in spider veins than in the surrounding skin, it means that AV shunts participate in the circulation of the telangiectasia. On the other hand, slow flow indicates reflux as the etiologic factor. Telangiectasias and the surrounding skin of 22 legs of 19 patients were examined with laser-Doppler equipment. The probe over the spider vein found a higher flow value (average 28.2 perfusion units [PU]) than in the surrounding skin (15.6 PU) in 13 limbs, but it was significantly higher only in 5 cases. In 9 limbs, the flow was slower. We interpret the higher flow values as a consequence of open AV shunts. This means that AV shunt pathophysiology was present in some of our cases.

The Use of Botox® in Interventional Radiology

Botox (Botulinum toxin A) has wide public recognition as a cosmetic agent. It has also established a firm foothold within the medical community for the treatment of a wide range of myospastic disorders. With imaging guidance, interventional radiologists can deliver this medication to a variety of otherwise difficult to reach targets with high accuracy and with minimal complications. We illustrate the use of Botox in interventional radiology by describing our fluoroscopic technique for the treatment of piriformis syndrome. The key to successful Botox therapy of myospastic disorders is accurate clinical diagnosis. Excellent communication and rapport with the referring clinicians is therefore essential to maximize the likelihood of a successful outcome. The range of services offered by interventional radiologists continues to evolve. With the recent growth of endovenous treatment for varicose veins, some have found it necessary to provide sclerotherapy for spider veins. As patients become accustomed to receiving these cosmetic treatments from interventionalists, they may come to us for advice about other esthetic therapy. The idea of some interventional radiologists adding cosmetic medicine to their practice should, therefore, not seem unreasonable. We illustrate the use of Botox for facial rejuvenation by describing our technique for the treatment of glabelar (frown) lines. Before entering into this type of practice, it is critical to obtain adequate and appropriate training for each cosmetic intervention. If possible, the interventionalist should seek to establish a mentor relationship with someone highly experienced in cosmetic medicine.

Angioarchitecture of spider veins

SummaryKnowledge of the anatomy of spider veins is scant and contradictory. The authors therefore decided to investigate the angioarchitecture of these lesions, i.e. the anatomy, interconnections, and morphological characteristics of the cutaneous vessels and capillaries that comprise them. Material and methods: A highly polymerising plastic was injected into the vascular system of skin-muscle tissue blocks so as to produce true-to-scale casts (corrosion casts) of the angioarchitecture of spider veins. In 35 skin-muscle tissue blocks obtained post mortem a total of 28 spider veins were found. Corrosion casts of these were examined by scanning electron microscopy with particular regard to their connections with larger veins. Results: All the spider veins examined showed the typical polygonal pattern of endothelial cell nuclear imprints. The subpapillary vascular plexus showed incompetent microvenous valves. A statistically significant difference was found between the diameter of spider veins of red and blue appearance (0.227 mm and 0.435 mm, respectively; p&lt;0.001). Feeder veins were only found in the case of stellate and fan-shaped spider veins. Conclusions: Spider veins are pathological venous changes in the subpapillary vascular plexus. Incompetent microvenous valves may play a role in their formation. In certain clinical situations sclerotherapy of spider veins may fail to achieve a lasting cure, since the feeder veins that drain the capillaries cannot be sclerosed.

CEAP classification and implications for investigations

Classification of diseases is a basic instrument for uniform diagnosis and meaningful communication about the disease. The credo of the American Venous Forum (AVF) is that “The cornerstone for management of chronic venous disorders (CVD) is a proper diagnosis and accurate classification of the underlying venous problem, which creates the base for correctly directed treatment”. In CVD reliance for too long has been placed on the clinical appearance of the superficial effects of CVD, such as spider veins, varicose veins, swelling, skin changes, and ulcerations, without requiring accurate objective testing of the venous system to substantiate the diagnosis. This practice has caused errors of diagnosis and has been largely responsible for the poor correlation of results between treatment methods. There have been several classifications in the past that have added to our understanding of CVD, but all lack the completeness and objectivity needed for scientific accuracy (1).