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A Journal on Phlebology
Acta Phlebologica 2000 September;1(1):33-38
Telangiectases in venous insufficiency. Investigation of refluxes and sclerotherapy. Follow-up at four years
Mariani F. 1, Trapassi S. 2, Manchini St. 2, Mancini S. 2
1 Interdepartmental Centre of Research, Treatment and Phlebolymphological Rehabilitation, Institute of General Surgery and Surgical Specializations, University of Siena, Siena, Italy;
2 Institute of Plastic and Reconstruction Surgery, University of Parma, Italy
BACKGROUND: The aim of our research has been to verify the role of possible sources of non-saphenous reflux on the appearance of reticular varices and telangiectases, also in points different from the lateral venous system of Albanese, studied by other authors.
METHODS: Setting: Siena University - Institute of General Surgery and Surgical Specializations - Interdepartmental Centre of Research, Treatment and Phlebolymphological Rehabilitation.
Patients: The study was carried out on 106 female patients aged between 18-65, who were affected by venous insufficiency (VCI) at the Cla-s Ep Asl stage, according to the CEAP classification. The patients showed telangiectases (200 telangiectactic areas, average surface 22.7 cm2, not more than 1 mm in diameter) and reticular varices of the lower limbs of the type II and III of the classification of Weiss, with continent saphenous axes and a normal deep venous system. Sclerotherapy was therefore performed, after clinical and instrumental study, and the records of 168 telangiectactic areas were reviewed four years later.
RESULTS: In 100% of the cases the presence of reticular varices was found together with the telangiectases, in 73.5% (147 out of 200) one or more incontinent perforating vein was found (average diameter 1.6 mm) and in 83.6% (123 out of 147) it was possible to establish that the source of the main reflux was to be found in the base area of the telangiectasia. The complete removal of the microvarices was acheived in 88% of the cases (176 areas out of 200; average sessions: 3,5), the complications were characterised by haemosiderinic pigmentation (1.5%, 3 out of 200) and matting (1%, 2 out of 200). In the 24 areas resistent to therapy it was not possible to demonstrate the presence of reflux while in 24.5% of the cases (49 areas out of 200, average surface 15.4 cm2) two sessions of sclerotherapy were sufficient to obtain in time (about four weeks later) the disappearance of the microvarices. The follow-up after four years revealed the appearance of new telangiectases in 61.3% of cases (103 out of 168 check-ups), of these 95.4% (98 out of 103) in areas different from those treated and therefore only 4.8% (5 out of 103) recurred in the area where the sclerosing treatment had been carried out.
CONCLUSIONS: In VCI all telangiectases are accompanied by “venulae comites” or reticular varices, even when not visible in only a clinical test; in most cases the sources of reflux are distinguishable as incontinent perforating veins and are situated in the base area of the telangiectactic efflorescences.