REVIEWS   

Acta Phlebologica 2001 December;2(2-4):71-6

Copyright © 2001 EDIZIONI MINERVA MEDICA

language: English

Sclerotherapy of reticular varices and telangiectasias. Therapeutic strategy and results

Mariani F. ¹, Izzo M. ¹, Trapassi S. ², Mancini S. ¹

¹ Institute of General Surgery and Surgical Specializations, Interdepartmental Centre of Research, Treatment and Phlebolymphological Rehabilitation, Siena University, Siena, Italy; ² Institute of Plastic and Reconstructive Surgery, Parma University, Parma, Italy

Therapy of iso­lat­ed retic­u­lar varic­es is suc­cess­ful in all ­patients, where­as ther­a­py of telan­giec­ta­sias of the infe­ri­or ­limbs ­presents ­even ­today con­sid­er­able dif­fi­cul­ties for ­owing to the var­i­able­ness of the ­results and a cer­tain inci­dence of com­pli­ca­tions ­such as hae­mo­sid­e­rin pig­men­ta­tions. The ­results dem­on­strate ­that, in ­most treat­ed ­patients, ther­a­py is ­more effec­tive ­when the strat­e­gy pro­vides for the abo­li­tion of the ­major reflux­es, par­tic­u­lar­ly if ­they ­have ­been locat­ed ­before the scle­ros­ing injec­tion. The prin­ci­ple is the ­same as ­that guid­ing the treat­ment of the larg­est varic­es: accu­rate map­ping of ­venous insuf­fi­cien­cy deter­mined the ­result of the treat­ment. In con­clu­sion, ­this ­study pro­vides ­some prac­ti­cal guide­lines:
— in CVI all tele­an­gec­ta­sias are accom­pa­nied by retic­u­lar varic­es, ­even ­when ­these are not vis­ible on clin­i­cal exam­ina­tion;
— in ­most cas­es, the sourc­es of reflux­es are dis­tin­guish­able as incom­pe­tent per­fo­rat­ing ­veins and are sit­u­at­ed ­beneath tele­an­giec­tac­tic efflo­res­cenc­es;
— correct diag­no­sis is there­fore essen­tial for a ­good ­result of the treat­ment;
— sclerosing injec­tions ­must there­fore ­first be giv­en in the retic­u­lar varic­es ­beneath the telan­giec­ta­sias;
— the elim­i­na­tion of the ­reflux is essen­tial for a ­good ­long-­term ­result. This reduc­es the num­ber of ses­sions need­ed and the inci­dence of com­pli­ca­tions, in par­tic­u­lar hae­mo­sid­e­rin pig­men­ta­tion, telan­giec­tac­tic mat­ting and the exten­sion of the telan­giec­ta­sias treat­ed.