CONCLUSIONS
Sclerotherapy, ambulatory phlebectomy, and endovenous vein ablation techniques are excellent treatments for both cosmetic and symptomatic venous disease. Although they all require some additional training and knowledge of superficial venous anatomy and physiology, remarkable medical and cosmetic improvements in the sensation and appearance of legs can be achieved. Thus, the dermatologic surgeon now can treat all forms of varicose and telangiectatic leg veins from the largest to the smallest.
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Nelson EA, Bell-Syer SE. Compression for preventing of Varicose and Telangiectatic Leg Veins. 6th ed. London: Elsevier; 2016.2. Boisseau MR. Venous valves in the legs: hemodynamic
-
Sadick NS. Treatment of varicose and telangiectatic recurrence of venous ulcers. Cochrane Database Syst Rev. 2012(8):CD002303.14. O’Meara S, Cullum N, Nelson EA, Dumville JC.
and biological problems and relationship to physio pathology. J Mal Vasc. 1997;22:122–127.3. Griton P, Vanet P, Cloarec M. Anatomic and functional leg veins with hypertonic saline: a comparative study of heparin and saline. J Dermatol Surg Oncol. 1990;16:24–28.25. Sadick NS, Farber B. A microbiologic study of diluted
Compression for venous leg ulcers. Cochrane Database Syst Rev. 2012(11):CD000265.15. Veraart JC, Neumann H. Interface pressure measure- features of venous valves. J Mal Vasc. 1997;22:97–100.4. Labropoulos N, Giannoukas AD, Nicolaides AN, et al. The sclerotherapy solutions. J Dermatol Surg Oncol. 1993;19:450–454.26. Leach BC, Goldman MP. Comparative trial between ments underneath elastic and non-elastic bandages. Phlebologie. 1996;1(Suppl):56–59.16. Veraart JC, Koster D, Neumann H. Compression role of venous reflux and calf muscle pump function in nonthrombotic chronic venous insufficiency. Correlation with severity of signs and symptoms. Arch Surg. 1996;131:403–406.5. Labropoulos N, Delis K, Mansour MA, et al. Prevalence sodium tetradecyl sulfate and glycerin in the treatment of telangiectatic leg veins. Dermatol Surg. 2003;29:612– 614, discussion 615.27. Weiss MA, Weiss RA, Goldman MP. Sclerotherapy: how therapy and the pressure in the deep venous system. Phlebologie. 1996;1(Suppl):68–73.17. Weiss RA, Sadick NS, Goldman MP, Weiss MA.
minor varicosities cause leg pain. Contemp Ob Gyn. 1991;36:113–125.28. Brittenden J, Cooper D, Dimitrova M, et al. Five-year
Post-sclerotherapy compression: controlled comparative study of duration of compression and its effects on clinical outcome. Dermatol Surg. 1999;25:105–108.18. Carlin MC, Ratz JL. Treatment of telangiectasia:
and clinical significance of posterolateral thigh perforator vein incompetence. J Vasc Surg. 1997;26:743–748.6. Butie A. Clinical examination of varicose veins. Dermatol
Surg. 1995;21:52–56.7. Kistner RL, Eklof B, Masuda EM. Diagnosis of chronic outcomes of a randomized trial of treatments for varicose veins. N Eng. J Med. 2019;381:912–922.29. Weiss MA, Weiss RA. Sclerotherapy. Curr Opin Dermatol.
comparison of sclerosing agents. J Dermatol Surg Oncol. 1987;13:1181–1184.19. Sadick NS. Advances in sclerosing solutions. Cosmet venous disease of the lower extremities: the “CEAP” classification. Mayo Clin Proc. 1996;71:338–345.8. Furderer CR, Marescaux J, Pavis d’Escurac X, Stemmer
1997;4:167–174.30. Goldman MP, Weiss RA, Bergan JJ. Diagnosis and
Dermatol. 1996;20:313–316.20. Sadick NS. Hyperosmolar versus detergent sclerosing
R. Junctions of the saphenous vein. Anatomy and treatment concepts. Phlebologie. 1986;39:3–14.9. Weiss RA. Evaluation of the venous system by Doppler treatment of varicose veins: a review. J Am Acad Dermatol. 1994;31:393–413, quiz 414–16.31. Goldman MP, Bennett RG. Treatment of telangiectasia: a agents in sclerotherapy. Effect on distal vessel obliteration. J Dermatol Surg Oncol. 1994;20:313–316.21. Goldman MP. A comparison of sclerosing agents.
ultrasound and photoplethysmography or light reflection rheography before sclerotherapy. Semin Dermatol. 1993;12:78–87.10. Weiss RA. Vascular studies of the legs for venous or review. J Am Acad Dermatol. 1987;17:167–182.32. Baccaglini H, Spreafico G, Castro C, Sorrentino P.
Clinical and histologic effects of intravascular sodium morrhuate, ethanolamine oleate, hypertonic saline (11.7%), and sclerodex in the dorsal rabbit ear vein. J Dermatol Surg Oncol. 1991;17:354–362.22. Sadick NS. Sclerotherapy of varicose and telangiectatic arterial disease. Dermatol Clin. 1994;12:175–190.11. Weiss RA, Weiss MA. Continuous wave venous Doppler
Consensus conference on sclerotherapy of varicose veins of the lower limbs. Phlebologie. 1997;12:2–16.33. Guex JJ. Microsclerotherapy. Semin Dermatol.
1993;12:129–134.34. Duffy DM. Sclerotherapy. Clin Dermatol. 1992;10:373–380.35. Bodian EL. Techniques of sclerotherapy for leg veins. Minimal sclerosant concentration of hypertonic saline and its relationship to vessel diameter. J Dermatol Surg Oncol. 1991;17:65–70.23. Weiss RA, Goldman MP. Advances in sclerotherapy.
examination for pretreatment diagnosis of varicose and telangiectatic veins. Dermatol Surg. 1995;21:58–62.12. Thibault PK. Duplex examination. Dermatol Surg.
1995;21:77–82.
Dermatol Clin. 1995;13:431–445.
sunburst venous blemishes. J Dermatol Surg Oncol. 1985;11:696–704.36. Duffy DM. Small vessel sclerotherapy: an overview. Adv
Dermatol. 1988;3:221–242.
Ultrasound-guided foam sclerotherapy (UGFS) is a technique whereby the GSV is sclerosed with a foaming agent such as sodium tetradecyl sulfate or polidocanol utilizing ultrasonography for guidance. This procedure can be effective at abolishing SFJ incompetence and improving clinical outcome in patients with venous disease. When compared to conventional surgery, UGFS has been equally efficacious in ameliorating reflux, but multiple treatment sessions may be required. Endovenous thermal ablation with steam is a more recently introduced technique that has been utilized to achieve both radiologic and clinical improvement of SFJ incompetence. Initial reports have suggested that it is not inferior to EVLA.
Several novel techniques have been developed for closure of the GSV that do not require tumescent anesthesia. Injection of polidocanol endovenous microfoam 1% (Varithena®; see above section for details) has led to improvement in both clinical symptomatology due to SFJ incompetence as well as aesthetic appearance. Similarly, a proprietary cyanoacrylate adhesive (VenaSeal™) has been developed for permanent closure of incompetent superficial truncal leg veins and was approved by the FDA in 2015. The adhesive is delivered via a hydrophobic catheter advanced to a point 5 cm below the SFJ. Mechanochemical endovenous ablation is a technique that combines a rotating wire and the infusion of liquid sclerosant to simultaneously induce endothelial injury. It is currently undergoing comparative trials with radiofrequency ablation.