Telangiectases in venous insufficiency: Point of reflux and treatment strategy

Objective: To verify the role of sources of non-saphenous reflux in the app earance of reticular varices and telangiectases in areas other than the lat eral venous system of Albanese. Setting: Institute of General Surgery and Surgical Specialisations, Interde partmental Centre of Research, Treatment and Phlebolymphological Rehabilita tion, University of Siena. Patients and methods: The study was carried out on 106 women aged 18-65 yea rs who were affected by chronic venous insufficiency (CVI) at the Cla-s Ep Asl stage, according to the CEAP classification. The patients had telangiec tases (200 telangiectactic areas) and reticular varices of the lower limbs of type II and III of the classification of Weiss, with competent saphenous trunks and a normal deep venous system. Sclerotherapy was therefore perfor med, after clinical and duplex ultrasound examination. The records of 185 t elangiectactic area treated 3 years earlier were reviewed. Results: In all cases reticular varices was found together with the telangi ectases. In 73.5% (147/200 areas) one or more incompetent perforating veins was found (average diameter 1.6 mm) and in 83.6% (123/147 areas) it was po ssible to establish that the main source of reflux was in the base of the t elangiectasia. Complete elimination of microvarices was achieved in 88% of cases (176/200 areas; average sessions: 3.5). The complications were haemos iderin pigmentation (1.5%, 3/200 areas) and matting (1%, 2/200 areas). In 2 4 areas resistant to the therapy it was not possible to demonstrate the pre sence of reflux, while in 24.5% of cases (49/200 areas, average surface 15. 4 cm(2)) two sessions of sclerotherapy were sufficient eventually to obtain (about 4 weeks later) the disappearance of the micro-varices. Follow-up af ter 3 years revealed the appearance of new telangiectases in 58.9% of cases (109/185 check-ups). Of these 95.4% (104/109) arose in areas other than th ose treated and therefore only 4.6% (5/109) recurred in the area where the sclerosing treatment had been carried out. Conclusion: In CVI all telangiectases are accompanied by reticular varices, even when not visible on clinical examination; in most cases the sources o f reflux are distinguishable as incompetent perforating veins and are situa ted beneath telangiectactic efflorescences.