Telangiectasia- sclerotherapy and foam therapy

Capillary varicose veins often settle under the skin and have a red or bluish color. They usually become thinner than 1mm and are also called telangiectasia. The appearance of these varicose veins is tree branches. Approximately 50% of adults have one or more capillary varicose veins in the leg.

Causes of Capillary Varicose veins

The first reason is the leaks in the deep veins, and it develops due to the backfire of the blood while sitting or standing. With the effect of this high pressure, the veins in the skin expand and the cosmotic disorder is exposed. In these patients with capillary varicose veins, firstly, the presence of leakage should be investigated with Doppler ultrasound.

Figure 1. Deep sources of capillary varicose veins

Apart from leakage, there are many reasons that can lead to capillary varicose veins. These are: congenital causes, chemical agents, radiation, trauma, rheumatic diseases, hormonal factors.

Treatment of Capillary Varicose Veins

The most important approach in the treatment of capillary varicose veins is to reveal the cause and attempt to treat it.

Superficial Laser Therapy

If the main problem is cosmetics, laser applications to superficial capillary varicose veins on the skin can be beneficial. Success in these laser applications varies depending on the skin color (melanin pigment), the thickness of the vein applied, the wavelength of the laser light applied, the amount of energy applied, the diameter of the laser light applied. For example, in short capillary varicose veins located 0.7mm deep on the surface, a short wavelength laser such as 500-600nm is applied, while in those 3mm deep, it is necessary to apply longer wavelength like 1064nm. The diameter of the applied laser light should be half the diameter of the applied vessel.

Figure 2. Laser application to capillary varicose veins

It is also beneficial to cool the skin during the procedure in order to prevent burns during the procedure.

With this treatment, 75-100% success can be achieved. Depending on this treatment, there may be a darkening problem in the skin.

SCLEROTHERAPY / FOAM TREATMENT

Sclerotherapy is the elimination of the vein by intravenous injection of intravenous cells into agents, either liquid or foam. Sclerotherapy is often applied to small-sized varicose veins such as capillaries or 1-3mm diameter superficial varicose veins without significant leakage.

Before sclerotherapy, venous Doppler ultrasound should be performed to determine whether these capillary varicose veins are due to a leak. If they have developed a leak result, sclerotherapy should be applied to the capillary varicose veins first after the treatments for this leak are performed.

When sclerotherapy is not applied

• Pregnant women,
• People over the age of 75,
• Very inactive people with a high risk of deep vein blockage,
• People with diabetes, liver, kidney, heart, lung or bleeding problems
• Those with serious leg artery disease
• Those with severe allergic asthma
• Patients who have recently had vascular infections

In this method, sclerosing agents such as high concentration salt water or other detergent derivation are applied by entering very thin needles into the capillary varicose veins.

The percentage of sclerosing agent to be applied according to the diameter of the vessel is selected in sclerotherapy. Their concentration ranges from 0.5% to 3%.

Following the application of these sclerosing agents into the vein, edema in the cells in the vein and then loses its life. The vessel disappears completely in the following months.

The most preferred form of administration is foam sclerotherapy. In this technique, the sclerotherapeutic agent penetrates more vascular areas. Therefore, its effectiveness is higher than direct application. In this technique, the foam is obtained by mixing the sclerotic agent with two 1/4 air injectors and the triple tap that mixes them. The tracking is the same as for direct application.

Figure 3.4. Foam preparation process

In foam sclerotherapy, an average of 12ml of foam is applied in each session.

Allergic reactions due to the agent applied to this treatment or skin necrosis due to escape from the vein may develop.

Following the procedure, elastic bandage is wrapped on the applied leg for 2 days or varicose socks are worn. Then varicose stockings or compression is continued for 1 week. Approximately 15-30 days after the application, the clots that accumulate in the vein where sclerotherapy was applied are punctured by needle and emptied. If this discharge is not done, yellow purple colors are formed due to the collapse of the clot in the vein. This situation is less common in evacuated patients. Compression is applied 2 days after the procedure.

During this treatment, the vessel disappears within seconds. However, the capillaries that disappear within a few minutes become visible again. Compression is applied to the applied area after this procedure and the vascular disappearance takes weeks or months (Figure 1).

Figure 6. Before and after Sclerotherapy

Figure 7. Before and after Sclerotherapy

It is not correct to show that it disappeared immediately after application in various sclerotherapy images. If the images belonging to a few minutes after the application are placed, it will be understood that the image is different. In other words, it will be seen that the existing vein has not disappeared. It takes 3-6 months for the true vessel to disappear.

SCLEROTHERAPY COMPLICATIONS

Sclerotherapy is one of the most frequently used and most effective methods in the treatment of capillary varicose veins. However, various complications are rarely encountered during and after scleroterpy applications.

These complications are;

1. Hyperpigmentation (Color darkening): It is the most common complication and it develops due to the appearance of substances such as hemosiderin with the destruction of thrombus accumulated in the vein following sclerotherapy. To prevent this, the thrombus inside the vessel is emptied on the 15th day. Telangiectases (Telangiectatic matting) developing due to scrotherapy: New thin telangiectasia may develop around the areas where scleroter is applied. The reason for these is not fully known. However, 80-90% of these newly developing telangiectasias disappear in an average period of 6 months.
2. Skin necrosis and ulcer: It develops due to the outflow of the sclerosing agent.This complication often develops due to the application of highly concentrated sclerosing agent to very small lesions. In cases where the sclerosing substance comes out of the vein, swelling under the skin should be removed by massage and if the applied substance is in high concentration, saline should be injected to provide dilution to that area.
3. Systemic allergic reaction: very rarely, hypersensitivity reaction may occur, characterized by symptoms such as rashes, shortness of breath, decreased blood pressure, palpitations. Treatment: urgent antihastamine and cortisone are applied. If the reaction is very severe, adrenaline can be administered. Subsequently, cortisone treatment is continued for one week.
4. Superficial thrombophlebitis and deep vein thrombosis: rarely, when high concentration sclerosing agents are used, these can cause clotting in the vessels if they reach superficial veins from capillaries. In these patients, genetic predisposition can be combined with birth control pills or other hormone drugs. Superficial thrombophlebitis recover in a short time. However, deep vein occlusion often develops after injections applied to superficial varicose veins at high volume and concentration. Long-term anticoagulants should be used in these patients.

In conclusion, although sclerotherapy is an effective method that is applied quite frequently, it is an application that can bring many complications, although rare, if not observed. The important thing is to take precautions for these complications and to know what can be done to eliminate them in patients who develop complications.

Dr.İlhan Gölbaşı