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Book Details
Abstract
This classic resource by Drs. Mitchel P. Goldman, Robert A Weiss, and Jean-Jerome Guex provides highly practical, up-to-date guidance for the effective management of varicose veins and other vascular anomalies. It is an indispensable reference for a wide audience including dermatologists, invasive radiologists, family practitioners, vascular and cosmetic surgeons. Clearly written by global experts, Sclerotherapy, 6th Edition, helps those new to the field to gain a firm understanding of successful techniques, as well as showing seasoned practitioners how to improve and hone their skills with today’s best and newest approaches. Case studies and detailed color illustrations offer step-by-step visual guidance.
- Covers everything you need to know with a practical approach , from the pathogenesis of varicosities to diagnostic and treatment options, including evidence-based decision making.
- Helps you optimize outcomes and improve your surgical, injection, and laser techniques with comprehensive, visual guidance, including coverage of common pitfalls and "tricks of the trade."
- Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability.
- Features hot topic coverage of endovenous glue and new endovenous ablation techniques, as well as updated techniques for optimal use of foam sclerotherapy and uses for solutions recently available on the market.
- Discusses new concepts for treating areas other than the legs, including rejuvenation of the hands and chest.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Sclerotherapy | i | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Video Contents | vi | ||
| Preface | vii | ||
| Additional Contributors | viii | ||
| Introduction | ix | ||
| Historical Aspects of Treatment | ix | ||
| Reasons for Treatment | xii | ||
| Present Day Treatment | xii | ||
| References | xiii | ||
| 1 Anatomy | 1 | ||
| Introduction | 1 | ||
| Nomenclature | 1 | ||
| General Considerations | 2 | ||
| Deep Venous System | 3 | ||
| Anatomy of the Superficial Veins | 4 | ||
| Great Saphenous Vein | 4 | ||
| Small Saphenous Vein | 5 | ||
| Other Superficial Veins and Collateral Veins | 6 | ||
| Duplex Ultrasound Anatomy | 6 | ||
| Duplex Ultrasound Markers for Vein Identification | 9 | ||
| The ‘Eye’ Sign | 9 | ||
| The ‘Alignment’ Sign | 9 | ||
| The E Point Sign (Fig. 1.20) | 10 | ||
| The Tibia-Gastrocnemius Angle Sign | 10 | ||
| The Small Saphenous Compartment Sign | 10 | ||
| Relationship between Saphenous Veins and Collaterals | 11 | ||
| Great Saphenous Vein | 11 | ||
| Saphenofemoral Junction | 11 | ||
| Arrangement of the GSV and Its Subcutaneous Collaterals in the Thigh | 12 | ||
| Arrangement of the GSV and Its Subcutaneous Collaterals at the Knee | 14 | ||
| T Vein | 15 | ||
| The Anterior Accessory Saphenous Vein | 15 | ||
| Small Saphenous Vein | 16 | ||
| Saphenopopliteal Junction | 17 | ||
| Thigh Extension of the SSV | 17 | ||
| Arrangement of the SSV and Its Collaterals | 18 | ||
| Foot Veins | 19 | ||
| Perforating Veins | 19 | ||
| Venous Valvular System | 20 | ||
| Nerves of the Leg of Phlebologic Interest | 21 | ||
| Histology | 21 | ||
| Vein Walls | 21 | ||
| Venous Valves | 23 | ||
| Vein Wall Variation | 23 | ||
| Venules | 23 | ||
| Telangiectasias | 24 | ||
| Innervation | 24 | ||
| References | 24 | ||
| 2 Adverse Sequelae and Complications of Venous Hypertension | 27 | ||
| Pathogenesis | 27 | ||
| Molecular Mechanisms | 27 | ||
| Inflammation and Skin Changes | 29 | ||
| Classification of Venous Disease | 30 | ||
| Incidence | 32 | ||
| Symptoms and Signs | 33 | ||
| Edema and Lipodermatosclerosis | 35 | ||
| Pigmentation | 36 | ||
| Venous (Stasis) Dermatitis | 37 | ||
| Atrophie Blanche | 39 | ||
| Ulceration | 40 | ||
| Malignant Degeneration | 42 | ||
| Secondary Complications of Venous Hypertension–Stasis | 43 | ||
| Hemorrhage | 43 | ||
| Superficial Thrombophlebitis | 44 | ||
| Deep Venous Thrombosis | 45 | ||
| Classification | 46 | ||
| References | 49 | ||
| 3 Pathophysiology of Varicose Veins | 55 | ||
| Histochemical Physiology of Varicose Veins | 55 | ||
| Pathophysiology | 59 | ||
| Increased Deep Venous Pressure | 61 | ||
| Proximal Origin | 62 | ||
| Pelvic Obstruction | 62 | ||
| Increased Intra-Abdominal Pressure | 62 | ||
| Saphenofemoral Incompetence | 63 | ||
| Distal Origin | 64 | ||
| Valvular Incompetence | 64 | ||
| Venous Obstruction | 65 | ||
| Arteriovenous Anastomosis | 65 | ||
| Primary Valvular Incompetence | 65 | ||
| Secondary Valvular Incompetence | 67 | ||
| Effects of Pregnancy | 67 | ||
| Menstrual Cycle Effects | 71 | ||
| Constitutive Elements and Progression of Varicose Veins | 71 | ||
| Heredity | 72 | ||
| Aging | 74 | ||
| References | 75 | ||
| 4 Pathophysiology of Telangiectasias | 81 | ||
| Classification | 81 | ||
| Patterns | 81 | ||
| Pathogenesis | 81 | ||
| Incidence | 82 | ||
| Pathophysiology | 82 | ||
| Genetic/Congenital Factors | 82 | ||
| Nevus Flammeus | 83 | ||
| Klippel–Tréaunay Syndrome | 84 | ||
| Nevus Araneus | 87 | ||
| Angioma Serpiginosum | 88 | ||
| Bockenheimer Syndrome (Diffuse Genuine Phlebectasia) | 88 | ||
| Maffucci Syndrome | 88 | ||
| Congenital Poikiloderma | 88 | ||
| Essential Progressive Telangiectasia | 89 | ||
| Cutis Marmorata Telangiectatica Congenita | 89 | ||
| Diffuse Neonatal Hemangiomatosis | 89 | ||
| Acquired Disease with a Secondary Cutaneous Component | 89 | ||
| Component of a Primary Cutaneous Disease | 90 | ||
| Varicose Veins | 90 | ||
| Keratosis Lichenoides Chronica | 91 | ||
| Other Acquired Primary Cutaneous Diseases | 91 | ||
| Hormonal Factors | 92 | ||
| Pregnancy and Estrogen Therapy | 92 | ||
| Malignancy | 93 | ||
| Topical Corticosteroid Preparations | 93 | ||
| Physical Factors | 93 | ||
| Actinic Neovascularization and Vascular Dilation | 93 | ||
| Trauma | 93 | ||
| Contusion | 93 | ||
| Surgical Incisions or Lacerations | 94 | ||
| Infection | 94 | ||
| Generalized Essential Telangiectasia | 94 | ||
| Progressive Ascending Telangiectasia | 95 | ||
| Human Immunodeficiency Virus | 95 | ||
| Radiodermatitis | 95 | ||
| Erythema ab Igne | 95 | ||
| References | 96 | ||
| 5 Noninvasive Examination of the Patient Before Sclerotherapy | 100 | ||
| Medical History | 100 | ||
| CEAP Classification | 100 | ||
| Diagnostic Approach | 102 | ||
| Prior Treatment | 102 | ||
| Symptoms | 102 | ||
| Complications of Varicose Vein Disease | 103 | ||
| Purpose of Venous Evaluation | 103 | ||
| Physical Examination | 103 | ||
| Clinical Testing | 103 | ||
| Trendelenburg Test | 104 | ||
| Cough Test | 104 | ||
| Percussion/Schwartz Test | 104 | ||
| Brodie-Trendelenburg Test | 105 | ||
| Bracey Variation | 107 | ||
| Perthes Test | 108 | ||
| Noninvasive Diagnostic Techniques | 108 | ||
| Doppler Ultrasound | 109 | ||
| Characteristics of Doppler Waveform | 109 | ||
| Doppler Examination Technique | 111 | ||
| Femoral Vein | 111 | ||
| Differentiation of Femoral from Saphenous Veins | 112 | ||
| Popliteal Vein | 112 | ||
| Posterior Tibial Vein | 113 | ||
| Superficial Veins | 113 | ||
| Perforating Veins | 113 | ||
| Posttreatment Evaluation | 114 | ||
| Duplex Ultrasound Scanning | 114 | ||
| Aid to Sclerotherapy | 115 | ||
| Posttreatment Evaluation | 117 | ||
| Photoplethysmography | 118 | ||
| Light Reflection Rheography | 120 | ||
| Air Plethysmography | 121 | ||
| Foot Volumetry | 122 | ||
| Use of Noninvasive Techniques | 123 | ||
| Examination of Deep Veins | 124 | ||
| Examination of Saphenous Vein Trunks | 125 | ||
| Examination of Tributaries of the Saphenous Trunks | 126 | ||
| Examination of Perforating Veins | 127 | ||
| Differentiation of the Relative Contribution of Deep and Superficial Reflux | 128 | ||
| Evaluation of the Origin of Recurrences after Ligation and Stripping | 129 | ||
| Evaluation of Vulvar Varices | 129 | ||
| Invasive Diagnostic Techniques | 130 | ||
| Venography | 130 | ||
| Ascending Venography | 130 | ||
| Descending Venography | 130 | ||
| Intraosseous Venography | 130 | ||
| Varicography | 131 | ||
| Thermography | 131 | ||
| Future Evaluation Techniques | 133 | ||
| Near-Infrared Imaging | 133 | ||
| References | 133 | ||
| 6 Use of Compression Therapy | 137 | ||
| Historical Development | 137 | ||
| Mechanism of Action | 137 | ||
| Edema | 137 | ||
| Lymph Drainage | 137 | ||
| Venous System | 138 | ||
| Microcirculation | 139 | ||
| Arterial Flow | 140 | ||
| Basic Principles of Compression | 140 | ||
| Terminology | 140 | ||
| Compression Pressure and Laplace’s Law | 141 | ||
| Practical Consequences of Laplace’s Law | 141 | ||
| Measurement of Compression Pressure | 142 | ||
| Laboratory Measurements of Compression Stockings | 142 | ||
| Measurements of Interface Pressure on the Leg | 144 | ||
| Resting and Working Pressure | 144 | ||
| Measurement of Stiffness | 145 | ||
| Compression Material | 145 | ||
| Compression Bandages | 145 | ||
| Standards for Compression Bandages | 145 | ||
| Inelastic and Short-Stretch Bandages | 146 | ||
| Elastic, Long-Stretch Bandages | 148 | ||
| Multilayer Bandages | 148 | ||
| Training in the Application of Bandages | 149 | ||
| Compression Bandages or Compression Stockings? | 151 | ||
| Compression Stockings | 152 | ||
| Characteristics of Medical Graduated Compression Stockings | 152 | ||
| Ready-Made Stockings | 153 | ||
| Custom-Made Stockings | 153 | ||
| Prescription of a Stocking | 153 | ||
| Stocking Lengths | 154 | ||
| Pressure Gradient | 154 | ||
| Proper Fit and Position | 154 | ||
| Donning Medical Compression Stockings | 155 | ||
| Patient Compliance | 156 | ||
| Care of the Medical Compression Stocking | 157 | ||
| Dangers, Complications and Contraindications | 157 | ||
| Clinical Indications for Compression Therapy | 158 | ||
| The Use of Compression Alone in Preventing Varicose and Telangiectatic Leg Veins | 158 | ||
| Rationale for the Use of Compression in Varicose Vein Sclerotherapy | 158 | ||
| How Much Pressure is Necessary for Varicose Veins? | 159 | ||
| Local Pads and Rolls | 159 | ||
| How Long Should Compression be Maintained? | 160 | ||
| Sclerotherapy of Small Veins | 162 | ||
| Rationale for the Use of Compression in the Treatment of Telangiectasias | 162 | ||
| How Much Pressure is Necessary to Compress Telangiectasias? | 162 | ||
| How Long Should Compression be Maintained after Sclerotherapy of Small Veins? | 164 | ||
| Compression Therapy after Venous Surgery and Endovenous Catheter Procedures | 164 | ||
| Pregnancy | 164 | ||
| Edema Caused by Sitting and Standing; Occupational Edema | 165 | ||
| Prevention of Deep Vein Thrombosis and Postthrombotic Syndrome | 166 | ||
| Treatment of Superficial Phlebitis, Deep Vein Thrombosis and Postthrombotic Syndrome | 166 | ||
| Venous Ulcers | 166 | ||
| Lymphedema | 167 | ||
| Other Indications | 167 | ||
| References | 167 | ||
| 7 Mechanism of Action of Sclerotherapy | 173 | ||
| General Mechanism for Producing Endothelial Damage | 173 | ||
| Categories of Sclerosing Solutions | 175 | ||
| Detergent Solutions | 175 | ||
| Osmotic Solutions | 176 | ||
| Chemical Solutions | 176 | ||
| Factors Predisposing to Thrombosis | 177 | ||
| Factors Predisposing to Endofibrosis | 177 | ||
| Experimental Evaluation of Sclerosing Solutions | 178 | ||
| Sodium Tetradecyl Sulfate | 179 | ||
| Sodium Morrhuate | 179 | ||
| Ethanolamine Oleate | 180 | ||
| Polidocanol | 180 | ||
| Polidocanol: Liquid Versus Foam | 180 | ||
| Hypertonic Saline | 181 | ||
| Hypertonic Glucose/Saline | 181 | ||
| Glycerin: Chromated Versus Nonchromated | 182 | ||
| Polyiodinated Iodine | 182 | ||
| Comparative Efficacy in the Animal Model | 182 | ||
| Comparative Efficacy in the Human Model | 183 | ||
| Clinical Use of Sclerosing Agents | 183 | ||
| Osmotic Agents | 184 | ||
| Hypertonic Saline | 184 | ||
| Advantages | 184 | ||
| Disadvantages | 184 | ||
| Modification of the Solution and the Technique | 185 | ||
| Hypertonic Glucose–Saline | 185 | ||
| Advantages | 185 | ||
| Disadvantages | 186 | ||
| Sodium Salicylate | 186 | ||
| Chemical Irritants | 186 | ||
| Chromated Glycerin/Glycerin | 186 | ||
| Advantages | 186 | ||
| Disadvantages | 187 | ||
| Ethanol | 187 | ||
| Detergent Sclerosing Solutions | 187 | ||
| Sodium Morrhuate | 187 | ||
| Ethanolamine Oleate | 187 | ||
| Advantages | 187 | ||
| Disadvantages | 188 | ||
| Sodium Tetradecyl Sulfate | 188 | ||
| Advantages | 188 | ||
| Disadvantages | 189 | ||
| Historical Manufacturing of STS Injections | 189 | ||
| Current Manufacturing of STS Injections | 190 | ||
| Polidocanol | 190 | ||
| Advantages | 192 | ||
| Disadvantages | 192 | ||
| Sclerosing Solution Combinations | 193 | ||
| Sequential Injections of Different Sclerosing Solutions | 193 | ||
| Volumes, Concentrations and Progressive Dilution of Sclerosing Agents | 193 | ||
| Foam Sclerotherapy (Foamed Sclerosing Agents, Sclerofoam) | 194 | ||
| References | 196 | ||
| 8 Complications and Adverse Sequelae of Sclerotherapy | 200 | ||
| Adverse Sequelae | 200 | ||
| Postsclerotherapy Hyperpigmentation | 200 | ||
| Etiologic Factors | 200 | ||
| Solution Type and Concentration | 202 | ||
| Technique | 203 | ||
| Gravitational and Other Intravascular Pressures | 203 | ||
| Vessel Diameter | 203 | ||
| Predisposition to Pigmentation | 203 | ||
| Postsclerotherapy Coagula | 205 | ||
| Duration | 206 | ||
| Prevention and Minimization | 206 | ||
| Treatment | 206 | ||
| Temporary Swelling | 209 | ||
| Etiologic Factors | 209 | ||
| Prevention and Treatment | 209 | ||
| Teleniectatic Matting | 209 | ||
| Etiologic Factors | 210 | ||
| Angiogenesis | 211 | ||
| Prevention and Treatment | 212 | ||
| Pain | 213 | ||
| Prevention | 213 | ||
| Type and Size of Needle | 213 | ||
| Technique | 213 | ||
| Type of Sclerosing Solution | 213 | ||
| Localized Urticaria | 214 | ||
| 9 Clinical Methods for Sclerotherapy of Varicose Veins | 262 | ||
| Historical Review of Techniques | 262 | ||
| Tournay (French) Technique | 262 | ||
| Sigg (Swiss) Technique | 263 | ||
| Fegan (Irish) Technique | 263 | ||
| Treatment of Reflux From the Saphenofemoral Junction | 264 | ||
| Injection Technique | 265 | ||
| Patient Position | 265 | ||
| Standing | 265 | ||
| Standing and Reclining | 265 | ||
| Leg Elevation (Fegan) | 266 | ||
| Two-Phase (Sigg) Technique | 267 | ||
| Reclining | 267 | ||
| Foam Sclerotherapy | 268 | ||
| Foam Stability | 270 | ||
| Side Effects | 274 | ||
| Our Technique for the Treatment of Reticular and Telangiectatic Leg Veins | 275 | ||
| Combination Therapy | 275 | ||
| Contraindications to Foam Sclerotherapy | 275 | ||
| Patent Foramen Ovale | 275 | ||
| Thromboembolism and Thrombophilia | 276 | ||
| Migraine | 276 | ||
| Other Injection Techniques | 276 | ||
| Air Bolus | 276 | ||
| Use of a Tourniquet | 276 | ||
| Ultrasound-Guided Injection | 276 | ||
| Doppler-Guided Injection | 279 | ||
| Endoscopic Injection | 280 | ||
| Intravascular Ultrasound- Controlled Injection | 280 | ||
| Transcatheter Duplex Ultrasound-Guided Sclerotherapy | 281 | ||
| Mechanochemical Endovenous Ablation (MOCA) | 281 | ||
| VeinRx Infusion Catheter | 281 | ||
| Device Preparation | 283 | ||
| Delivery of Sclerosant | 283 | ||
| Radiologically Assisted Foam Sclerotherapy | 283 | ||
| Treatment of Specific Problems | 283 | ||
| Treatment of Large-Diameter Great Saphenous Veins | 283 | ||
| Treatment of Vulvar Varicosities | 283 | ||
| Treatment of Ulcers | 284 | ||
| Treatment of Venous Malformations | 284 | ||
| Treatment of Other Venous Conditions | 285 | ||
| Treatment of Recurrences | 285 | ||
| Does the Menstrual Cycle Influence Sclerotherapy? | 285 | ||
| Recommended Sclerosing Solution Amounts and Concentrations for Nonfoam Sclerotherapy | 286 | ||
| Postsclerotherapy Compression | 288 | ||
| General Contraindications to Treatment | 288 | ||
| Pregnancy | 288 | ||
| Inability to Ambulate | 289 | ||
| History of Thrombophlebitis and Deep Vein Thrombosis | 289 | ||
| Allergic Reaction | 289 | ||
| Patients Taking Disulfiram | 290 | ||
| Patients Taking Tamoxifen | 290 | ||
| Patients Taking Hormones | 290 | ||
| Other Contraindications | 290 | ||
| Warm Weather | 290 | ||
| Travel | 290 | ||
| Age | 290 | ||
| Case Histories | 290 | ||
| References | 307 | ||
| Chapter 9: Appendix | 311 | ||
| Schematic Principal Types of Varicose Networks, Schematic Treatments | 311 | ||
| 10 Role of Surgery in the Treatment of Varicose Veins | 313 | ||
| Background | 313 | ||
| Basis and Aim of Surgery | 313 | ||
| The Different Surgical Procedures | 313 | ||
| Surgery Without Saphenous Trunk Preservation | 313 | ||
| Principle and Controversies | 313 | ||
| Technical Information | 314 | ||
| Conventional Surgery Variants | 314 | ||
| Saphenous Trunk Stripping with Preservation of Saphenofemoral Confluence, with or Without Incompetent Tributary Phlebectomy and/or Incompetent Perforator Interruption | 314 | ||
| Cryostripping | 315 | ||
| Surgery with Saphenous Trunk Preservation | 315 | ||
| Isolated Flush Ligation or Limited Resection | 316 | ||
| SFJ and/or SPJ Ligation Plus Incompetent Tributary Phlebectomy with or Without Incompetent Perforator Interruption | 317 | ||
| SFJ Wrapping or Valvuloplasty Plus Incompetent Tributary Phlebectomy with or Without Incompetent Perforator Interruption | 317 | ||
| SFJ Wrapping | 317 | ||
| Valvuloplasty or Valve Repair | 317 | ||
| Ambulatory Phlebectomy | 317 | ||
| Varices Phlebectomy | 317 | ||
| CHIVA Method | 317 | ||
| Investigations to be Done before Varicose Vein Surgery | 317 | ||
| Patient Information | 319 | ||
| Anesthesia and Hospitalization | 319 | ||
| Anesthesia | 319 | ||
| Hospitalization | 320 | ||
| Postoperative Care and Convalescence | 320 | ||
| Drug Treatment | 320 | ||
| Postoperative Elastic Compression | 321 | ||
| Recovery and Convalescence | 321 | ||
| Surgical Complications | 321 | ||
| Perioperative Complications | 321 | ||
| Postoperative Complications | 321 | ||
| Hematoma | 322 | ||
| Local Infectious Complications | 322 | ||
| Lymphatic Complications | 322 | ||
| Neurologic Complications | 322 | ||
| Venous Thromboembolic Complications | 322 | ||
| Cosmetic Complications | 322 | ||
| Redo Surgery | 322 | ||
| Postsurgical Follow-Up | 322 | ||
| Results From Surgery | 322 | ||
| Surgery Without Preservation of the Saphenous Trunk | 323 | ||
| Conventional Surgery | 323 | ||
| Natural Evolution of the Disease Versus Conventional Surgery | 323 | ||
| Conservative Treatment Versus Open Surgery | 323 | ||
| Outcome of Conventional Surgery in Observational Studies | 323 | ||
| RCTs on Conventional Surgery Versus Other Operative Treatment | 323 | ||
| Classical Surgery Variants | 323 | ||
| Saphenous Trunk Stripping with Preservation of the Saphenofemoral Confluence with or without Incompetent Tributaries Phlebectomy with or without Incompetent Perforator Interruption | 323 | ||
| Cryostripping | 323 | ||
| Surgery with Saphenous Trunk Preservation | 323 | ||
| Isolated Flush Ligation or Limited Resection of the SFJ and/or SPJ | 323 | ||
| SFJ and/or SPJ Ligation Plus Incompetent Tributaries Phlebectomy with or Without Incompetent Perforator Interruption | 336 | ||
| SFJ Wrapping or Valvuloplasty Plus Incompetent Tributaries Phlebectomy with or Without Incompetent Perforator Interruption | 336 | ||
| Ambulatory Phlebectomy | 336 | ||
| Hook Phlebectomy or Powered Phlebectomy | 336 | ||
| Varices Phlebectomy with Conservation of the Refluxing Saphenous Trunk | 336 | ||
| CHIVA Method | 338 | ||
| Indications for Surgery | 338 | ||
| Indications According to Etiology | 339 | ||
| Indications According to the Clinical Presentation | 339 | ||
| Pregnancy | 341 | ||
| Association of VV with Another Disease | 341 | ||
| Obesity | 341 | ||
| Coronary and Peripheral Arterial Occlusive Disease | 341 | ||
| Lymphedema | 341 | ||
| Indications According to the CEAP CLASS | 342 | ||
| Indications According to Anatomic and Physiopathologic Anomaly | 342 | ||
| Reflux at the SFJ and/or at the SPJ | 342 | ||
| Competent Saphenous Trunk | 342 | ||
| Combination of Primary Deep Reflux and Primary Varices | 342 | ||
| Combination of Primary Deep Obstruction and Primary Varices | 342 | ||
| Incompetent Perforator and Varices | 342 | ||
| Conclusions | 343 | ||
| References | 343 | ||
| Appendix 10.1 | 346 | ||
| Information for the Patient | 346 | ||
| 11 Intravascular Approaches to the Treatment of Varicose Veins | 347 | ||
| Introduction | 347 | ||
| Open Venous Surgery | 347 | ||
| Radiofrequency Ablation | 347 | ||
| Closurefast Catheter | 351 | ||
| Combination with Ambulatory Phlebectomy | 352 | ||
| Endovenous Laser Ablation | 352 | ||
| 810-nm Diode Laser | 354 | ||
| 940-nm Diode Laser | 355 | ||
| 980-nm Diode Laser | 355 | ||
| 1064-nm Nd:YAG Laser | 355 | ||
| 1320-nm Nd:YAG Laser | 356 | ||
| 1470-nm Diode Laser | 356 | ||
| 1500-nm Diode Laser | 357 | ||
| Endovenous Laser Treatment of the Small Saphenous Vein | 357 | ||
| Technique for Endoluminal Laser Ablation Using a Standard Sharp Fiberoptic | 357 | ||
| Ultrasound Guided Foam Sclerotherapy | 358 | ||
| Cyanoacrylate Adhesive | 360 | ||
| Mechanochemical Ablation | 360 | ||
| Endovenous Steam Ablation | 361 | ||
| Conclusion | 361 | ||
| References | 361 | ||
| 12 Clinical Methods for Sclerotherapy of Telangiectasias | 365 | ||
| Historical Review of Techniques | 365 | ||
| Indication | 365 | ||
| Injection Technique | 365 | ||
| Preinjection Procedure | 365 | ||
| Preparation and Visualization of the Vessels | 369 | ||
| Equipment | 369 | ||
| Needle and Syringe | 369 | ||
| Table and Lighting | 370 | ||
| Skin Tension | 370 | ||
| Depth of Injection | 370 | ||
| Air-Bolus (Block) or Foam Technique | 371 | ||
| Foam Injection | 371 | ||
| Quantity of Sclerosing Solution Per Injection Site | 372 | ||
| Concentration and Strength of Sclerosing Solutions | 373 | ||
| Pressure of Injection | 373 | ||
| Post-Treatment Techniques | 374 | ||
| Post-Treatment Compression | 374 | ||
| Microthrombectomy | 374 | ||
| Repeat Treatment Sessions | 375 | ||
| Poor Results of Microsclerotherapy: How to Analyze the Reasons | 375 | ||
| Sclerotherapy for Facial Telangiectasia | 376 | ||
| Sclerotherapy for Essential Telangiectasia | 376 | ||
| Sclerotherapy for Other Lesions | 377 | ||
| Conclusions | 377 | ||
| References | 386 | ||
| 13 Treatment of Leg Telangiectasias with Laser and High-Intensity Pulsed Light | 388 | ||
| Histology of Leg Telangiectasias | 390 | ||
| Laser Treatment of Leg Telangiectasias | 390 | ||
| Carbon Dioxide Laser | 393 | ||
| Argon Laser | 393 | ||
| Argon Laser: Contact Probe Delivery | 394 | ||
| Krypton Triphosphate and Frequency-Doubled Nd:YAG (532 nm) | 394 | ||
| Copper Bromide 578 nm | 396 | ||
| Flashlamp-Pulsed Dye Laser, 585 or 595 nm | 397 | ||
| Long-Pulse Flashlamp-Pumped Pulsed Dye Laser | 399 | ||
| Long-Pulse Alexandrite (755 nm) | 405 | ||
| Diode Lasers | 406 | ||
| Radiowave Coagulation (RFA) | 408 | ||
| Fiber-Guided Laser Coagulation | 408 | ||
| High-Intensity Pulsed Light | 408 | ||
| Nd:YAG Laser, 1064 nm | 412 | ||
| Vasculite | 413 | ||
| Cooltouch Varia | 413 | ||
| Coolglide | 414 | ||
| Lyra | 414 | ||
| Gentleyag | 416 | ||
| Smartepil LS | 416 | ||
| Xeo | 416 | ||
| Quantel Medical Multipulse Mode | 416 | ||
| Protection of Epidermis: Epidermal Cooling | 416 | ||
| Percutaneous Laser Treatment: Nd:YAG | 418 | ||
| Combined Treatment Approaches | 418 | ||
| Combined Laser–Sclerotherapy Treatment of Leg Telangiectasias | 418 | ||
| Combined Laser Nd:YAG/PDL Treatment of Leg Telangiectasias | 421 | ||
| Future Directions | 422 | ||
| Conclusions | 422 | ||
| References | 422 | ||
| 14 Venoactive Drugs | 426 | ||
| Introduction | 426 | ||
| Classification of VAD | 426 | ||
| Benzopyrones | 426 | ||
| α-Benzopyrones | 426 | ||
| γ-Benzopyrones (Flavonoids) | 427 | ||
| Diosmin and Micronized Purified Flavonoid Fraction | 428 | ||
| Rutosides and Oxerutin | 428 | ||
| Saponins | 428 | ||
| Escin | 428 | ||
| Ruscus | 428 | ||
| Other Plant Extracts | 428 | ||
| Phytotherapy | 428 | ||
| Nutritional Supplements | 428 | ||
| Other Preparations Used in the Past | 429 | ||
| Synthetic Drugs | 429 | ||
| Calcium Dobesilate | 429 | ||
| Benzarone | 429 | ||
| Naftazone | 429 | ||
| Tribenoside | 429 | ||
| Animal-Derived Drugs | 429 | ||
| Principal Mode of Action of Vad | 429 | ||
| Administration, Dosage and Limits | 429 | ||
| Duration of Treatment | 429 | ||
| Premenstrual Syndrome | 430 | ||
| Pregnancy and Lactation | 430 | ||
| Topical Application | 430 | ||
| Adverse Effects | 430 | ||
| Scientifically Recognized Indications | 430 | ||
| Main Indications for VAD | 430 | ||
| Leg Ulcer | 431 | ||
| Other Indications | 431 | ||
| Combination with Compression | 431 | ||
| Results | 431 | ||
| Demonstrated Therapeutic Effect | 431 | ||
| Guidelines | 431 | ||
| Conclusions | 431 | ||
| References | 432 | ||
| Index | 435 | ||
| A | 435 | ||
| B | 435 | ||
| C | 435 | ||
| D | 437 | ||
| E | 437 | ||
| F | 438 | ||
| G | 438 | ||
| H | 438 | ||
| I | 439 | ||
| K | 439 | ||
| L | 439 | ||
| M | 440 | ||
| N | 440 | ||
| O | 440 | ||
| P | 440 | ||
| Q | 441 | ||
| R | 441 | ||
| S | 441 | ||
| T | 443 | ||
| U | 443 | ||
| V | 443 | ||
| W | 444 | ||
| X | 444 |