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Bulging varicose veins and unsightly “roadmap” telangiectatic webs affect millions of patients around the world. The incidence is highest in Caucasian patients in which telangiectasias comprise the most common of all cosmetic complaints. This is borne out by epidemiologic surveys in which leg telangiectasia are reported in 70% of women.1 These same 24 city studies of thousands of patients indicate that 53% of the population over 50 years of age show some venous reverse flow.1 Women are at least 4 times more likely than men to develop telangiectasia, while males have double the risk of developing large varicose veins.2 Women aged over 50 years are five times more likely than women aged 29 or less to develop large varicose veins. Pregnancy increases the risk of varicose vein development by a factor of 1.5× to 3× and is associated with higher risks following three pregnancies.1,3,4 Increased body mass index correlates with a higher risk of reverse flow or reflux which leads to pain, swelling and abnormalities of the saphenous system.5,6 A positive familial history of disease is well known to increase the risk for varicose veins. Varicose veins may cause significant morbidity including chronic stasis dermatitis, ankle edema, spontaneous bleeding, superficial thrombophlebitis, recurrent cellulitis, lipodermatosclerosis and skin ulceration on the ankle and foot.
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The incidence of varicose veins increases with each decade of life. Increased incidence has led to increased demand for treatment of varicose and telangiectatic veins as the average age of the US population grows. While 41% of women in the fifth decade have varicose veins, this number rises to 72% in the seventh decade.7 Statistics for men are similar with 24% incidence in the fourth decade, increasing to 43% by the seventh decade. Six million workdays per year may be lost in the United States due to complications of varicose veins, although this number is being affected by endovenous ablation techniques.8 Treatment is now much less complicated as an outpatient procedure avoiding dreaded stripping. As such noninvasive treatments are more frequently utilized so that lost workdays may actually be decreasing, although these statistics do not exist.
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The main techniques employed in the dermatologist's office for treatment of cosmetic spider veins are sclerotherapy and lasers. For larger varicose veins, dermatologic surgeons employ sclerotherapy (with or without Duplex ultrasound guidance), ambulatory phlebectomy, and endovenous ablation by radiofrequency or laser. Sclerotherapy, which is defined as the intravascular introduction of a sclerosing substance, is the most frequently utilized procedure. We recommend ...