Varicose Veins Chronic Venous Insufficiency

Total Page:16

File Type:pdf, Size:1020Kb

Varicose Veins Chronic Venous Insufficiency Sonocartography: Don’t be a technician!! Marcus Stanbro, DO, FSVM Center for Venous & Lymphatic Medicine Saturday, March 24, 2018 Standing venous reflux exam Disclosures No pertinent disclosures Standing Venous Duplex Objectives 1. Quickly review indications for obtaining a standing venous exam 2. Introduce basic methodology for performing the standing reflux exam 3. Highlight a few examples and diagnostic pearls Limitations 1. Today’s discussion will focus on the duplex exam, but this information must be combined with patient history and physical exam. 2. Other tools used include the clinical, etiologic, anatomic and pathophysiologic scoring (CEAP score), Venous Clinical Severity Score (VCSS), and different QOL assessments. 3. Will not discuss ultrasound guided access Abbreviations DUS = Duplex Ultrasound FV = Femoral Vein (replaces superficial femoral vein) GSV = Great saphenous vein (replaces Greater or Long) SSV = Small saphenous vein (replaces Short or Lesser) AASV = Anterior accessory saphenous vein (replaces lateral) PASV = Posterior accessory saphenous vein SFJ = Saphenofemoral Junction SPJ = Saphenopopliteal Junction Supine basics 1. Four components: 1. B-Mode – Appearance 2. Color 3. Doppler 4. Compression Reflux Definition Flow = wrong direction 1. Reflux = pathologic retrograde flow 1. Deep system = >1.0 second 2. Superficial system = >0.5 seconds 2. How do you elicit reflux? Needs standardization 1. For flow: you have to create a pressure gradient 1. Valsalva 2. Compression – Release (calf squeeze) Indications 1. Evaluation of leg discomfort and/or swelling 2. Pre-operative (VV/CVI +/- ulcers) 3. Post-operative (VV/CVI +/- ulcers) 4. Surveillance* *Not proven Varicose Veins Chronic Venous Insufficiency Importance & Impact Presentation Diagnosis Treatment Etc. (special circumstances, complications, etc) Importance & Impact IMPORTANCE OF VENOUS DISEASE It is estimated that 20% of American women and 7% of American men suffer from venous disease Venous disease results in symptoms such as aching, fatigue, swelling, and pain in the legs that can interfere with daily living Cosmetic issues may affect quality of life At least 20% of patients with venous disease (namely GSV reflux) will develop leg ulcers Venous Ulcers Many take > 9 months to heal Up to 66% last > 5 years Affect 1% general population w/ annual healthcare cost of $3 billion Presentation: Spectrum of venous disease C4b lipodermatosclerosis C1 telangiectasia C2 varicose veins C6 venous ulceration C1 reticular veins C3 Swelling Terms to describe Varicose Vein Saphenofemoral Junction (SFJ) Deep/superficial vein junction Great Saphenous Vein (GSV) Trunk vein, usually straight Reflux Retrograde flow in the leg Varicosities Superficial tributaries beneath the skin Typically below the knee Duplex Testing Patient History Duplex Testing-History Absolutely essential components: Previous DVT or superficial thrombophlebitis Previous intervention Vein “stripping”, true ligation, division, and removal of saphenous vein Phlebectomy Catheter-based ablations (length of treated vein), etc Injection sclerotherapy Duplex Testing-History Detailed (working with vein center/phlebologist) Previous DVT or superficial thrombophlebitis Previous intervention Treatment of the junction None Flush ligation Distal ligation preserving terminal valve and superficial epigastric Repeat for recurrence, foam sclerotherapy, etc. Treatment of the main trunk None Ablation (length) Stripping (length) Duplex Testing-History Detailed cont’d Treatment of tributaries (concomitant vs delayed) None phlebectomies Sclerotherapy (foam or liquid) Catheter ablations Treatment of perforating veins None Ablation Ligation (epifascial vs subfascial i.e. SEPS) Sclerotherapy (foam or liquid) Duplex Testing-Exam Duplex Testing-Exam Lipodermatosclerosis – Severe Venous Hypertension Duplex Testing Methodology Venous Duplex-Deep Supine Duplex Assess for patency of deep system CFV FV Popliteal vein Standing Duplex Reflux of CFV Pop V Venous Duplex-Superficial Standing Duplex Assess size and function of superficial system Determine source of reflux Determine status of perforating veins Standing Reflux Exam Eliciting the Reflux Essential to create adequate pressure gradient!! Valsalva Attempts at standardizing involve devise using forced expiration Compression and release Hand squeeze Rapid cuff deflator Eliciting the Reflux Essential to create adequate pressure gradient!! Rapid cuff deflator Typically placed on the proximal calf, BUT ideally should be placed over the “reservoir” A Comparison of the Cuff Deflation Method With Valsalva's Maneuver and Limb Compression in Detecting Venous Valvular Reflux Arie Markel, MD; Mark H. Meissner, MD; Richard A. Manzo, CCVT; Robert O. Bergelin, MS; D. Eugene Strandness, Jr, MD Arch Surg. 1994;129(7):701-705 ←Reservoir The “Reservoir” Standing venous exam Areas of concern or sources of errors 1. Position of body (Standing if possible) 2. Position of cuff 3. Time of day? 4. Use of stockings? 5. Patterns of veins and likely suspects Terms to describe Varicose Vein Saphenofemoral Junction (SFJ) Deep/superficial vein junction Great Saphenous Vein (GSV) Trunk vein, usually straight Reflux Retrograde flow in the leg Varicosities Superficial tributaries beneath the skin Typically below the knee Standing venous exam Sources of reflux Name the 4 sources of reflux. Standing venous exam Sources of reflux 1. Junctional (GSV, SSV) 2. Pudendal/pelvic 3. Perforators 4. “Siphon” 5. “Re-entry” (original source is 1-4 above) Examples Potential sources of reflux: AASV Pudendal Hach’s perforator Pudendal/ Vulvar Varices Hach’s Perforator Profunda Femoral Vein Patterns of Reflux Big vein – big reservoir Smaller vein- big reservoir Patterns of Reflux Big vein – small reservoir Examples Examples Examples Examples Examples Examples Examples WW Examples Examples Examples Examples Pearls Significant findings- Asymmetry Significant Findings - STP Significant Findings – Pulsatile Flow Significant Findings-Perforators Duplex Testing-Exam Lipodermatosclerosis – Severe Venous Hypertension Significant Findings-Perforator Venous duplex Supine Standing Reflux “Post-op” Endovenous Heat Induced Thrombosis (EHIT) EHIT Conclusion It’s all about reflux Look at the leg first, making note of VV location Pay attention to placement of cuff, area of compression/rapid deflation Be aware of sources of error Be suspicious of VV or large axial vein without reflux (usually means you missed it!) Before and After Pictures GSV Distribution .
Recommended publications
  • Commodity Analysis of Compression Products for Varicose Veins
    Pharmacia 68(3): 607–611 DOI 10.3897/pharmacia.68.e67587 Research Article Commodity analysis of compression products for varicose veins Tetiana Diadiun1, Inna Baranova1, Svitlana Kovalenko1, Rymma Yeromenko1, Mykola Rybalkin1 1 National University of Pharmacy, Kharkiv, Ukraine Corresponding author: Tetiana Diadiun ([email protected]) Received 20 April 2021 ♦ Accepted 9 June 2021 ♦ Published 9 August 2021 Citation: Diadiun T, Baranova I, Kovalenko S, Yeromenko R, Rybalkin M (2021) Commodity analysis of compression products for varicose veins. Pharmacia 68(3): 607–611. https://doi.org/10.3897/pharmacia.68.e67587 Abstract Compression therapy occupies a key place in the complex treatment and prevention of chronic venous insufficiency of the low- er extremities. Today the pharmaceutical market of Ukraine is represented by a wide range of compression products. Popular in Ukraine are manufacturers of compression products from the Baltic region, Ukraine, there are also Russian, but leading in quality are Germany, USA, and Italy. A survey of consumers and pharmacy practitioners has been performed. The results obtained indicate that compression products for varicose veins treatment are inferior to medicinal products in sales. The main motive for buying a compression product is a doctor’s prescription. The most popular compression garments are stockings. Keywords commodity analysis, compression products, consumer properties, medical knitwear Introduction 2014). Not to mention that CVI is a dangerous disease, its presence in a human significantly
    [Show full text]
  • Endovascular Laser Therapy for Varicose Veins
    Ontario Health Technology Assessment Series 2010; Vol. 10, No. 6 Endovascular Laser Therapy for Varicose Veins An Evidence-Based Analysis Presented to the Ontario Health Technology Advisory Committee in November 2009 April 2010 Medical Advisory Secretariat Ministry of Health and Long-Term Care Suggested Citation This report should be cited as follows: Medical Advisory Secretariat. Endovascular laser therapy for varicose veins: an evidence-based analysis. Ont Health Technol Assess Ser [Internet]. 2010 April [cited YYYY MM DD]; 10(6) 1-92. Available from: http://www.health.gov.on.ca/english/providers/program/mas/tech/reviews/pdf/rev_EVLT_20100422.pdf Permission Requests All inquiries regarding permission to reproduce any content in the Ontario Health Technology Assessment Series should be directed to [email protected]. How to Obtain Issues in the Ontario Health Technology Assessment Series All reports in the Ontario Health Technology Assessment Series are freely available in PDF format at the following URL: www.health.gov.on.ca/ohtas. Print copies can be obtained by contacting [email protected]. Conflict of Interest Statement All analyses in the Ontario Health Technology Assessment Series are impartial and subject to a systematic evidence-based assessment process. There are no competing interests or conflicts of interest to declare. Peer Review All Medical Advisory Secretariat analyses are subject to external expert peer review. Additionally, the public consultation process is also available to individuals wishing to comment on
    [Show full text]
  • Ulcers and Wound Healing of Venous Stasis Ulcers by Robert C
    Center for Vein Restoration The Official Journal of Center for Vein Restoration To Foam or Not to Foam ........................................................ Page 2 Vol. 5, Issue 2 New CMEs Announced .......................................................... Page 4 inside this issue New Centers Open in DC & Virginia ....................................... Page 5 Ulcers and Wound Healing of Venous Stasis Ulcers by Robert C. Kiser, DO, MSPH Human skin is messy. Epidermis, from the mechanical forces change interstitial microscopic cells to macroscopic pressures and pressure gradients, flakes are constantly being shed reduce capillary exchange, and create an and replenished from lower layers. environment in which tissue necrosis is Furthermore, if epidermis is injured by favored over tissue healing. trauma it must replenish itself to provide Malignancy the protective, semi-permeable barrier against the environment that it maintains. Skin cancer can manifest as erosive non- This process requires a dynamic balance healing ulcers. between building up of skin and shedding Systemic Diseases or breaking down skin. If the building up of skin is too exuberant, conditions such Numerous systemic diseases are as psoriasis and Ichthyosis occur in which associated with cutaneous ulcers, the skin becomes thick and scaly. When including diabetes, renal disease, lupus skin does not replenish and heal fast and inflammatory bowel diseases. enough, or when conditions favor break- Ulcers of Venous Insufficiency or down of skin more than growth of new Venous Stasis Ulcers skin, ulcers develop. Venous stasis ulcers will be the topic of Types of Ulcers: Mechanical Pressure the rest of this article. Ulcers are the end- Ulcers may be caused by many different stage of venous insufficiency. The region factors, or several factors acting in most commonly affected is the “gaiter concert.
    [Show full text]
  • Road Map Phlebology
    1 MJC in Phlebology - Road Map This document’s goal is to outline the current position of the MJC in Phlebology (MJCP) in relation to the European recognition of Phlebology and the Union Européenne des Médecins Spécialistes (UEMS) certification of Phlebologists. In addition the desired education and acceptance of Phlebology by the UEMS will be explained. The MJCP has been created by the UEMS Council meeting in April 2014 with the support of the UEMS sections of Dermatology, Surgery, Vascular Surgery and Radiology. The kick-off meeting of MJCP was held in Brussels April 10th, 2015 (MJCP Board in Appendix, doc.1). The Road Map for the European Recognition of Phlebology I. Phlebology - Definition II. Venous Chronic Diseases - Relevance for society III. Education of the Phlebologist IV. Certification of Phlebology V. European Recognition VI. Conclusions VII. Appendix I. Phlebology - Definition. Diagnosis and treatment of venous diseases is a multidisciplinary issue. Phlebology is the study of the anatomy, physiology, diseases and treatments of the veins. Complaints and clinical signs of Chronic Venous Disorders (CVD) are related to disturbances of the macro and microcirculation. Venous Disorders concern mainly the lower legs, and it can be acute e.g. superficial and/or deep venous thrombosis, varicose vein bleeding, or chronic e.g. varicose veins, post-thrombotic syndrome and venous malformations. The CEAP classification is a clinical classification method accepted worldwide; it was first developed in 1995 and revised in 2004. The CEAP classification describes Clinical classes (from 0 to 6), Etiology, Anatomy and Pathophysiology of CVD. Venous symptoms may include tingling, aching, burning, pain, muscle cramps, swelling, sensations of throbbing or heaviness, itching skin, restless legs, leg tiredness, and/or fatigue.
    [Show full text]
  • EVLA Standard 2010 Page 1 of 13
    Endovenous Laser Ablation Diagnose venous disease and treat superficial venous incompetence with Endovenous Laser Ablation under Ultrasound Guidance Security status: ACP copyright© Australasian College of Phlebology www.phlebology.com.au EVLA Standard 2010 Page 1 of 13 CONTENTS PAGE INTRODUCTION 3 1 Scope of Application 3-4 2 Purpose 4 3 Context/Environment/Service Delivery 4 4 Entry requirements 4-5 5 References 5 6 Risk Management 5-6 7 Special Notes 6 8 Definitions 6-7 9 Attachments 8 STANDARD ELEMENTS AND ASSESSMENT CRITERIA 9-14 1 Conduct initial consultation and clinical assessment 9 2 Map Deep and Superficial Veins with Duplex/Doppler Ultrasound 11 3 Establish and agree treatment plan 11-12 4 Cauterise veins with Endovenous Laser Ablation under ultrasound Guidance 12-13 5 Provide post treatment advice to patient and record treatment details 13-14 EVLA Standard 2010 Page 2 of 13 INTRODUCTION This standard is for practitioners needing to diagnose the cause of venous disease in legs prior to using Endovenous Laser Ablation for treatment of superficial venous incompetence. It has been developed by Australasian College of Phlebology (ACP) doctors working in the Phlebology modality* ‘Endovenous Laser Ablation’ (ELA) to provide an assessment tool for doctors in training towards their ACP Fellowship, and for recertification of ACP certified doctors under the ACP Maintenance of Professional Standards (MOPS) programme. The criteria and outcomes of this standard consider competency in terms of interpersonal, diagnostic and management interactions. It is strongly procedure based, while at the same time focusing on the systems and processes required to ensure a safe and responsive service is provided.
    [Show full text]
  • Motherhood and Thrombophlebitis By: Marilyn Mulldoon
    The Arthritis Newsletter: Winter 2015 Motherhood and Thrombophlebitis By: Marilyn Mulldoon I entered the realm of motherhood rather late. Like many other creatures, I guess I just didn’t breed well in captivity. Joking aside, I did not get around to reproducing until my 37th year when my Sjögren’s syndrome was already present but not yet diagnosed. And in spite of my age, I experienced a normal pregnancy except for a little elevated blood pressure. The lineage of women with varicose veins in my family is legendary. I have had varicosity issues since my late teens, and I really didn’t think my legs looked any worse during my pregnancy – well ­­ not until I went into labour. I awoke at 2:00 a.m. and quickly realized that the “big show” had started. With only two hours of sleep, I was not prepared for the next 18 sleepless hours of labour. I had done the pre­natal classes and knew how to breathe, but push? Nothing prepares you for the amount of exertion required to “move things along”. After 45 minutes in the delivery suite, we were done. Following the birth, and in spite of complete physical exhaustion, I could not sleep. I worried about how to look after this new person who had the gall to arrive without any sort of owner’s manual or instruction kit. Eventually, after only a short rest, I turned on the lights to check why my legs, my left leg in particular, were becoming so painful and tender. I was shocked to see the state of my veins ­­ they were turning black! I buzzed for the nurse, who sent for the doctor, who quickly sent for anti­embolism stockings.
    [Show full text]
  • Sclerotherapy for Leg Varicose Veins
    ` Alberta Heritage Foundation for Medical Research Sclerotherapy for leg varicose veins Paula Corabian, Christa Harstall May 2004 IP-19 Information Paper © Copyright Alberta Heritage Foundation for Medical Research, 2004 Comments relative to the information in this paper are welcome and should be sent to: Director, Health Technology Assessment Unit Alberta Heritage Foundation for Medical Research 1500 10104 - 103 Avenue Edmonton, AB T5J 4A7 CANADA Tel: (780) 423-5727 Fax: (780) 429-3501 Web address: www.ahfmr.ab.ca E-mail: [email protected] ISBN 1-896956-96-3 (Print) ISBN 1-896956-98-X (On-Line) ISSN: 1706-7863 Alberta's health technology assessment program has been established under the Health Research Collaboration Agreement between the Alberta Heritage Foundation for Medical Research and Alberta Health and Wellness. ACKNOWLEDGEMENTS The Alberta Heritage Foundation for Medical Research is grateful to Dr. Louis Grondin, Calgary, Alberta, for provision of extensive clinical input regarding the current status of using sclerotherapy for leg varicose veins. The Foundation would also like to thank the following persons for provision of information and comments on the draft report. The views expressed in the final report are those of the Foundation. • Dr. Douglas Dunn, Calgary, Alberta • Dr. Douglas A. Hill, Calgary, Alberta • Dr. Monika Moniuszko, Edmonton, Alberta • Dr. Anthony Salvian, Vascular Surgeon, Vancouver, BC • Dr. Jeanette Soriano, Calgary, Alberta Alberta Heritage Foundation for Medical Research i Health Technology Assessment ABBREVIATIONS/GLOSSARY
    [Show full text]
  • New Treatment Methods in Phlebology
    The Official Journal of Center for Vein Restoration Understanding Post Thrombotic Syndrome ........................................................Page 2 Vol. 6, Issue 2 Q&As .............................................................................................................Page 4 CME Courses & Events ....................................................................................Page 5 inside this issue Community Outreach:Free Workshops in our LegsWork Program..........................Page 5 Meet Drs. Nguyen, Hong & Ahuja .....................................................................Page 6 CME Conferences ...........................................................................................Page 6 New Treatment Methods in Phlebology By Robert C. Kiser, DO, MSPH Phlebology is a rapidly advancing branch Newer phlebology treatments focus of medicine. It has been just over 10 on providing highly effective treatment years that thermal closure techniques methods (>90% success over multiple such as radiofrequency and laser years) with less bodily invasion, less time ablation were invented, and now they and fewer or equal risks.1 are the standard of care for ablation of Supergluing Veins: Sapheon superficial venous insufficiency. Thermal closure is extremely effective and safe. It Cyanoacrylate has been used in is far less time consuming and has much medicine for many years, primarily to less down time and associated expense close skin wounds. It also has been used compared with ligation and stripping. to close arterio-venous
    [Show full text]
  • Endovenous Thermal Ablation for Varicose Veins
    ISSN 1286-0107 Vol 19 • No.4 • 2012 • p161-204 Endovenous thermal ablation for varicose veins: . PAGE 163 strengths and weaknesses Renate R. van den BOS (Rotterdam, The Netherlands) Venous embryology: the key to understanding . PAGE 170 anomalous venous conditions Byung-Boong LEE (Washington D.C., USA) The “C0s” patient: worldwide results . PAGE 182 from the Vein Consult Program Jean-Jérôme GUEX et al. (Nice, France) Sclerotherapy in the patient with diabetes: . PAGE 193 indications and results Francesco FERRARA, Giovanni FERRARA (Naples, Italy) AIMS AND SCOPE Phlebolymphology is an international scientific journal entirely devoted to venous and lymphatic diseases. Phlebolymphology The aim of Phlebolymphology is to pro- vide doctors with updated information on phlebology and lymphology written by EDITOR IN CHIEF well-known international specialists. H. Partsch, MD Phlebolymphology is scientifically sup- Professor of Dermatology, Emeritus Head of the Dermatological Department ported by a prestigious editorial board. of the Wilhelminen Hospital Phlebolymphology has been pub lished Baumeistergasse 85, A 1160 Vienna, Austria four times per year since 1994, and, thanks to its high scientific level, was included in several databases. Phlebolymphology comprises an edito- EDITORIAL BOARD rial, articles on phlebology and lympho- logy, reviews, news, and a congress C. Allegra, MD calendar. Head, Dept of Angiology Hospital S. Giovanni, Via S. Giovanni Laterano, 155, 00184, Rome, Italy P. Coleridge Smith, DM, FRCS CORRESPONDENCE Consultant Surgeon & Reader in Surgery Thames Valley Nuffield Hospital, Wexham Park Hall, Wexham Street, Wexham, Bucks, SL3 6NB, UK Editor in Chief Hugo PARTSCH, MD Baumeistergasse 85 M. De Maeseneer, MD 1160 Vienna, Austria Department of Dermatology, Tel: +43 431 485 5853 Fax: +43 431 480 0304 Erasmus Medical Centre, BP 2040, 3000 CA Rotterdam, Netherlands E-mail: [email protected] A.
    [Show full text]
  • Varicose-Spider-Veins.Pdf
    F REQUENTLY ASKED QUESTIONS prevent blood from flowing backwards as it moves up your legs. If the valves Varicose become weak, blood can leak back into the veins and collect there. (This problem is called venous insufficiency.) Veins and When backed-up blood makes the veins bigger, they can become varicose. Spider veins can be caused by the back- Spider Veins up of blood. They can also be caused by hormone changes, exposure to the sun, http://www.womenshealth.gov and injuries. 1-800-994-9662 Q: What are varicose veins and spi- der veins? TDD: 1-888-220-5446 Q: How common are abnormal leg A: Varicose (VAR-i-kos) veins are enlarged veins? veins that can be blue, red, or flesh- A: About 50 to 55 percent of women and colored. They often look like cords and 40 to 45 percent of men in the United appear twisted and bulging. They can States suffer from some type of vein be swollen and raised above the surface problem. Varicose veins affect half of of the skin. Varicose veins are often people 50 years and older. found on the thighs, backs of the calves, or the inside of the leg. During preg- nancy, varicose veins can form around Q: What factors increase my risk of the vagina and buttocks. varicose veins and spider veins? Spider veins are like varicose veins but A: Many factors increase a person's chances smaller. They also are closer to the of developing varicose or spider veins. surface of the skin than varicose veins. These include: Often, they are red or blue.
    [Show full text]
  • Superficial Varicose and Deep Vein Concerns
    Superficial Varicose and Deep Vein Concerns - ACOI Chicago Hospitalist Meeting Davin Haraway DO,FACOI,FACCWS,RPhS Diplomate – American Board of Venous and Lymphatic Medicine Vein issues encountered by Hospitalists • Cellulitis • Infected venous stasis ulcerations • Leg ulcers – consultations for evaulation and treatment • Lymphedema Lymphangitis • Superficial thrombophlebitis • Post phlebetic syndrome • Pulmonary Embolus • Acute DVT at or above Common femoral vein • Acute DVT below the Common femoral vein • Upper extremity DVT • Phlegmesia Cerula Dolens • Venous malformations • Stasis dermatitis vs Cellulitis vs hemosiderosis, vs calciphylaxis Who do you hand off when the patient is discharged and what do you recommend? • Sleep study • Education on lymphedema treatment • Referral to OP wound care/HBO • Referral to phlebologist • Who is going to manage their DVT/Anticoagulants/Stents • Who is going to manage their wound care • Do you have local support and know providers in the community to help the PCP? Impact on venous disease outside the hospital Davin Haraway DO,FACOI,FACCWS,RPhS Diplomate Certified – American Board of Venous and Lymphatic Medicine Outline • Incidence and prevalence • Anatomy • Function and Physiology diagnosis • Classification • Conservative tx • Intervention treatment • Special considerations What I see What I do The Spectrum of Chronic Venous Disease telangiectasias superficial phlebitis varicose veins lipodermatosclerosis venous ulceration Prevalence of Chronic Venous Disease • 1 in 22 or 4.5% or 12.2 million people
    [Show full text]
  • By Dr Adrian Lim, Phlebologist and Dermatoligist
    by Dr Adrian Lim, phlebologist and Hand dermatoligist rejuvenation he face and hands are prominent aesthetic features that VEIN INJECTIONS (SCLEROTHERAPY) command significant attention. Age related changes in these The dilated hand veins are treated first with sclerosant injections that areas result in volume loss – through bone and soft tissue collapse the veins. The most effective sclerosants are either fibrovein Tresorption – as well as skin laxity resulting in sagging and (sodium tetradecyl sulfate) or polidocanol (aethoxysklerol). The veins wrinkling. The face and hands are also more exposed to the premature can usually be injected by direct vision or in more difficult cases and for photoageing effects of ultraviolet radiation resulting in additional increased safety, under ultrasound guidance. The treated veins undergo pigmentary, vascular and textural degeneration. Much has been said sclerosis (shrinkage and hardening) and either disappear with time (up to about the face but the hands are starting to gain attention as an important three months) or become smaller in diameter and less prominent. Usually focus for rejuvenation. Undoubtedly, demand for hand rejuvenation will one to three treatment sessions are required for permanent results. soar when the procedure becomes more accessible as more practitioners Scientifically and clinically established sclerotherapy techniques exist become skilled in hand rejuvenating techniques. for effective treatment of varicose veins, especially on the lower limbs. When considering hands, volume depletion through subcutaneous fat In hand rejuvenation, sclerotherapy of dorsal hand veins are desirable to loss results in wrinkled skin, sinewy appearance and dilated veins typical correct dilated veins that are often not satisfactorily improved with filler of “old-looking” hands.
    [Show full text]