2/7/13

Angiogenesis Following Sclerotherapy

A not uncommon complication after sclerotherapy is angiogenesis or often times referred to as ‘matting.’ These multiple small telangiectasia occur secondary to inflammation or continued inflow into a partially treated vein.

For the most part, this response is inflammatory in nature as vessels form around a previously treated area.

Angiogenesis 1 month post sclerotherapy – Copyright 2013 by www.veinexperts.org

Closeup - Angiogenesis 1 month post sclerotherapy – Copyright 2013 by www.veinexperts.org

Ultrasound image angiogenesis– Copyright 2013 by www.veinexperts.org

The ultrasound image shows a thrombosed superficial vessel with surrounding inflammation. In this instance, there is probably leakage of sclerosant through the venous wall causing intense inflammation. The exact concentration is not known.

The treatment best treatment for angiogensis is heat therapy. Intense pulsed light (IPL) can be tried. Laser is usually not effective because the vessels are small and have little blood volume.

My preferred treatment is ohmic thermolysis after doing subdermal infiltration with a dilute xylocaine (similar to tumescent). Using ohmic thermolysis the individual vessels are cannulated and treatment is done to as many vessels as possible. Effective treatment is blanching of the vessel at time of application.

If the vessel is greater than 0.5 mm, I leave the tip in for two separate firings at 3 pulses each, using 5% power. Higher power can be used if necessary.

In my experience, this has been the best treatment for angiogenesis with many patients clearing in just one treatment.

Dilute 1% xylocaine with epi solution injected subdermally – Copyright 2013 by www.veinexperts.org

VeinGogh with Bristle needle – Copyright 2013 by www.veinexperts.org

Post treatment VeinGogh– Copyright 2013 by www.veinexperts.org

VeinGogh before & after treatment - – Copyright 2013 by www.veinexperts.org