The status of dermal fillers as class III medical devices, and the process of their approval and marketing in the EU need to be seriously reconsidered to avoid unnecessary and serious adverse reactions.
Leg telangiectasias resistant to repeated courses of sclerotherapy in patients without deep and superficial venous incompetence are not uncommon. Little is known about factors which may underlie the resistance. Among 26 patients with such telangiectasias we found a direct communication of the vessels with deep and saphenous veins in 65% of patients. Ultrasound-guided injection of 0.5% polidocanol foam into the feeding veins or their perforating segments led to clearance of all the telanagiectasias. In 23% of cases no feeding veins could have been identified by ultrasound. Direct injections of a sclerosant into perforating feeding veins may clear refractory telangiectasias in a majority of patients though it is obvious that other factors may contribute to the failure of sclerotherapy in others.
Results of the retrospective analysis indicate that the routine use of DHC during RFSA for incompetent saphenous veins is equally safe but potentially more efficacious considering mid-term venous closure rates.
SummaryWe have performed a retrospective analysis of side-effect profile of endovenous laser ablation (EVLA) of great saphenous veins in patients operated on in general sedation or general/regional anesthesia with or without tumescence solution injection. The results confirmed our initial assumptions that omitting tumescence (and in addition, avoiding any external compression and cooling) may actually significantly reduce the incidence of moderate/severe postoperative pain and brusing without compromising closure rates. As these are probably caused by vessel wall perforations they seem to be more common in the tumescence cohort. The results are in line with recent basic research which showed that fiber tip centering may reduce perforations (easier to perform in vessels filled with blood), that blood itself does not either reduce or enhance laser‘s effect, and that various lasers over a wide range of wavelengths (from hemoglobin-absorbing to water-absorbing) have comparable clinical efficacy. Hence, omitting tumescence and external compression probably reduces the incidence of postoperative pain and brusing in patients treated with EVLA.
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