A sonographic study of thigh telangiectasias

Abstract

Introduction To date, there are limited descriptive data on the ultrasonographic characteristics of reticular and perforator veins associated with telangiectasias of the thigh. Objectives Evaluate the prevalence, anatomic correlations of reticular and perforator veins associated with lateral thigh telangiectasias. Methods This was a cohort study performed between June and December of 2014. Twenty-four female patients (43 limbs) with telangiectasias of the lateral thigh were evaluated by duplex ultrasound. Reticular and perforator veins were characterized according to valvular competency, vein diameter and connection with perforator veins at the thigh. Body mass index, current use of oral contraceptive, and history of pregnancy correlation data were also collected. A non-parametric Kruskal-Wallis test and a Student's t-test test were used for analysis. Results All 43 limbs had incompetent reticular veins underlying telangiectasias sites. A total of 20 incompetent perforator veins were found to be connected to the reticular veins. Obese and overweight patients had a higher prevalence of incompetent perforator veins and larger reticular veins when compared to those with normal weight (P < 0.05). Lower extremities with telangiectasias had a higher frequency of total perforator veins (n = 33) and incompetent perforator veins (n = 16) than extremities without telangiectasias (p = 0.001). Conclusion Lateral thigh telangiectasias were associated with both incompetent reticular and perforator veins. Obese and overweight patients were especially affected.

Global guidelines trends and controversies in lower limb venous and lymphatic disease

“…208 The general idea is that chronic venous disease refluxes must be treated before the aesthetic component, so to avoid venous hypertension potentially triggering recurrences. To the best of our knowledge, limited evidence-based data 209 , 210 are available on this topic and future investigations should clarify this common belief, even if rightfully based on the concept that the treatment of a pathological aspect should always precede the aesthetic issue. Moreover, future research lines should try to make the different telangiectasia classifications more homogeneous, incorporating both morphological (spider, arboriform, filiform, point-like, etc.)…”

Pathophysiology of telangiectasias of the lower legs and its therapeutic implication: A systematic review

“…Raymond-Martinbeau et al 24 found a direct relation between reticular veins and telangiectasias in 71% of the cases; and Mariani et al 25 even found connections in 100% of the 200 areas of telangiectasias examined with side-illumination and Doppler. In a duplex ultrasonographic study of 43 asymptomatic limbs with lateral thigh telangiectasias, 26 all limbs had incompetent reticular veins. Twenty incompetent perforators were connected to the reticular veins.…”

“…In a sonographic study of thigh telangiectasias, 26 obese and overweight patients (BMI > 25) presented a significant higher prevalence of incompetent perforators and reticular veins, and had a larger diameter when compared to normal weight.…”

“…29 Except in the case of a saphenous anterior accessory vein, or an incompetent perforating vein of the proximal thigh, reticular veins of the lateral aspect of the thigh drain mainly distally through perforating veins located near the knee or the leg. 26 Opposite to the static pressure model of gravity, we postulate a more dynamic venous system. During venous systole provoked by the very high pressure induced by muscular contraction, venous pressure spreads through incompetent micro-perforators throughout the venous system and more particularly to the weakest resistant veins, even if they go proximally.…”

Brazilian guidelines on chronic venous disease of the Brazilian Society of Angiology and Vascular Surgery

“…Obese and overweight patients had a higher frequency of incompetent perforator veins and larger reticular veins compared to when compared to those with normal weight (P < 0.05). 53 The same process was applied to C1 patients to determine whether ultrasound mapping of the saphenous veins is justified. There was a statistically significant tendency that the increased presence of incompetent deep and/ or superficial venous incompetence also increases the presence of telangiectasias.…”