Foam Sclerotherapy With or Without Transdermal Laser for Reticular Veins and Telangiectasias

Comparison Between Isolated Foam Sclerotherapy and Foam Sclerotherapy Combined With Transdermal Laser for the Treatment of Reticular Veins and Telangiectasias: A Prospective Randomized Clinical Trial

his prospective, randomized, controlled, intraindividual split-leg clinical trial will compare isolated polidocanol foam sclerotherapy with the Laser After Foam (LAAF) technique for the treatment of reticular veins and telangiectasias of the lower limbs. The study will include 70 women aged 18 to 60 years with bilateral CEAP C1 telangiectasias and/or reticular veins. Each participant will receive LAAF in one lower limb and isolated foam sclerotherapy in the contralateral limb, with treatment laterality determined by randomization. The study will evaluate vascular clearance, residual vascular area, hyperpigmentation, retained thrombi and need for drainage, pain, adverse events, aesthetic improvement, patient satisfaction, and quality of life during follow-up through 180 days.

Telangiectasias and reticular veins are common manifestations of chronic venous disease classified as CEAP C1. Although they are frequently considered primarily aesthetic findings, they may be associated with local symptoms and may negatively affect quality of life and body perception.

Foam sclerotherapy with polidocanol is widely used for the treatment of reticular veins and telangiectasias. However, post-treatment hyperpigmentation, retained thrombi, telangiectatic matting, superficial phlebitis, prolonged ecchymosis, and the need for drainage may occur.

The Laser After Foam (LAAF) technique combines chemical sclerotherapy with subsequent transdermal laser treatment. In this technique, polidocanol foam is injected first, followed immediately by application of a long-pulsed 1064 nm Nd:YAG laser over the foam-filled treated vessels. The proposed rationale is that combining chemical and photothermal mechanisms may enhance vascular occlusion and potentially reduce residual intravascular blood, retained thrombi, and hyperpigmentation.

This is a prospective, randomized, controlled, intraindividual, split-leg, assessor-blinded, single-center clinical trial. Seventy participants with bilateral relatively symmetrical CEAP C1 telangiectasias and/or reticular veins will be included. Randomization will determine which lower limb receives LAAF, while the contralateral limb receives isolated foam sclerotherapy. Each participant will therefore serve as her own control.

Treatment will be performed in standardized bilateral 20 × 15 cm areas of the lateral thigh-leg region. Standardized digital photographs and semiautomated image analysis will be used to assess residual vascular area and vascular clearance. Skin pigmentation will also be evaluated clinically, photographically, and instrumentally with a Mexameter®. Additional outcomes will include Global Aesthetic Improvement Scale (GAIS), pain, retained thrombi, need for drainage, matting, superficial phlebitis, other adverse events, patient satisfaction, and quality of life. Follow-up assessments are planned through 180 days.

Inclusion Criteria:

• Female participants aged 18 to 60 years.
• Fitzpatrick skin phototype I, II, or III.
• CEAP clinical class C1.
• Bilateral relatively symmetrical presence of telangiectasias and reticular veins on the lateral thigh.
• Presence of telangiectasias and reticular veins measuring 0.1 to 3 mm in diameter.
• Willingness to participate in the complete study follow-up and provision of written informed consent.

Exclusion Criteria:

• Saphenous or perforator venous reflux.
• Varicose veins greater than 3 mm in diameter (CEAP C2-C6).
• Fitzpatrick skin phototype IV, V, or VI.
• Recent venous thrombosis or known thrombophilia.
• Use of anticoagulant therapy.
• Pregnancy or breastfeeding.
• Known allergy to polidocanol.
• Peripheral arterial disease with ankle-brachial index (ABI) < 0.8.
• Diabetes mellitus.
• Local dermatitis in the treatment area.
• Previous venous treatment within the last 6 months.
• Failure to attend the treatment session or scheduled follow-up visits.