A sonographic study of thigh telangiectasias

Introduction

Lower extremity telangiectasia affects millions of people worldwide, causing significant cosmetic embarrassment, and ultimately leading to the search for medical care. ¹ Although sclerotherapy is considered effective, its etiology and pathogenesis is still unclear. ² Weiss and Weiss demonstrated a possible association between telangiectasias and insufficient reticular veins. ³ Although some reports suggested the role of insufficient reticular and perforator veins, especially associated with telangiectasias refractory to treatment,^4,5 there were limited descriptive data on the ultrasonographic characteristics of the associated reticular and perforator veins of the thigh. The aim of this study was to evaluate the prevalence, anatomic correlations and ultrasonographic characteristics of reticular and perforator veins associated with lateral thigh telangiectasias.

Methods

A cohort study was conducted between June and December of 2014. Twenty-four asymptomatic patients (43 limbs) with telangiectasia of the lateral thigh were evaluated by duplex ultrasonography with linear transducer of 5–7 MHz (Philips HD 11 XE Ultrasound System, Andover, MA) in standing position. We measured body mass index (BMI), current use of oral contraceptive, and history of pregnancy. All reticular and perforator veins were characterized according to (1) valvular competency defined as the presence or absence of reflux time greater than 0.5 s, (2) vein diameter (mm), and (3) connection with perforator veins at the level of the thigh or leg. A comparison was performed with a group of 20 limbs (14 patients) without telangiectasia.

The study was approved by the Institutional Review Committee, with all participants receiving and signing an informed consent. A non-parametric Kruskal-Wallis test was used for the analysis of anthropometric baseline characteristics, while a Student's t-test test was used for the evaluation of numeric variables. A P value < 0.05 indicated statistical significance.

Results

All 43 limbs had reticular veins with a reflux time greater than 0.5 s underlying telangiectasias sites. A total of 43 perforator veins were found to be connected to the reticular veins with reflux. Of these, 20 were incompetent (46.5%, P > 0.05), these veins being located at the lateral thigh (n = 4), posterior thigh (n = 2), lateral knee (n = 4), lateral leg (n = 8), and posterior leg (n = 2). The reticular veins were not connected to perforator veins in 10 limbs. Obese and overweight patients (BMI > 25) presented a greater prevalence of incompetent perforator veins compared to those with BMI < 25 (P < 0.05). In this subgroup, reticular veins also presented a larger diameter (P < 0.05) (Table 1). Oral contraceptive use and previous pregnancy were not associated at a statistically significant level. Lower extremities with a diagnosis of telangiectasia were associated with a higher frequency (n = 33) of total perforator veins, both competent and incompetent, as well as a higher frequency (n = 16) of incompetent perforator veins than extremities without telangiectasias (P = 0.001).

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Table 1.

Perforator vein distribution and competence, reticular vein diameter (mm) in obese and non-obese individuals.

BMI	Reticular vein diameter (average)	Incompetent perforator veins (n)	Incompetent perforator veins diameter (average)
Normal	1.5	6	0.23
Overweight  + obese	1.7	14	0.82
p	0.0379	0.0023	0.008

Conclusion

Lateral thigh telangiectasias were associated with both incompetent reticular and perforator veins. Obese and overweight patients were associated with a higher frequency of incompetent perforator veins, along with reticular veins of larger diameters.