Foam and Liquid Sclerotherapy With or Without Herbal Gel for Small Vein Treatment

Telangiectasias, also known as spider veins, are dilated intradermal venules less than 1 mm in diameter. They often appear close to the surface of the skin in a tree-like pattern and may be red, blue, or purple. Spider veins are commonly located on the thighs, calves, or ankles and are primarily of cosmetic concern.

Reticular veins are slightly larger, measuring 1-3 mm in diameter, and are located just beneath the skin surface. They are bluish or greenish in color and often act as feeder veins to telangiectasias. Reticular veins are commonly found on the legs but can also appear on the face, breasts, or knees. While they do not typically protrude like varicose veins, they may cause discomfort or pain and contribute to an unattractive marbled skin appearance.

Both telangiectasias and reticular veins are classified as C1 disease within the CEAP (Clinical, Etiological, Anatomical, Pathophysiological) classification of chronic venous disorders. Chronic venous insufficiency is associated with dilatation of lower extremity veins, impaired venous return, and abnormal blood stasis. It is a common condition affecting a significant proportion of both men and women, and may be associated with symptoms such as swelling, fatigue, cramps, and restless legs. If left untreated, it can progress to more serious complications, including venous thrombosis.

Sclerotherapy is a well-established treatment for telangiectasias and reticular veins. It involves injection of a sclerosant solution into the affected veins, leading to endothelial damage, inflammation, and fibrosis. Historically, liquid sclerotherapy has been in use for over 160 years. More recently, foam sclerotherapy was developed to enhance the contact between sclerosant and the vein wall, potentially improving efficacy. Both liquid and foam sclerotherapy are considered safe and effective, though their comparative advantages remain under investigation.

Herbal gels with anti-inflammatory and venotonic properties have been explored as adjuvant therapies in the treatment of superficial venous disease. These may help reduce post-procedural symptoms, improve patient comfort, and enhance cosmetic results. However, clinical evidence regarding their effectiveness in combination with liquid or foam sclerotherapy is limited.

Rationale Telangiectasias and reticular veins represent a prevalent form of chronic venous disease with both cosmetic and symptomatic impact. While sclerotherapy is the primary treatment, the relative benefits of foam versus liquid sclerotherapy, as well as the potential added value of herbal gels, remain uncertain. A randomized controlled trial is therefore warranted to compare these approaches and evaluate their clinical outcomes.

Inclusion criteria

• telangiectasis on thigh or leg side
• Competent saphenofemoral and saphenopoliteal junction
• Patient post surgical stripping or post thermal ablation
• clinical classification of chronic venous disease C1(mild venous disease), -
• minimum age of 18 year-old and maximum age 65 year-old -

Exclusion criteria

• varicose disease in any quantity or location with clinical classification of chronic venous
• disease different of C1(mild venous disease)
• arterial insufficiency
• patient allergic to the sclerosant material or herbal gel
• dermatitis on application site
• patient with serious comorbidities like heart failure, respiratory failure, - uncontrolled hypertension with medication, and uncontrolled hypothyroidism - pregnancy - previous deep vein thrombosis (DVT) - family history of DVT - thrombophilia