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Reasons for ulceration after injection treatment of telangiectasia
Background:
Sclerotherapy of telangiectasias is widely used for their treatment, but causes skin ulceration in 0.2-1.2% of patients. The cause of this complication is still unclear.
Objective:
We hypothesized that an arteriole is occluded because the sclerosant gets into an arteriovenous (AV) shunt. We have looked for these communications underneath the telangiectasias.
Methods:
Doppler examination was performed in 155 cases above the telangiectasias to reveal the presence of an AV shunt. Twenty-two positive sites were excised and histologically screened for AV shunts.
Results:
Pulsatile sound could be detected by Doppler transducer above spider veins in 112 cases (72.2%). Of the 22 Doppler-positive telangiectasias, 19 AV microshunts could be found histologically.
Conclusions:
Understanding the mechanism of this complication can lead to its prevention. No more than 0.2 ml of sclerosant should be administered to a single site. The warning sign of backwash of sclerosant into arterials is the temporary blanching of the skin from the arterial spasm.