With increasing experience and recognition of common patterns, injection sites are based on known patterns of reflux. For example, reticular veins usually feed a group of telangiectasias on the lateral thigh from a varicose lateral subdermic venous system. During the treatment session, treatment would begin with reticular veins from which reflux is suspected to arise and would proceed along the course of the reticular vein, with injections every 3-4 cm along the feeder.
Our typical treatment regimen is to foam or agitate STS at 0.1 to 0.2% using a ratio of one part sclerosant to four parts air. This foam mixture is injected into reticular veins that are directly connected to visible telangiectasias (see Figure 14.2). It is not advisable to treat every reticular vein of the thigh; only those reticular veins visibly connected to a telangiectatic web should be targeted.
As sclerosing solution/foam flows away from the point of injection, it is clearly seen for a distance of several centimeters before it is diluted by blood and becomes less potent.
When injecting a reticular vein, the sclerosing foam is sometimes seen flowing into the telangiectasia. When this is observed, the telangiectasias do not need to be injected directly. Similarly, sclerosing solution injected into a telan-giectasia may be seen flowing into the feeder vein, but reticular veins usually still need to be injected directly, because it is difficult to deliver an effective volume and concentration of sclerosant foam to the reticular vein indirectly.
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