Jornal Vascular Brasileiro
https://app.periodikos.com.br/journal/jvb/article/doi/10.1590/1677-5449.202501622
Jornal Vascular Brasileiro
Original Article

Subclinical varicose vein recurrence: modern approaches in aesthetic phlebology

Recorrência varicosa subclínica: abordagens modernas em flebologia estética

Serhii Shchukin

http://dx.doi.org/10.1590/1677-5449.202501622 J Vasc Bras, vol.24, e20250162, 2025
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Abstract

Background: Recurrence after varicose vein treatment is usually framed as varices on a previously treated limb, potentially overlooking patients with cosmetic C0–C1 concerns who still experience duplex Doppler ultrasound-verified reflux.

Objectives: To characterize patterns of subclinical (C1-dominant) recurrences in duplex Doppler ultrasound and evaluate a 2-stage pathway prioritizing hemodynamic correction before aesthetic care.

Methods: This retrospective single-center cohort study (2018-2024) was conducted with patients from a vascular clinic. The participants were 354 women with unaesthetic telangiectasias/reticular veins without C2 varices on the index limb after prior varicose treatment. The interventions (exposures) were: (Stage 1) ultrasound-guided 3% polidocanol foam for segments ≤ 3 mm and endovenous laser ablation ≥ 3 mm (anterior accessory saphenous vein/ greater saphenous vein /small saphenous vein/perforators); (Stage 2) 2 sessions of cryo-laser and cryo-sclerotherapy at a 1-month interval, guided by near-infrared augmented-reality. The main outcomes were duplex-verified occlusion of Stage-1 targets at 1 month and aesthetic outcome at 6 months (rated on a 5-point Likert scale). Safety measures included symptomatic venous thromboembolism and minor adverse effects.

Results: At 1 month, all targets were occluded and no symptomatic venous thromboembolisms had occurred. Mapping frequently showed multilevel reflux (anterior accessory saphenous vein, angiomatosis in the vein stump or strip tract, junctional complexes, perforators), with 78% of patients having ≥ 2 sources. At 6 months, good/excellent aesthetic outcomes (Likert scale score 4-5) were achieved in 83.1% of patients (mean score: 4.22). The scoring distribution was: 1 point: 7 (2.0%); 2 points: 11 (3.1%); 3 points: 42 (11.9%); 4 points: 131 (37.0%); and 5 points: 163 (46.0%). Minor events were limited to transient pigmentation/matting.

Conclusions: Subclinical recurrence is chiefly hemodynamic. An etiology-first strategy using duplex Doppler ultrasound followed by cryo-laser and cryo-sclerotherapy yields high early satisfaction and could mitigate early cosmetic recurrence.

Supplementary material

Keywords

varicose veins; recurrence; telangiectasis; sclerotherapy; laser therapy; ultrasonography, Doppler; endovascular procedures; augmented reality; CLaCS (cryo-laser and cryo-sclerotherapy)

Resumo

Contexto: Recorrência pós-tratamento de varizes é geralmente classificada como C2 em membro previamente tratado, potencialmente negligenciando pacientes com queixas estéticas C0–C1 que ainda apresentam refluxo verificado por dúplex.

Objetivos: Caracterizar padrões dúplex de recorrências subclínicas (C1-dominante) e avaliar uma abordagem de duas etapas, priorizando correção hemodinâmica pré-tratamento estético.

Métodos: Coorte retrospectiva unicêntrica em clínica vascular ambulatorial (2018–2024). Participantes: 354 mulheres com telangiectasias/veias reticulares inestéticas sem varizes C2 no membro inicialmente tratado pós-tratamento venoso prévio. Etapa 1: espuma de polidocanol 3% guiada por ultrassom para segmentos ≤3 mm; EVLA para ≥3 mm (VSAA/VSM/VSP/perfurantes). Etapa 2: CLaCS (criolaser + crioescleroterapia) em duas sessões com intervalo de um mês, guiado por realidade aumentada em infravermelho próximo. Principais desfechos e medidas. Primários: oclusão por dúplex dos alvos da Etapa 1 em 1 mês e desfecho estético em 6 meses (Likert, 5 pontos). Segurança: TEV sintomático e efeitos adversos menores.

Resultados: Em 1 mês, todas as veias-alvo estavam ocluídas; nenhum TEV sintomático ocorreu. Mapeamento mostrou frequentemente refluxo multinível (VSAA, angiomatose de coto/faixa, complexos juncionais, perfurantes); 78% tinham ≥2 fontes. Em 6 meses, resultados bons/excelentes (4–5) em 83,1% (média 4,22). A distribuição das pontuações Likert foi: 1 ponto: 7 (2,0%); 2 pontos: 11 (3,1%); 3 pontos: 42 (11,9%); 4 pontos: 131 (37,0%); 5 pontos: 163 (46,0%). Eventos menores foram limitados à pigmentação/matting transitória.

Conclusões: Recorrência subclínica é predominantemente hemodinâmica. Estratégia guiada por dúplex, priorizando etiologia, seguida por CLaCS, produz alta satisfação precoce e pode mitigar a recidiva estética precoce.

Material suplementar

Palavras-chave

varizes; recorrência; telangiectasia; escleroterapia; terapia a laser; ultrassonografia doppler; procedimentos endovasculares; realidade aumentada; CLaCS (criolaser e crioescleroterapia)

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Submitted date:
09/04/2025

Accepted date:
12/17/2025

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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