Telangiectatic Matting

The new appearance of a fine web of erythematous telangiectasias occurring after sclerotherapy or surgical ligation of varicose or telangiectatic veins is referred to as distal angioplasia or, more commonly, telangiectatic matting (TM) [2]. The reported incidence ranges from 5% to 75%, with an overwhelming female predominance. The etiology of matting is unknown but is felt to be related to either neoangiogenesis (a normal reparative process after “wounding” of injection), or dilation of existing subclinical blood vessels by promoting collateral flow through arteriovenous anastomoses [11]. Heparin has been demonstrated to produce angiogenesis in vivo [2]. Ouvry, Davy, and Mantse first described postsclerosis TM and have noticed a decreased incidence of matting when the pressure of injection is minimized and the sclerosant is dispersed not more that 1 cm beyond each injection site [2].Davis and Duffy reported their findings identifying risk factors among 160 patients who developed TM. Significantly more patients with matting were overweight, on hormone therapy during treatment, had a family history of spider veins, and a longer duration of their spider veins prior to treatment. Additionally, the matting group noted the onset of their veins after excess hormonal states [23]. Age and excessive standing do not appear to play a role in the development of TM [2]. Therefore, any technique that may limit this occurrence should be employed, such as limiting the injection blanch to 1–2 cm, discontinuation of estrogen preparations prior to and during treatment, and avoidance of heparin in the sclerosant. Fortunately, TM usually resolves over a 3- to 12-month period. For the rare permanent TM, use of the newer vascular lasers may provide resolution of this condition.