Treatment for telangiectasias and reticular veins (Protocol)

Abstract

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

To assess the effects of sclerotherapy, laser therapy, intensive pulsed light (IPL), thermocoagulation, and microphlebectomy treatment for telangiectasias and reticular veins.

Full text

Cochrane Database of Systematic Reviews
Treatment for telangiectasias and reticular veins (Protocol)
Nakano LCU, Cacione DG, Baptista-Silva JCC, Flumignan RLG
Nakano LCU, Cacione DG, Baptista-Silva JCC, Flumignan RLG.
Treatment for telangiectasias and reticular veins.
Cochrane Database of Syst ematic Reviews 2017, Issue 7. Art. No.: CD012723.
DOI: 10.1002/14651858.CD012723.
www.cochranelibrary.com
Treatment for telangiectasias and reticular veins (Protocol)
Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

T A B L E O F C O N T E N T S
1HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7ADDITIONAL TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
iTreatment for telangiectasias and reticular veins (Protocol)
Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

[Intervention Protocol]
Treatment for telangiectasias and reticular veins
Luis CU Nakano1, Daniel G Cacione2, Jose CC Baptista-Silva3, Ronald LG Flumignan4
1Vascular Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo,Brazil. 2Department of Surgery, UNIFESP
- Escola Paulista de Medicina, São Paulo, Brazil. 3Evidence Based Medicine, Cochrane Brazil, Universidade Federal de São Paulo, São
Paulo, Brazil. 4Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo,
Brazil
Contact address: Luis CU Nakano, Vascular Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Borges
Lagoa, 754, Sao Paulo, Sao Paulo, 04038-001, Brazil. luiscnakano@uol.com.br,luiscnakano@unifesp.br.
Editorial group: Cochrane Vascular Group.
Publication status and date: New, published in Issue 7, 2017.
Citation: Nakano LCU, Cacione DG, Baptista-Silva JCC, Flumignan RLG. Treatment for telangiectasias and reticular veins. Cochrane
Database of Systematic Reviews 2017, Issue 7. Art. No.: CD012723. DOI: 10.1002/14651858.CD012723.
Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
A B S T R A C T
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
To assess the effects of sclerotherapy, laser therapy, intensive pulsed light (IPL), thermocoagulation, and microphlebectomy treatment
for telangiectasias and reticular veins.
B A C K G R O U N D
Description of the condition
Telangiectasias, or spider veins, are dilated venules or arterioles
(small superficial veins) measuring less than 1.0 mm in diameter
and occurring predominantly in the lower extremities (Thomson
2016). Reticular veins have a diameter less than 3 mm and are
often tortuous and located in the subdermal or subcutaneous tissue
(Eklof 2004;Porter 1995). The cause is unknown. Patients may be
asymptomatic or can report pain, burning or itching. Risk factors
include family history, pregnancy, local trauma, and hormonal
factors (Goldman 2002).
The diagnoses of telangiectasias and reticular veins are clinical
and made according to the Clinical, Ethiological, Anatomical and
Pathophysiological (CEAP) classification system for chronic ve-
nous disorders in the lower limb. This CEAP classification system
consists of seven main categories: C0 to C6, and telangiectasias
are classified as C1 (Eklof 2004).
C0 - no visible or palpable signs of venous disease
C1 - telangiectasia or reticular veins (thread veins)
C2 - varicose veins (diameter of 3 mm or more)
C3 - oedema
C4 - changes in the skin and subcutaneous tissue: pigmenta-
tion (C4a), eczema (C4a), lipodermatosclerosis (C4b) or atrophic
blanche (C4b)
C5 - healed venous ulcer
C6 - active venous ulcer
The incidence of telangiectasias increases with age (Schwartz
2011). Telangiectasias on the lower limbs are very common and
have been found in 41% of women over the age of 50 years (Engel
1988). They represent an important aesthetic or cosmetic problem
(Hercogova 2002). The presence of telangiectasias may be asso-
ciated with insufficiency of major venous systems; approximately
50% to 62% of insufficient perforating veins are found in the
1Treatment for telangiectasias and reticular veins (Protocol)
Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

presence of telangiectasias (Andrade 2009).
Description of the intervention
Treatments for telangiectasias and reticular veins include scle-
rotherapy, laser therapy, intense pulsed light treatment, microphle-
bectomy and thermocoagulation. These techniques can be used in
combination to maximise the effects and avoid any harms of the
individual techniques. The most common treatment for telang-
iectasias is sclerotherapy (Schwartz 2011), which is a technique or
group of techniques for destruction of spider veins by injection of
a medication that destroys the vein endothelium, leading to oc-
clusion and subsequent fibrosis. Sclerosant agents are injected into
the vein by hypodermic needles until the area around the puncture
site blanches or resistance is felt. The injection is immediately dis-
continued if there is extravasation. Individual injections utilize be-
tween 0.1 mL and 0.5 mL sclerosant agent for each telangiectasias
area, although larger volumes or sclerosant agent are required for
larger veins (Worthington-Kirsch 2005). There are many scleros-
ing agents and they are generally categorized as detergents, osmotic
or chemical irritants. These agents cause endothelial damage that
results in blocking the vein (vessel occlusion) and subsequent dis-
appearance of the vessel being treated (Vitale-Lewis 2008). Foam
sclerotherapy mixes gas and fluid sclerosant agents between two
syringes (Tessari 2001). Foam with detergent sclerosants results in
a more efficient effect by increasing both dwell time and contact
area. This increase in efficiency also allows for lower sclerosant
doses (Worthington-Kirsch 2005). Foam is associated with side
effects such as microthrombi, matting and transient visual distur-
bance (Kern 2004). These adverse effects may also occur in con-
ventional sclerotherapy.
Laser therapy is used for the treatment of telangiectasias in patients
with veins of a diameter less than a 30 gauge needle. Patients with
a phobia to needles or allergy to certain sclerosing agents can also
benefit from this technique. There are several types of lasers for
treatment of telangiectasias with varying wave lengths between
532 to 1064 nm (Meesters 2014). Treatment with a Nd:yag 1064
nm laser has shown similar results to sclerotherapy (Parlar 2015).
Side effects of laser therapy in treatments for telangiectasias are
erythema, crusting, swelling, and blistering (Tierney 2009). Laser
therapy may cause less pain but also may result in complications
such as spotting (Mujadzic 2015).
Intense Pulsed Light (IPL) is similar to laser therapy as high-in-
tensity light sources emit polychromatic light ranging within the
wavelength spectrum of 515 to 1200 nm. The treatment of vas-
cular lesions with IPL depends on the type and size of vessels,
with angiomas and spider veins demonstrating the best response
(Goldberg 2012).There are many clinical indications for treat-
ment with IPL (Raulin 2003). IPL is indicated for the treatment
of unwanted hair growth, vascular lesions, pigmented lesions, acne
vulgaris, photo damage and skin rejuvenation (Babilas 2010). The
negative side effects of IPL include vesicles, burns, erosions, blis-
ters and crust formation, as well as hypo and hyperpigmentations
and are common (Stangl 2008).
Microphlebectomy is performed using hooks which enable venous
extraction through minimal skin incisions or even needle punc-
tures. Ambulatory microphlebectomy is indicated in varicose veins
in any part of the body, such as arms, periorbital, abdomen and
dorsum (Ramelet 2002).
Thermocoagulation or the radiofrequency energy method is a
technique for treatment of telangiectasias or reticular veins.The
method is based on the production of high frequency waves, 4
MHz, transmitted through a thin needle, causing thermal damage
in the veins (Chadornneau 2012).
How the intervention might work
All of the above techniques cause lesions in the vascular endothe-
lium and consequently result in the disappearance of the target
vessel.
In sclerotherapy, the ideal sclerosant causes full destruction of the
vessel wall and minimal thrombus formation. Incomplete destruc-
tion of wall or local thrombosis may lead to recanalisation. The
ideal agent would also be nontoxic, easily manipulated, and pain-
less (Worthington-Kirsch 2005).
Laser and IPL therapies are alternative options but they have a high
cost compared to sclerotherapy. Both techniques act by exposing
red elements of blood to light energy. Oxyhaemoglobin is the ma-
jor chromophore in blood vessels, with two absorption bands in
the visible light spectrum at 542 nm and 577 nm. Following ab-
sorption by oxyhaemoglobin, light energy is converted to thermal
energy, which diffuses in the blood vessel, causing photocoagula-
tion, mechanical injury, and finally thrombosis and occlusion of
the target vessel (Micali 2016).
Different laser wavelengths can be successfully used to treat vascu-
lar lesions. Each type of laser has advantages specific to its wave-
length, pulse duration, spot size, and cutaneous cooling profile.
The 532 to 595 nm lasers have multiple applications treating not
only telangiectasia, but also pigmentation and even fine wrinkles.
The main advantage in using a 1064 nm laser is that its longer
wavelength can penetrate more deeply, allowing effective thermo
sclerosis of spider veins (Goldman 2004).
A possible advantage of IPL issel ective photothermolysis, in which
thermal damage is confined to specific epidermal or dermal pig-
mented targets. Tissues surrounding these targeted structures are
spared, potentially reducing nonspecific, widespread thermal in-
jury. There are three main chromophore’s: haemoglobin, water,
and melanin. They have broad absorption peaks of light energy,
allowing them to be targeted by a range as well as a specific wave-
length of light (Goldberg 2012).
The advantage of microphlebectomy is minimal or no scarring, no
skin necrosis and no residual hyperpigmentation (Ramelet 2002).
Thermocoagulation is a relatively new technology with advantages
such as immediate disappearance of veins, no allergic manifesta-
2Treatment for telangiectasias and reticular veins (Protocol)
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tions, no pigmentation and necrosis, and applicability to all skin
types (Chadornneau 2012).
Why it is important to do this review
There is a high prevalence of telangiectasias, or spider veins and
the most common age for presentation is between 30 and 50 years
(Ruckley 2008). The incidence increases with age and represents
an important aesthetic problem (Hercogova 2002). In Brazil, the
incidence of telangiectasias in young women is 50% and represents
a cosmetic problem to these patients (Scuderi 2002). A report of
research from Poland, including women between 18 and 60 years
old found an incidence of 27% of telangiectasias (Karch 2002).
Sclerotherapy, the treatment most often used for telangiectasias, is
low cost but is not free from complications. Laser therapy is a safe
and efficacious treatment of telangiectasias and can be achieved
with multiple lasers (McCoppin 2011 ). The IPL is versatile, which
allows treatment of both vascular and pigmented lesions (Wall
2007). IPL may offer an advantage due to its selective photother-
molysis but has a high cost compared to sclerotherapy. Currently,
there is a lack of evidence over which of these methods is more
effective in the treatment of telangiectasias. A previous Cochrane
review has been published on sclerotherapy (Schwartz 2011), but
none have addressed other methods of treatment for telangiec-
tasias. This review will report on the evidence available to allow
healthcare professionals and consumers to choose the most appro-
priate treatment method for telangiectasias and reticular veins.
O B J E C T I V E S
To assess the effects of sclerotherapy,l aser therapy, intensive pulsed
light (IPL), thermocoagulation, and microphlebectomy treatment
for telangiectasias and reticular veins.
M E T H O D S
Criteria for considering studies for this review
Types of studies
Wewill search and consider for inclusion all randomised andquasi-
randomised studies that compare treatment methods for telangiec-
tasias and reticular veins in the lower limb. We will include studies
that compare individual treatment methods against placebo or no
treatment and compare treatment methods against each other. We
will also include studies that use a combination of methods.
Types of participants
We will consider all participants, both male and female and of all
ages, with telangiectasias and reticular veinsin the lower limb, con-
firmed by either the CEAP C1 classification or clinical assessment
of a physician. We will exclude participants with hereditary haem-
orrhagic telangiectasias (HHT), mucous telangiectasias, patients
treated for telangiectasias or superficial vein reflux within the pre-
vious 30 days, and patients undergoing a simultaneous treatment
for telangiectasias and superficial vein reflux.
Types of interventions
We will evaluate the following interventions:
1. Sclerotherapy with any sclerosant agents of any dose or
duration (with or without compression treatment);
2. Laser therapy applied directly to the telangiectasias or
reticular veins (any wavelength, any treatment regimen);
3. Intensive Pulsed Light (IPL) applied directly to the
telangiectasias or reticular veins (any wavelength, any treatment
regimen);
4. Thermocoagulation applied directly to the telangiectasias or
reticular veins;
5. Microphlebectomy in reticular veins.
Comparisons:
1. Sclerotherapy versus placebo;
2. Sclerotherapy versus sclerotherapy;
3. Sclerotherapy versus laser therapy;
4. Sclerotherapy versus IPL;
5. Sclerotherapy versus thermocoagulation;
6. Sclerotherpay versus microphlebectomy;
7. Laser therapy versus placebo;
8. Laser therapy versus laser therapy;
9. Laser therapy versus IPL therapy;
10. Laser therapy versus thermocoagulation;
11. Laser therapy versus microphlebectomy;
12. IPL versus placebo;
13. IPL versus IPL therapy;
14. IPL versus thermocoagulation;
15. IPL versus microphlebectomy;
16. Thermocoagulation versus placebo;
17. Thermocoagulation versus microphlebectomy;
18. Any combination of the above treatments versus any
combination.
Types of outcome measures
Primary outcomes
•Clinically or photographically assessed resolution or
improvement (or both) of telangiectasias: resolution or
improvement will be measured by clear diagnostic scales (e.g.
3Treatment for telangiectasias and reticular veins (Protocol)
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Vessel Clearance < 20%, 20 to 40%, 40 to 60%, 60 to 80%, >
80% (Shamma 2005)) or study definitions;
•Adverse events (including hyperpigmentation, bruising,
anaphylaxis, necrosis of the skin).
Secondary outcomes
•Pain during procedure and postprocedure: pain will be
measured by clear diagnostic scales during the procedure and 24
hours postprocedure (e.g. visual analogue pain scale (VAS), used
for determining the pain level during laser treatment. Pain is
graded by the participant with the help of a coloured gradient
and graduated line from 1 to 10 (Kozarev 2011));
•Recurrence: recurrence will be measured by clear diagnostic
scales until 30 days after the procedure (e.g. Vessel Clearance <
20%, 20 to 40%, 40 to 60%, 60 to 80%, > 80% (Shamma
2005));
•Time to resolution (time unit: days);
•Quality of life: any scale of quality of life (e.g. Aberdeen
Varicose Vein Severity Score (AVVSS) (Smith 1999)).
Search methods for identification of studies
Electronic searches
The Cochrane Vascular Information Specialist (CIS) will search
the following databases for relevant trials:
•The Cochrane Vascular Specialised Register;
•The Cochrane Central Register of Controlled Trials
(CENTRAL) via The Cochrane Register of Studies Online.
See Appendix 2 for details of the search strategy which will be used
to search CENTRAL.
The Cochrane Vascular Specialised Register is maintained by the
CIS and is constructed from weekly electronic searches of MED-
LINE Ovid, Embase Ovid, CINAHL, AMED, and through hand-
searching relevant journals. The full list of the databases, journals,
and conference proceedings which have been searched, as well as
the search strategies used, are described in the Specialised Register
section of the Cochrane Vascular module in the Cochrane Library
(www.cochranelibrary.com).
In addition, the CIS will search the following trial registries for
details of ongoing and unpublished studies;
•ClinicalTrials.gov (www.clinicaltrials.gov);
•World Health Organization International Clinical Trials
Registry Platform (www.who.int/trialsearch);
•ISRCTN Register (www.isrctn.com/).
The authors will perform additional searches in LILACS and
IBECS databases. The search strategy will be designed by the
authors and checked by the Cochrane Information Specialist of
Cochrane Brazil. See Appendix 3 for details of the search strategy
that will be used for the authors’ search.
Searching other resources
We will check the bibliographies of included trials for further
references to relevant trials. We will contact specialists in the field,
manufacturers and authors of the included trials for any possible
unpublished data.
Data collection and analysis
Selection of studies
We will examine the titles and abstracts to select the relevant
reports after merging the search results and removing duplicate
records. Three review authors (LCUN, DGC and RLGF) will in-
dependently evaluate the trials to determine if they are appropriate
to include. We will resolve disagreements by discussion within the
review team. We will then retrieve and examine the full text of the
relevant trials for compliance with eligibility criteria. Where a trial
does not meet the eligibility criteria, we will exclude the trial and
document the reason for exclusion.
Data extraction and management
Three review authors (LCUN, DGC and RLGF) will extract data
independently and collect data on paper data extraction forms. We
will resolve disagreements by discussion within the review team.
We will collect the following information:
1. Study features: publication details (e.g. year, country, authors);
study design; population data (e.g. age, comorbidities, severity of
telangiectasias, duration, history concerning treatments, and re-
sponses); details of intervention (e.g. manufacture, material, site
of insertion, additional procedures); number of participants ran-
domised into each treatment group; the number of participants
in each group who failed treatment; the numbers of participants
lost to follow-up; the duration of follow-up; cost of treatment.
2. Outcomes: types of outcomes measured; timing of outcomes.
Assessment of risk of bias in included studies
Three review authors (LCUN, DGC and RLGF), will indepen-
dently assess the included studies for risk of bias using Cochrane’s
’Risk of bias’ tool, described in Section 8.5 of the Cochrane Hand-
book for Systematic Reviews of interventions (Higgins 2011). We
plan to resolve disagreements by discussionwithin the review team,
if necessary.
We will assess the following domains and rate them as at low,
unclear, or high risk of bias:
4Treatment for telangiectasias and reticular veins (Protocol)
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1. Random sequence generation;
2. Adequate concealment of allocation;
3. Blinding of participants and personnel;
4. Blinding of outcome assessment;
5. Incomplete outcome data;
6. Selective outcome reporting; and
7. Other potential threats to validity.
We will report these assessments for each individual study in the
’Risk of bias’ tables located in the ’Characteristics of included
studies’ section. We plan to contact the study author(s) to seek
clarification in cases of uncertainty over data.
Measures of treatment effect
We will use risk ratio (RR) for dichotomous data and mean differ-
ence (MD) for continuous data with the same scale or standardised
mean difference (SMD) for continuous data with different scales,
all with 95% confidence intervals (CI).
Unit of analysis issues
We will consider each participant as a unit of analysis. For trials
that consider multiple interventions in the same group, we will
analyse only the partial data of interest.
Dealing with missing data
We will analyse only the available data and will contact the trial
authors to request missing data. We will report dropout rates in
the ’Characteristics of included studies’ tables of the review, and
we will use intention-to-treat analysis.
Assessment of heterogeneity
We will quantify inconsistency among the pooled estimates using
the I2statistic (where I2= ((Q - df )/Q) x 100% where Q is the Chi
2statistic, and ’df ’ represents the degree of freedom). This illus-
trates the percentage of the variability in effect estimates resulting
from heterogeneity rather than sampling error (Higgins 2011).
We will interpret the thresholds for the I2statistic as follows: 0 to
30% = low heterogeneity; 30% to 60% = moderate heterogeneity;
60% to 90% = substantial heterogeneity and more than 90% =
considerable heterogeneity (Higgins 2011).
Assessment of reporting biases
We will assess the presence of publication bias and other reporting
bias using funnel plots if sufficient studies (more than 10) are
identified for inclusion in the meta-analysis (Higgins 2011).
Data synthesis
We will synthesise the data using Review Manager 5.3 software
(RevMan 2014). We will use the fixed-effect model to synthesise
the data if there are low to moderate le vels of heterogeneity. If there
is substantial heterogeneity, we will use a random-effects model. If
there is considerable heterogeneity, we will not undertake a meta-
analysis but will describe the data narratively in the text.
Subgroup analysis and investigation of heterogeneity
If there are sufficient data available, we will perform subgroup
analyses for the following:
1. Interventions: types of sclerosants, IPL and laser wave
lengths; and combination of methods;
2. Participant characteristics: age (e.g. youth (15 years to 24
years), adults (25 years to 64 years) and seniors (65 years and
over)), gender and race.
Sensitivity analysis
If there are an adequate number of studies, we will perform sensi-
tivity analysis based on allocation concealment (high, low, or un-
clear) and blinding of outcome assessment (high, low, or unclear).
We will carry out sensitivity analyses by excluding those trials that
are judged to be of high risk of bias according to Higgins 2011.
Summary of findings
We will prepare a ’Summary of findings’ table to provide the key
information presented in the review comparing treatments in par-
ticipants with telangiectasias and reticular veins. For each com-
parison summarised and at one time point we will include the
outcomes described in the Types of outcome measures:
•Clinically or photographically assessed resolution or
improvement, or both;
•Adverse events (including hyperpigmentation, bruising,
anaphylaxis);
•Pain during procedure and postprocedure;
•Recurrence;
•Time to resolution;
•Quality of life.
We will assess the quality of the evidence for each outcome as high,
moderate, low or very low based on the criteria of risk of bias,
inconsistency, indirectness, imprecision, and publication bias, us-
ing the GRADE approach (Grade 2004). We will base this ta-
ble on methods described in Chapter 11 and 12 of the Cochrane
Handbook, and justify any departures from the standard methods
(Grade 2004;Higgins 2011). We have included an example of a
’Summary of findings’ table for the comparison of sclerotherapy
versus laser therapy for telangiectasias in the Additional tables sec-
tion (Table 1).
5Treatment for telangiectasias and reticular veins (Protocol)
Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

A C K N O W L E D G E M E N T S
We would like to thank Cochrane Vascular, Cochrane Brazil and
the Division of Vascular and EndovascularSurgery of Universidade
Federal de Sao Paulo, Brazil for their methodological support.
R E F E R E N C E S
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7Treatment for telangiectasias and reticular veins (Protocol)
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A D D I T I O N A L T A B L E S
Table 1. Is sclerotherapy more effective in treating telangiectasias compared to laser therapy
Sclerotherapy versus laser therapy for telangiectasias
Patient or population: people with telangiectasias and reticular veins in the lower limb
Settings: secondary care, outpatient
Intervention: sclerotherapy
Comparison: laser therapy
Outcomes Illustrative comparative risks*
(95% CI)
Relative effect
(95% CI)
No of Partici-
pants
(studies)
Quality of the
evidence
(GRADE)
Comments
Assumed risk Corresponding
risk
Sclerotherapy Laser therapy
Clin-
ically or photo-
graphically as-
sessed res-
olution or im-
provement (or
both)
[range of scale
or scale descrip-
tion]
[follow up]
[value] per
1000
[value] per
1000
RR
[value] ([value]
to [value])
[value]
([value])
⊕
very low
⊕⊕
low
⊕⊕⊕
moderate
⊕⊕⊕⊕
high
Adverse events
(including
hyperpigmen-
tation, bruising,
anaphy-
laxis, necrosis of
the skin)
[range of scale
or scale descrip-
tion]
[follow up]
[value] per
1000
[value] per
1000
RR
[value] ([value]
to [value])
[value]
([value])
⊕
very low
⊕⊕
low
⊕⊕⊕
moderate
⊕⊕⊕⊕
high
Pain during
procedure and
post procedure
[range of scale
or scale descrip-
tion]
[follow-up]
The mean pain
score ranged
across control
groups from
[value][measure]
The
mean pain score
in the interven-
tion groups was
[value] [lower/
higher]
[value]
([value])
⊕
very low
⊕⊕
low
⊕⊕⊕
moderate
⊕⊕⊕⊕
8Treatment for telangiectasias and reticular veins (Protocol)
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Table 1. Is sclerotherapy more effective in treating telangiectasias compared to laser therapy (Continued)
high
Recurrence
[follow-up]
[value] per
1000
[value] per
1000
([value] to
[value])
RR
[value] ([value]
to [value])
[value]
([value])
⊕
very low
⊕⊕
low
⊕⊕⊕
moderate
⊕⊕⊕⊕
high
Time to resolu-
tion
[range of scale
or scale descrip-
tion]
[follow-up]
The mean time
ranged across
control groups
from
[value][measure]
The mean time
in the interven-
tion groups was
[value] [lower/
higher]
[value]
([value])
⊕
very low
⊕⊕
low
⊕⊕⊕
moderate
⊕⊕⊕⊕
high
Quality of life
[range of scale
or scale descrip-
tion]
[follow-up]
The mean qual-
ity of
life score ranged
across control
groups from
[value][measure]
The mean qual-
ity of life score in
the intervention
groups was
[value] [lower/
higher]
[value]
([value])
⊕
very low
⊕⊕
low
⊕⊕⊕
moderate
⊕⊕⊕⊕
high
*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk
(and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention
(and its 95% CI).
CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change
the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to
change the estimate.
Very low quality: We are very uncertain about the estimate.
9Treatment for telangiectasias and reticular veins (Protocol)
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A P P E N D I C E S
Appendix 1. Glossary
acne vulgaris skin disease caused by overactivity of sebaceous glands
ambulatory people treated out with the hospital setting
angiomas dilatation or new formation of blood vessels
arterioles small branches of an artery
atrophic blanche small smooth ivory-white areas on the skin with hyperpigmented borders and telangiectasias
chromophore chemical group that absorbs light at a specific frequency
dermal relating to skin and specially to the dermis
dorsum the dorsal part of an organism
endothelium tissue that forms a single layer of cells lining various organs
epidermal nonsensitive layer of the skin
erythema superficial reddening of the skin
extravasation escape of blood from a vessel into the tissues
fibrosis the thickening and scarring of connective tissue
hypopigmentation decreased pigmentation of an area of the skin
hyperpigmentation increased pigmentation of an area of the skin
lipodermatosclerosis chronic fibrosing panniculitis associated with venous insufficiency
matting new telangiectasis after treatment
melanin pigment responsible for determining skin and hair colours
microthrombi small thrombus (blood clot formed in situ within the vascular system)
necrosis death of most or all of the cells in an organ or tissue
occlusion blockage of blood vessel
oedema excess of watery fluid collecting in the tissue of the body
10Treatment for telangiectasias and reticular veins (Protocol)
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(Continued)
osmotic diffusion of fluid through a semipermeable membrane
oxyhaemoglobin substance formed by the combination of haemoglobin with oxygen
periorbital tissues surrounding or lining the orbit of the eye
photocoagulation coagulation of tissue using a laser or other intense light source
photothermolysis a method of laser skin resurfacing
polychromatic various wavelengths or frequencies
recanalisation process of restoring flow of the blood vessels
subcutaneous situated or applied under the skin
subdermal situated or lying under the skin
thermocoagulation coagulation of tissue with high-frequency currents
thermosclerosis coagulation of blood vessels for heat
thrombosis local coagulation or clotting of the blood in a part of circulatory system
vascular relating to blood vessels
venous relating to a vein
venules very small veins
vesicles small fluid-filled bladders, sacs, or cysts
Appendix 2. CENTRAL search strategy
#1 MESH DESCRIPTOR Telangiectasis EXPLODE ALL TREES
#2 telangiectas*:TI,AB,KY
#3 microvaric*:TI,AB,KY
#4 (reticular near3 vein*):TI,AB,KY
#5 (reticular near3 varic*):TI,AB,KY
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(Continued)
#6 (reticular near3 venous):TI,AB,KY
#7 (thread near3 vein*):TI,AB,KY
#8 (thread near3 varic*):TI,AB,KY
#9 (thread near3 venous):TI,AB,KY
#10 (spider near3 vein*):TI,AB,KY
#11 (spider near3 varic*):TI,AB,KY
#12 (spider near3 venous):TI,AB,KY
#13 angioectasias:TI,AB,KY
#14 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13
Appendix 3. LILACS/BECS search strategy
((MH: “Telangiectasis” OR MH: “Telangiectasia” OR MH: “Telangiectasia” OR “Spider Veins”) AND (MH: “Lasers” OR MH:
“Rayos Láser” OR MH: “Lasers” OR “Masers” OR E07.632.490$ OR E07.710.520$ OR SP4.011.087.698.384.075.166.027$
OR VS2.006.002.009$ OR MH: “Laser Coagulation” OR MH: “Coagulación con Láser” OR MH: “Fotocoagulação a Laser” OR
“Laser Thermocoagulation” OR “Thermocoagulation, Laser” OR E02.520.745.410$ OR E02.594.530$ OR E04.014.520.530$ OR
E04.350.750.410$ OR E04.540.630.410$ OR MH: “Low-Level Light Therapy” OR MH: “Terapia por Luz de Baja Intensidad” OR
MH: “Terapia com Luz de Baixa Intensidade” OR “Laser Therapy, Low-Level” OR “Laser Biostimulation” OR “Laser Irradiation, Low-
Power” OR “LLLT” OR E02.594.540$ OR E02.774.500$ OR MH: “Laser Therapy” OR MH: “Terapia por Láser” OR MH: “Terapia
a Laser” OR “Laser Knife” OR “Laser Scalpel” OR “Surgery, Laser” OR “Vaporization, Laser” OR E02.594$ OR E04.014.520$
OR MH: “Lasers, Gas” OR MH: “Láseres de Gas” OR MH: “Lasers de Gás” OR “Argon Ion Lasers” OR “Carbon Dioxide Lasers”
OR “CO2 Lasers” OR “Copper Vapor Lasers” OR “Gas Laser” OR “Gas Lasers” OR “Gold Vapor Lasers” OR “Helium Lasers” OR
“Helium Neon Gas Lasers” OR “Metal Vapor Lasers” OR “Nitrogen Lasers” OR “Xenon Ion Lasers” OR E07.632.490.367$ OR
E07.710.520.367$ OR MH: “Intense Pulsed Light Therapy” OR “Tratamiento de Luz Pulsada Intensa” OR “Terapia de Luz Pulsada
Intensa” OR MH: “Sclerotherapy” MH: “Escleroterapia” MH: “Escleroterapia” OR MH: “Sclerosing Solutions” OR MH: “Soluciones
Esclerosantes” OR MH: “Soluções Esclerosantes” OR “Injections, Sclerosing” OR “Sclerosing Agents” OR D26.776.708.822$ OR
D27.505.954.411.700$ OR D27.505.954.578.822$ OR D27.720.752.822$)) AND (DB:(“IBECS” OR “LILACS”))
C O N T R I B U T I O N S O F A U T H O R S
LCUN: protocol drafting, acquiring trial reports, trial selection, data extraction, data analysis, data interpretation, review drafting, and
future review updates, guarantor of the review.
DGC: protocol drafting, trial selection, data extraction, data analysis, data interpretation, review drafting, and future review updates.
JCCB: protocol drafting, trial selection, data interpretation, review drafting, and future review updates.
RLGF: protocol drafting, trial selection, data extraction, data analysis, data interpretation, review drafting, and future review updates.
12Treatment for telangiectasias and reticular veins (Protocol)
Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

D E C L A R A T I O N S O F I N T E R E S T
LCUN: none known.
DGC: none known.
JCCB: none known.
RLGF: none known.
S O U R C E S O F S U P P O R T
Internal sources
•No sources of support supplied
External sources
•Chief Scientist Office, Scottish Government Health Directorates, The Scottish Government, UK.
The Cochrane Vascular editorial base is supported by the Chief Scientist Office.
N O T E S
Parts of the methods section of this protocol are based on a standard template established by Cochrane Vascular.
13Treatment for telangiectasias and reticular veins (Protocol)
Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.