Title : The phlebectic crown: The importance of treatment

Background: Corona phlebectatica, also known as corona paraplantaris, is a recognized cutaneous manifestation of chronic venous insufficiency (CVI). It is characterized by dilated perimalleolar veins, blue and red telangiectasias, and capillary stasis. This clinical sign has been associated with a significantly increased risk of trophic skin disorders, with studies reporting up to a six-fold higher risk in affected patients compared to those without phlebectic crown (1,2).

Objective: To evaluate the efficacy of combined versus sequential treatment strategies involving sclerotherapy and laser therapy in patients presenting with corona phlebectatica.

Methods: A total of 578 patients with symmetrical clinical and aesthetic involvement of both lower limbs were included in this study and followed over a 5-year period. All patients were classified as C4 according to the CEAP classification. Each patient received two different treatment modalities: a combined approach (sclerotherapy immediately followed by laser therapy in the same session) on one limb, and a sequential approach (sclerotherapy followed by laser therapy after one month) on the contralateral limb.

Results: The combined treatment approach was associated with reduced procedural pain. In contrast, the sequential approach required a greater number of laser sessions to achieve comparable clinical outcomes. Furthermore, the combined modality demonstrated lower annual recurrence rates.

Conclusion: The treatment of corona phlebectatica should be considered a preventive intervention against trophic complications in patients with CVI. The combination of laser therapy and sclerotherapy enhances therapeutic efficacy while improving overall treatment quality. These findings support the integration of combined treatment strategies into routine clinical practice for optimal patient outcomes.

Valentina Kieffer, born on 11 July 1978, is a distinguished medical professional specializing in Vascular Medicine and Angiology. She is a practitioner attached to the Department of Vascular Medicine at the University Hospital Center of Nancy and previously served as Head of the Vascular Medicine Department at the Émile Durkheim Hospital Center in Épinal. She currently practices Angiology privately in Orléans, France, and serves as an Expert in Vascular Medicine at the Court of Appeal of Orléans. She is also actively involved in medical education as a Teacher and Internship Supervisor for the University Diploma of Phlebology and the University Diploma of Endovenous Diagnostic and Therapeutic Techniques at Sorbonne University, Paris, as well as at the University of Medicine of Tours. In addition, she is a member of the Scientific Committee of the journal Vascular Pathologies.