Optimal and safe treatment of spider leg veins measuring less than 1.5 mm on skin type IV patients, using repeated low-fluence Nd:YAG laser pulses after polidocanol injection

Abstract

Treatment of micro-veins of less than 1.5 mm with laser and with chemical sclerosis is technically challenging because of their difficulty to remedy. Laser treatment is even more difficult when dark phototypes are involved.Three groups of 30 patients each, skin type IV, and vessels measuring less than 1.5 mm in diameter, were enrolled for two treatment sessions 8 weeks apart: group A, polidocanol (POL) micro-foam injection; group B, Nd:YAG laser alone; and group C, laser after POL injection. Repeated 8-Hz low-fluence pulses, moving the hand piece over a 3-cm vein segment with an average of five laser passes maximum and with a total time irradiation of 1 s were used. Sixteen weeks after the second treatment, statistically, degree of clearance after examining photographs and patients satisfaction index, plotted on a visual analogue scale and comparing results of all three groups, results were significantly better for group C (p<0.0001). No significant differences in complications were noticed between the three groups. Efficacy of combining POL and laser proved safe and satisfactory in 96 % of patients using low-fluence laser pulses with a total cumulative energy in the 3 cm venous segment, lower than that of conventional treatment. Very few and transient complications were observed. POL foam injection followed by laser pulses is safe and efficient for vein treatment in dark-skinned patients.

Global guidelines trends and controversies in lower limb venous and lymphatic disease

“…226 In the same way, comparison data are missing regarding the potential combination of sclerotherapy followed by Nd:YAG treatment: an option that has been proposed already more than 15 years ago. 227 To the contrary, data show no benefit in combining pulsed dye laser with sclerotherapy. 228 Innovative devices combining diode laser and radiofrequency emission have been reported in the literature, yet without a direct comparison with laser only treatment.…”

Nd:YAG Laser

“…For small leg veins (0.5-2 mm), the Nd:YAG laser may be equivalent to sclerotherapy. A recent study using an Nd:YAG laser immediately after polidocanol sclerotherapy resulted in a statistically significant improvement over sclerotherapy or laser alone [26]. Another similar study yielded similar findings [27].…”

1064 nm Nd:YAG long pulse laser after polidocanol microfoam injection dramatically improves the result of leg vein treatment: A randomized controlled trial on 517 legs with a three-year follow-up

“…It was confirmed that the properties of both POL and the Nd:YAG laser could be altered when certain conditions were achieved. [7][8][9] The presence of POL foam bubbles inside the vessel while applying pulse lengths and fluences lower than those used by other authors is required. [7][8][9][10] Another study assessed the efficacy of this method in the treatment of spider leg veins measuring less than 1.5 mm, on skin type IV patients, comparing the results of the combined therapy (POL þ Laser) with those obtained when only POL or the Nd:YAG laser, separately, were applied.…”

“…[7][8][9] The presence of POL foam bubbles inside the vessel while applying pulse lengths and fluences lower than those used by other authors is required. [7][8][9][10] Another study assessed the efficacy of this method in the treatment of spider leg veins measuring less than 1.5 mm, on skin type IV patients, comparing the results of the combined therapy (POL þ Laser) with those obtained when only POL or the Nd:YAG laser, separately, were applied. The combined treatment produced a considerable improvement in the clearing of veins in the short term (three months after treatment), in comparison to both treatments in isolation, but the results could not be proven to be permanent.…”

“…The combined treatment produced a considerable improvement in the clearing of veins in the short term (three months after treatment), in comparison to both treatments in isolation, but the results could not be proven to be permanent. 9 The purpose of this paper is to present the clinical evaluation of the treatment of leg telangiectasias and reticular veins (classes I to III) using 1064 nm Nd:YAG laser pulses, following prior injections of POL microfoam in a large series of patients with a long-term control and follow-up.…”