Overview
Background
Public interest in laser and light treatment of leg veins is high, and, under the right circumstances,
excellent results can achieve with this treatment modality. With any laser or light source treatment,
reverse pressure from associated reticular or varicose veins must be recognized and eliminated; otherwise,
the treatment doom to fail. Many patients benefit from a combination of portfolio such as sclerotherapy,
ambulatory phlebectomy, and intravascular laser or radiofrequency closure because external lasers and light
sources do not effectively treat associated reticular and varicose veins. Lasers can be effective in treating vessels
of less than 1-2 mm in diameter that are resistant to sclerotherapy and telangiectatic matting, which can occur
postsclerotherapy. However, sclerotherapy remains the criterion standard for the treatment of leg veins and telangiectasias.
Indications
Lasers typically reserve for the smallest telangiectasias of the leg, but newer longer-wavelength lasers can
be useful for spider veins up to 2 mm in diameter, although they produce much more pain than when small-diameter
vessels treate. The typical treatment sequence for patients with spider veins is to treat axial (saphenous) varicosities if
present, followed by branch varicosities, and then reticular veins, which are first treated using appropriate surgical means
(ie, intravascular laser or radiofrequency closure and/or ambulatory phlebectomy) or sclerotherapy.
Once these vessels adequately treate, lasers have the greatest utility in a “clean-up” role, on vessels
smaller than the diameter of a 30-gauge needle.
Additionally, lasers are a good option to treat vessels resistant to sclerotherapy. Laser and light source portfolio should be
considered in a primary role (prior to superficial sclerotherapy) in certain patients, such as those who are fearful of needles or
who do not tolerate sclerotherapy (extremely rare in the authors’ more than 30 years of experience), patients whose
vessels do not respond to sclerotherapy (also extremely rare when appropriate diagnosis and treatment of feeding
reticular veins has occurred), or those who are prone to postsclerotherapy telangiectatic matting.
Most importantly, lasers should consider in patients who are not willing to commit to postsclerotherapy
usage of compression stockings. Because thermal injury of the vein endothelium is essentially immediate,
compression has not show to enhance the efficacy of treatment, as has show with sclerotherapy.
Technology
The primary lasers used for bright-red, small (0.5 mm or smaller) leg veins are the pulsed visible light lasers
or intense pulsed light (IPL) sources. Lasers tried on 0.5-mm or larger leg veins near-infrare pulsed lasers.
Lasers that have been reported to be effective include green (potassium titanyl phosphate [KTP] 532 nm),
yellow pulsed dye (585-605 nm), alexandrite (infrared, 755 nm), diode (infrared, 810 nm), Nd:YAG (infrared to 1064 nm),
and the IPL broadband light source (515-1200 nm).Most recently, 940-nm diode lasers have been shown to have
efficacy in the treatment of leg veins. [8] These lasers have all designe with large spot sizes,
typically 3-8 mm in diameter, and with pulse durations of 2-100 milliseconds to match the thermal
relaxation time of larger telangiectasias. Most incorporate a mechanism to cool the skin to allow higher fluence
to be delivered with less chance of inadvertent injury to the epidermis.
Postoperative Results
After laser treatment of leg veins, the patient seldom experiences postoperative pain. Pain medication is usually not required.
Smaller vessels may have disappeared completely, affording the patient and the physician with a visual record of success.
Larger spider veins and reticular veins usually do not disappear following treatment, and they
may even darken as the blood in the vessels coagulates.
Use of the 1064-nm laser may cause mild edema or surrounding erythema around the treatment site,
which usually resolves rapidly (see image below). Compression for a defined period following
treatment may be helpful in achieving maximal benefit, but it is not mandatory, as it is with sclerotherapy.
Posttreatment hyperpigmentation is often seen for 1-3 months and should be discussed with patients
as an expected occurrence prior to treatment.
The incidence of hyperpigmentation increases with the size of the treated vessel.
In the authors’ experience, unlike sclerotherapy, which usually can effectively clear a blood vessel
in 1-2 portfolio, laser therapy often requires 3 or more portfolio to effect a similar degree of improvement.
https://richmondhillcc.ca/portfolio/laser-pigment-removal/
Summary
Laser treatment of leg veins and telangiectasia has been the subject of much patient and physician interest.
Although laser technology continues to evolve and improve, optimal results for leg telangiectasias may often
be achieved with sclerotherapy or sclerotherapy followed by laser or IPL therapy.
The authors’ experience has borne out that sclerotherapy is more efficient and effective for most patients
with telangiectatic leg veins. Combination treatment allows sclerotherapy to treat the larger, feeding venous system,
while laser or IPL effectively seals the superficial vessels to prevent extravasation, thereby theoretically minimizing
pigmentary changes, recanalization, and telangiectatic matting.
Longer wavelengths (eg, 1064 nm), used at pulse durations of 10-50 milliseconds, improve the capability
of lasers to treat larger, deeper deoxygenated blood vessels.
This wavelength minimizes the risk to the epidermis, even when patients tanne.
Other wavelengths and systems have make safer with the addition of epidermal cooling systems.
For excellent patient education resources, see eMedicineHealth’s patient education article Varicose Veins.
