Interstitial Laser Treatment of Venous Malformations

Abstract

Summary Objective: Venous malformations are aside from hemangiomas the most common vascular lesions observed in the pediatric age group. While interstitial Nd:YAG laser treatment was first used to treat hemangiomas in infancy, the mechanism of this treatment also can be used for venous malformations to reduce bulk and hypervascularisation, and improve contour and function. Study design: We reviewed our experience with the use of interstitial Nd:YAG laser therapy in treating complicated venous or mixed malformations. The lesions reported were particular troublesome because of significant cosmetic disfigurement, maceration or ulceration, bleeding, coagulopathy, painful swelling, and of potential functional impairment. During a 15-year period, 176 patients with predominantly venous malformations were treated by interstitial Nd:YAG laser treatment, and 157 of the 176 patients were treated additionally by transcutaneous Nd:YAG laser treatment with local ice cube cooling to protect the overlying skin. By using interstitial laser treatment, the laser beam was transmitted using a 0.6 mm bare fiber that was placed through an 16G abbocath into the lesion to be treated. The laser energy ranged from 5 W to 8 W in continuous mode. Color-coded duplex sonography was used for monitoring the procedure. Treatments were done under general anesthesia. Results: Overall, excellent results were achieved in 43% of patients and good results occured in 52%. In 5% treatment was deemed to have failed. Complications included paresthesia, dysesthesia, mild trismus, and local motoric plegia. All complications were transient and disappeared completely. Overall, satisfaction was high because of clear reduction of complaints, and all but 1 patient would have laser treatment again. Conclusions: On the base of our results we conclude that interstitial Nd:YAG laser treatment may successfully prevent enlargement and promote improvement with flattening of the lesion, less swelling, and improvement in the vascular red or bluish hue with minimal adverse effects.