Noninvasive In Vivo Assessment of Vessel Characteristics in Capillary Vascular Malformations Exposed to Five Pulsed Dye Laser Treatments

Abstract

The treatment of capillary vascular malformations by pulsed dye laser results in fading of these disfiguring lesions in the majority of patients. In only a minority, however, is full clearance of the lesion achieved. It is believed that the capillary composition of a capillary vascular malformation is an important determinant of whether it will respond to further laser treatment. Moreover, by determining the type, size, and depth of the ectatic capillaries within a capillary vascular malformation, it may be possible to target these vessels with specific laser parameters. The noninvasive technique of depth measurement videomicroscopy was used to delineate the capillary structure of 22 previously untreated capillary vascular malformations and examine how this structure changes after five treatments with a 0.45-msec pulse duration using a 585-nm pulsed dye laser. After one and five treatments, there was a statistically significant lightening (p < 0.02 and p < 0.001, respectively) of the lesions, as seen on Munsell Color Chart testing. Before any laser treatment, the majority (59 percent) of capillary vascular malformations displayed a superficial type 1 or mixed capillary pattern, whereas after five laser treatments, the majority displayed a deep type 2 pattern (81 percent). After five laser treatments, there was a statistically significant increase in the depth of the remaining capillaries within the lesion compared with normal skin (p < 0.02) and a statistically significant reduction in the vessel diameters (p < 0.001). The authors found that vessels with a diameter greater than 50 mum were adequately treated, whereas those smaller than 50 microm appeared resistant to laser treatment. These data would suggest that pulse durations longer than 0.45 msec are not required to treat large ectatic capillary vascular malformation vessels. The authors suggest that the failure to treat very-small-diameter vessels is attributable to thermal dissipation from the target vessels, whose thermal relaxation time is much shorter than the pulse duration of the laser used.