Laser Treatment Of Vascular Lesions Research Articles

Cutaneous Hypervascularization Treatment Using Photo-Mediated Ultrasound Therapy

Photo-mediated ultrasound therapy (PUT) is a cavitation-based, highly selective antivascular technique. In this study, the effectiveness and safety of PUT on cutaneous vascular malformation was examined through invivo experiments in a clinically relevant chicken wattle model, whose microanatomy is similar to that of port-wine stain and other hypervascular dermal diseases in humans. Assessed by optical coherence tomography angiography, the blood vessel density in the chicken wattle decreased by 73.23% after one session of PUT treatment in which 0.707 J/cm2 fluence laser pulses were applied concurrently with ultrasound bursts (n= 7, P < .01). The effectiveness of removing blood vessels in the skin at depth up to 1 mm was further assessed by H&E-stained histology at multiple time points, which included days 1, 3, 7, 14, and 21 after treatment. Additional immunohistochemical analyses with CD31, caspase-3, and Masson's trichrome stains were performed on day 3 after treatment. The results show that the PUT-induced therapeutic effect was confined and specific to blood vessels only, whereas unwanted collateral damage in other skin tissues such as collagen was avoided. The findings from this study demonstrate that PUT can efficiently and safely remove hypervascular dermal capillaries using laser fluence at a level that is orders of magnitude smaller than that used in conventional laser treatment of vascular lesions, thus offering a safer alternative technique for clinical management of cutaneous vascular malformations.

Dye laser and long-pulsed Nd: YAG laser treatment of vascular lesions: Clinical experience

Introduction: Hemangiomas and vascular malformations are common vascular lesions. Although various methods have been described in the treatment of vascular lesions, the place of lasers is very important. Today, dye laser and Nd: YAG lasers are most commonly used in the laser treatment of vascular lesions. Materials and Methods: A total of 137 patients treated with 585–600 nm flashlamp pulsed dye laser and 1064-nm long-pulsed Nd: YAG laser in three laser units were searched, and laser setups and the number of sessions used were evaluated. Evaluations were made by three plastic surgeons over photographs. According to the discoloration and decrease in height of the lesion, it was classified as 0%–25% (poor), 25–50 (average), 50–75 (good), and 75–100 (excellent). The age of the patients ranged from 2 months to 55 years. 53 port-wine stain, 18 telangiectasia, 8 cherry angioma, 12 spider angioma, 18 hemangioma, 8 venous lake, 11 intraoral hemangioma, and 9 other vascular lesions constituted the distribution of diagnoses between patients. Laser power used in dye laser treatments ranged between 7 and 19 J/cm2, the mean sequence was 6.4, and duration ranged between 1.5 and 20 msec. Nd:YAG l laser power ranged between 120 and 240 J/cm2, the mean sequence was 2.8, and duration ranged between 10 and 50 msec. Results: Seventy patients (51.1%) achieved excellent results, 32 patients (23.36%) achieved good results, 14 patients (10.21%) achieved average clearance, and 21 patients (15.33%) showed low or no removal of their lesion. High success was achieved with minimal complications. Conclusion: Today, dye laser and Nd: YAG lasers provide a satisfactory aesthetic result, low morbidity, and effective treatment for many vascular lesions in terms of patient comfort. In order to optimize results and reduce negative effects, it is necessary to master the properties of the laser and have sufficient knowledge of the interactions of the laser with tissue.

Topical anaesthetic effects on skin vasculature with potential implications for laser treatment

Laser treatment of vascular lesions is affected by parameters including the diameter and depth of the vessels and flow within the vessels. Topical anaesthetics are in common use prior to laser treatment but may have effects on vessel parameters and, subsequently, the efficacy of laser treatment. Eleven patients with capillary vascular malformations were investigated for vessel diameter before and after elective application of a topical anaesthetic, Eutectic Mixture of Local Anaesthetics (EMLA) (AstraZeneca) or Ametop (S&N Health), prior to pulsed dye laser treatment. EMLA contains 2.5% lidocaine ad 2.5% prilocaine, and Ametop gel contains 4% tetracaine. Patients' capillary malformations were assessed using confocal laser scanning microscopy (CLSM) (Vivascope 1500 Mavig GmbH, Munich). Six of the 11 patients recruited had EMLA topical anaesthetic, and five had Ametop. Four hundred twenty-one diameters were measured. The mean vessel diameter was 50.87 μm. Previous laser treatments undergone by each patient were noted to exclude this as a confounding variable, and no significant difference was found between topical anaesthetic groups. Statistical calculations were made using GenStat and Minitab. There is no evidence that Ametop affects mean diameter (p value is 0.361). EMLA reduces the mean diameter of vessels (p = 0.002), with a 27% reduction in post-EMLA diameter. This study demonstrates that the use of EMLA cream has a statistically significant reduction vessel diameter. As it is known that vessel diameter is important for the response of laser treatment, the use of EMLA may affect outcome.

Laser treatment of vascular lesions

Laser treatment of vascular lesions

Cosmetic Facial Surgery

Dermatologic Surgery: September 2011 - Volume 37 - Issue 9 - p 1320 doi: 10.1111/j.1524-4725.2011.02104.x

Basics of laser application to dermatology

Q-switched lasers, with a pulse of light sufficiently short (nanosecond-domain) is demonstrated to be useful for treatment of dermal melanocytosis, blue-black tattoos, melanocytic nevi, and solar lentigines, although transient postinflammatory hyperpigmentation usually developed in the irradiated area during the following 3-4 months. If the postinflammatory pigmentation does not disappear after 1 year, incontinentia pigmenti histologica is a possibility. However, the pigment in café-au-lait macules responds variably to treatment. Melasma shows no response to laser. Therefore, accurate diagnosis is the key to success in the laser treatment. Laser treatment of vascular lesions is based on selective absorption by blood with thermal injury to the vessel wall. Therefore, the pulse-width of the vascular-specific lasers must be longer (microsecond-domain) than that of pigment-specific lasers. Because the wavelength of the lasers for vascular lesions, however, cannot penetrate into the deep areas of the skin, not all vascular lesions can be treated. Laser or light-assisted hair removal offers an efficient way to permanently reduce excessive hair growth. Skin rejuvenation is possible by laser or pulsed light with millisecond-domain pulse-width. Because these light sources, however, cause severe damage to the skin surface, the exposure energy must be reduced and the treatment must be combined with cooling devices. Therefore, the clinical results of light-assisted skin rejuvenation are not prominent. In conclusion, the pulse-width and wavelength of the laser light are critical parameters for laser treatments. If we obtain information about these parameters for specific lasers, we can expect the results of the treatment to be positive.

A Side-by-Side Prospective Study of Intense Pulsed Light and Nd:YAG Laser Treatment for Vascular Lesions

A Side-by-Side Prospective Study of Intense Pulsed Light and Nd:YAG Laser Treatment for Vascular Lesions

O.298 Laser treatment of vascular lesions in maxillofacial surgery

O.298 Laser treatment of vascular lesions in maxillofacial surgery

A Side-by-Side Prospective Study of Intense Pulsed Light and Nd:YAG Laser Treatment for Vascular Lesions

Recently, lasers and light systems are used more for the treatment of vascular lesions due to their noninvasiveness, ease of use, and short recovery time. This side-by-side prospective study compares results, satisfaction, and complications after intense pulsed light (IPL) and Nd:Yag laser treatment of small vascular lesions. Twenty-five patients with telangiectases, leg veins, or cherry angiomas underwent treatment of the same category of lesion in the same area. One year after completing treatment, patients were asked to report their satisfaction level after comparing digital photos before and after treatment; 72% felt they had good to excellent results after Nd:Yag treatment, while only 48% felt the same after IPL. The most common side effect after Nd:Yag was hyperpigmentation. Satisfaction level was significantly higher after Nd:Yag than after IPL. Patients with telangiectases, cherry angiomas, or leg veins <1 mm were more satisfied after IPL, while those with leg veins >1 mm were more satisfied after Nd:Yag. Overall, satisfaction with treatment of vascular lesions was greater with Nd:Yag although this method was more painful.

Laser treatment in hemangiomas and vascular malformations

Various lasers have been used throughout the last 40 years for laser treatment of vascular lesions. At present, we use highly specialized lasers as the flashlamp-pumped dye laser or less specific, more coagulative lasers as the KTP-, diode or Nd:YAG-laser either with pulsed or continuous emission, with and without additional cooling and compression systems or interstitially or intraluminally techniques. With these methods an adapted treatment is possible in a wide range of vascular lesions with high precision and efficiency and little side effects. Eine große Zahl unterschiedlicher Laser fand in den letzten 40 Jahren eine Anwendung zur Behandlung von Gefäßfehlern und Hämangiomen. Heute werden hochspezialisierte Laser, wie der Blitzlampen-gepumpte Farbstofflaser oder unselektive, koagulative Laser wie der KTP-, verschiedene Dioden- oder Nd:YAG-Laser, mit oder ohne Hautkühlung bzw. Kompression oder interstitieller oder intraluminaler Technik zur Behandlung mit guten Ergebnissen und geringen Nebenwirkungen eingesetzt.

Treatment of vascular lesions with combined dynamic precooling, postcooling thermal quenching, and ND:YAG 1,064-nm laser.

The purpose of this study is to evaluate the effectiveness and safety of the newly developed neodymium:yttrium-aluminum-garnet (Nd:YAG) 1,064-nm laser system for nonablative laser treatment of vascular lesions in Asians. Five patients with vascular lesions in the periorbital area received serial treatments. The fluences were set between 80 and 90 J/cm(2). The patients were followed for 6 months. Improvements were noted in all patients. Transient erythema and swelling were noted in all patients during the postoperative period. Transient purpura occurred in one patient. The Nd:YAG 1,064-nm laser system, when coupled with dynamic precooling and postcooling thermal quenching, is effective and safe in treating periorbital vascular lesions even when multiple treatments are performed. No significant adverse effects were noted in this study.

Time-sequence histologic imaging of laser-treated cherry angiomas with in vivo confocal microscopy

Objective: To chronicle the pathophysiologic changes that occur subsequent to laser treatment of vascular lesions, we used a confocal scanning laser microscope that yields high-resolution microscopic images of skin in vivo. Methods: Cherry angiomas were treated with the 585-nm flashlamp-pumped pulsed-dye laser (PDL) and the 568-nm continuous-wave krypton laser. Repeated confocal reflectance imaging was performed before and immediately after treatment, as well as after several hours, 1 day, 2 days, 1 week, 2 weeks, 3 weeks, and 4 weeks. Results: Before treatment, confocal images revealed dilated blood vessels ranging from 10 to 50 μm in caliber, closely spaced at 5 to 50 μm apart. After PDL treatment, amorphous cords of refractile material conformed to the shape of the original vessels, followed by dark nonrefractile spaces where the vessels once were. Inflammation and necrosis ensued, with eventual replacement after 3 weeks by normal-appearing skin. After krypton laser treatment, dark nonrefractile spaces appeared immediately, with subsequent inflammation, necrosis, and eventual healing by 4 weeks. Conclusion: Confocal laser microscopic imaging elucidates the dynamic pathophysiologic events that occur after laser treatment of vascular lesions and has added insight into the different mechanisms of vessel damage induced by the PDL and krypton laser. (J Am Acad Dermatol 2000;43:37-41.)

Laser Treatment Of Vascular Lesions

The principle of selective photothermolysis, which states that thermal destruction can be predicted by choosing the appropriate wavelength, pulse duration, and pulse energy for a particular target, applies to the laser treatment of vascular lesions. The most commonly used vascular lesion lasers and light sources emit wavelengths of 532 nm, 577-600 nm, and 1064 nm. A wide range of vascular lesions can be treated using these systems.

New approaches to the laser treatment of vascular lesions.

The pulsed dye laser (PDL) was developed based on the concept of selective photothermolysis. Using a wavelength of light well absorbed by the target and a pulse duration short enough to spatially confine thermal injury, specific vascular injury could be produced. While the PDL revolutionized the treatment of port wine stains (PWS) and a variety of other vascular lesions, the mathematical model predicted that the ideal thermal relaxation time for the vessels in PWS is actually 1-10 msec, not 450 microseconds. These original theoretical calculations have been proved correct recently in a study using both an animal vessel model and in human PWS. Longer wavelengths of light within the visible spectrum penetrate deeper into the skin and are more suitable for deeper vessels; while longer pulse duration is required for larger calibre vessels. A variety of lasers have been developed recently for the treatment of vascular lesions that incorporate these concepts into their design, including PDL at 1.5 msec, a filtered flash-lamp pulsed light source with pulse durations of 1-20 msec, several 532 nm pulsed lasers with pulse durations of 1 to as high as 100 msec, long pulsed alexandrite lasers at 755 nm with pulse durations up to 20 msec, pulsed diode lasers in the 800-900 nm range, and long pulsed 1064 Nd:YAG sources. Preliminary results are encouraging.

Measuring Patient Satisfaction with Pulsed Dye Laser Treatment of Vascular Lesions

Before their first appointment at a pulsed dye laser clinic, 76 patients with a variety of vascular abnormalities completed a pretreatment assessment pack containing personal and demographic questions and the SF-36 Health Questionnaire, a self-report instrument for assessment of health status. These patients continued to receive laser treatment at approximately 3-monthly intervals.At 3 months and again at 6 months after their initial visit, the patients were sent postal follow-up packs containing the SF-36 Questionnaire and questions requesting information on: (a) opinions of the treatment itself; (b) the result in terms of clearance of coloration and (c) effect of treatment result on everyday life. The response rate to the follow-up questionnaire was 71% at 3 months and 60% at 6 months.Of the eight dimensions of health measured by the SF-36 Health Questionnaire, only mental health was found to be significantly improved at 6 months after initiation of treatment, and this improvement was dependent on gender, pertaining only to women.Information gained from the patients' perceptions of their treatment showed that opinions of the service delivery and advice and information offered were good. Overall, at the 6 month follow-up period, 83% of responders were satisfied with the treatment result, and the majority were pleased with its effect on their everyday life.

Pulsed dye laser treatment of vascular lesions in children.

The flashlamp-pumped pulsed dye laser (577,585 nm) with 300 to 450 microseconds pulsewidths has been demonstrated to effectively and safely treat port-wine stains, telangiectases, and superficial hemangiomas in children. The objective of this manuscript is to review the indications of the pulsed dye laser in the treatment of vascular lesions in children. Pulsed dye laser treatment of port-wine stains can remove or lighten the lesions with multiple treatment sessions. Spider telangiectases respond with complete resolution, usually within one to two treatment sessions. Superficial hemangiomas respond quite easily and effectively with the pulsed dye laser, while a more variable response is noted in deeper hemangiomas, early proliferative lesions, and ulcerated hemangiomas. This procedure is safe with a low incidence of scarring and pigmentary alteration.

A computer controlled scanner for the laser treatment of vascular lesions and hyperpigmentation

A computer controlled scanner has been used with a copper vapour laser for the treatment of vascular lesions and hyperpigmented lesions. The computer controls the position and speed of travel of the laser spot during treatment. The illumination time is adjustable with a minimum of 1 ms. The light from the laser is scanned over the lesion so that the lesion is 'painted in' in a raster-like scan of arbitrary shape and produces a series of parallel lines 0.6 mm apart.