Treatment Of Telangiectatic Leg Veins Research Articles

Indocyanine green-augmented diode laser therapy vs. long-pulsed Nd:YAG (1064 nm) laser treatment of telangiectatic leg veins: a randomized controlled trial

Telangiectatic leg veins (TLV) represent a common cosmetic problem. Near infrared lasers have been widely used in treatment because of their deeper penetration into the dermis, but with varying degrees of success, particularly because of different vessel diameters. Indocyanine green (ICG)-augmented diode laser treatment (ICG+DL) may present an alternative treatment option. This trial evaluates the efficacy of ICG+DL in the treatment of TLV and compares the safety and efficacy of therapy with the standard treatment, the long-pulsed neodymium-doped yttrium aluminium garnet (Nd:YAG) laser. In a prospective randomized controlled clinical trial, 29 study participants with TLV were treated with a Nd:YAG laser (λem = 1064 nm, 160-240 J cm(-2) , 65-ms pulse duration, 5-mm spot size) and ICG+DL (λem = 810 nm, 60-110 J cm(-2) , 48-87-ms pulse duration, 6-mm spot size; total ICG dose 4 mg kg(-1) ) in a side-by-side comparison in one single treatment setting that included histological examination in four participants. Two blinded investigators and the participants assessed clearance rate, cosmetic appearance and adverse events up to 3 months after treatment. According to both the investigators' and participants' assessment, clearance rates were significantly better after ICG+DL therapy than after Nd:YAG laser treatment (P < 0·05). On a 10-point scale indicating pain during treatment, participants rated ICG+DL therapy to be more painful (6·1 ± 2·0) than Nd:YAG laser (5·4 ± 2·0). ICG+DL therapy represents a new and promising treatment modality for TLV, with high clearance rates and a very good cosmetic outcome after one single treatment session.

Single-Blind, Randomized Study Comparing Chromated Glycerin, Polidocanol Solution, and Polidocanol Foam for Treatment of Telangiectatic Leg Veins

BACKGROUND A single-blind, randomized, comparative study was performed to evaluate the efficacy of pure chromated glycerin (CG), polidocanol (POL) 0.25% solution, and POL 0.25% foam (Monfreux technique) for treatment of telangiectasias and reticular leg veins. OBJECTIVE To determine the relative efficacy and safety of two sclerosing agents and foam. METHOD Of 150 randomized patients presenting comparable areas (lateral face of thigh) of telangiectasias and reticular leg veins, 147 could be evaluated by photographic assessment, patients' satisfaction score, and pain at injection sites. Internal and external agreement for the photographic assessment was good for two independent blinded experts. RESULTS CG cleared vessels significantly better than POL solution or foam (p < 0.002). The patients' satisfaction score was also higher in the CG group, although the difference did not reach statistical significance. CG was significantly more painful at injection sites. Other side effects were very few, precluding any statistical comparison. Foam was associated with more side effects (microthrombi, matting) than CG or POL solution. Three patients treated with POL foam experienced a transient visual disturbance. CONCLUSION This study shows that CG is superior to POL solution and foam for sclerotherapy of leg telangiectasias.

Comparative Trial Between Sodium Tetradecyl Sulfate and Glycerin in the Treatment of Telangiectatic Leg Veins

BACKGROUND. Thirteen patients were treated with either sodium tetradecyl sulfate (STS) or glycerin to compare the efficacy and adverse sequelae of each agent. OBJECTIVE. To determine the relative safety and efficacy of two sclerosant solutions. METHODS. Each patient's leg veins that were from 0.2 to 0.4 mm in diameter and that did not have incompetence from the saphenofemoral junction and whose feeding reticular veins had been already treated in a prior sclerotherapy session were randomly treated with either 0.25% STS or 72% glycerin solution. Patients were evaluated from 2 to 6 months postsclerotherapy for overall clinical improvement and incidence of adverse sequelae. RESULTS. Glycerin was comparable to STS in discomfort of injection but demonstrated a significant decrease in bruising, swelling, and postprocedural hyperpigmentation. Glycerin also demonstrated a better, more rapid clearance of treated telangiectasias. Conclusions. Seventy-two percent glycerin is a safe and effective sclerosant with fewer side effects and more rapid clearance of telangiectatic leg veins than STS.

Recent advances in laser therapy for the treatment of cutaneous vascular disorders.

The use of lasers for the treatment of cutaneous vascular disorders has expanded rapidly since its inception in the early 1960s. The flashlamp-pumped pulsed tunable dye laser (PDL), which is the best laser system for the treatment of port-wine stains (PWS), is based on the premise of selective photothermolysis. Recent literature demonstrates enhanced selective photothermolysis by modifying the PDL to include a longer pulse width, a longer wavelength and higher energy fluences through the use of dynamic cooling. Multiple pulse laser irradiation, a new innovative method, shows promising preliminary results in eradicating hypertrophic PWS. In the treatment of capillary haemangiomas, previous uncontrolled studies suggest benefit with early PDL therapy but a recent randomised controlled trial does not support this claim. Mixed haemangiomas respond poorly to PDL treatment, uncomplicated tumours are best left to involute spontaneously whilst life/organ-threatening lesions require early active intervention. The efficacy of lasers in the treatment of telangiectatic leg veins (TLV) remains controversial. The literature revealed many conflicting claims. Larger and properly controlled studies are necessary to better define the role of lasers in the treatment of TLV.

Laser therapy of telangiectatic leg veins: clinical evaluation of the 810 nm diode laser.

Telangiectatic leg veins (TLV) are experienced by millions of women and men. As they cause significant cosmetic embarrassment, many women seek effective treatment. Options include sclerotherapy and treatment with different lasers. We investigated the safety and efficacy of an 810-nm diode laser in the treatment of TLV. Ten females had treatment to a >/= 25 cm2 area of TLV four times at 4-weekly intervals at 25-35 W, 0.1 s duration, 0.5 s interval and a 5-mm circular spot size (fluence of 12.7-17.8 J/cm2). Assessment of response was performed 4 weeks after the final treatment and patients were asked to complete a questionnaire requesting information regarding the treatment. No statistically significant clearing of the leg veins was demonstrated although some improvement was noted in individual patients. Side-effects were negligible, consisting of discomfort or mild pain. There was no scarring, purpura or pigment alteration. A visual analogue scale questionnaire (0-10) revealed that patients found the treatment acceptable (range, 4-10). Overall difference as assessed by the patients ranged from 0 to 8.4 and degree of satisfaction with the treatment from 0 to 9.8. Currently, the treatment of choice for TLV remains sclerotherapy. Our results suggest that the 810-nm diode laser is safe and well tolerated. Further research could establish whether effectiveness can be improved with higher fluences or in combination with sclerotherapy.