Transcutaneous laser treatment of leg veins

被引:60
作者
Meesters, Arne A. [1 ]
Pitassi, Luiza H. U. [2 ]
Campos, Valeria [3 ,4 ]
Wolkerstorfer, Albert [1 ]
Dierickx, Christine C. [5 ]
机构
[1] Univ Amsterdam, Acad Med Ctr, Dept Dermatol, Netherlands Inst Pigment Disorders SNIP, NL-1105 AZ Amsterdam, Netherlands
[2] Univ Campinas UNICAMP, Dept Dermatol, Sao Paulo, Brazil
[3] Univ Mogi das Cruzes, Dept Dermatol, Mogi das Cruzes, Brazil
[4] UJ, Dept Dermatol & Laser, Sao Paulo, Brazil
[5] Laser & Skin Clin, Boom, Belgium
关键词
Laser; Leg vein; Leg vessel; Vascular lesions; Telangiectasia; Lower extremity; ND-YAG LASER; PORT-WINE STAIN; PULSE DYE-LASER; LOWER-EXTREMITY TELANGIECTASES; LONG-PULSE; DIODE-LASER; NM LASER; INDOCYANINE GREEN; RETICULAR VEINS; ARGON-LASER;
D O I
10.1007/s10103-013-1483-2
中图分类号
R318 [生物医学工程];
学科分类号
0831 ;
摘要
Leg telangiectasias and reticular veins are a common complaint affecting more than 80 % of the population to some extent. To date, the gold standard remains sclerotherapy for most patients. However, there may be some specific situations, where sclerotherapy is contraindicated such as needle phobia, allergy to certain sclerosing agents, and the presence of vessels smaller than the diameter of a 30-gauge needle (including telangiectatic matting). In these cases, transcutaneous laser therapy is a valuable alternative. Currently, different laser modalities have been proposed for the management of leg veins. The aim of this article is to present an overview of the basic principles of transcutaneous laser therapy of leg veins and to review the existing literature on this subject, including the most recent developments. The 532-nm potassium titanyl phosphate (KTP) laser, the 585-600-nm pulsed dye laser, the 755-nm alexandrite laser, various 800-983-nm diode lasers, and the 1,064-nm neodymium yttrium-aluminum-garnet (Nd:YAG) laser and various intense pulsed light sources have been investigated for this indication. The KTP and pulsed dye laser are an effective treatment option for small vessels (< 1 mm). The side effect profile is usually favorable to that of longer wavelength modalities. For larger veins, the use of a longer wavelength is required. According to the scarce evidence available, the Nd:YAG laser produces better clinical results than the alexandrite and diode laser. Penetration depth is high, whereas absorption by melanin is low, making the Nd:YAG laser suitable for the treatment of larger and deeply located veins and for the treatment of patients with dark skin types. Clinical outcome of Nd:YAG laser therapy approximates that of sclerotherapy, although the latter is associated with less pain. New developments include (1) the use of a nonuniform pulse sequence or a dual-wavelength modality, inducing methemoglobin formation and enhancing the optical absorption properties of the target structure, (2) pulse stacking and multiple pass laser treatment, (3) combination of laser therapy with sclerotherapy or radiofrequency, and (4) indocyanin green enhanced laser therapy. Future studies will have to confirm the role of these developments in the treatment of leg veins. The literature still lacks double-blind controlled clinical trials comparing the different laser modalities with each other and with sclerotherapy. Such trials should be the focus of future research.
引用
收藏
页码:481 / 492
页数:12
相关论文
共 91 条
[1]   Comparison of the 595 nm long-pulse (1.5 msec) and ultralong-pulse (4 msec) lasers in the treatment of leg veins [J].
Alora, MB ;
Stern, RS ;
Arndt, KA ;
Dover, JS .
DERMATOLOGIC SURGERY, 1999, 25 (06) :445-449
[2]   Contact cooling of the skin [J].
Altshuler, GB ;
Zenzie, HH ;
Erofeev, AV ;
Smirnov, MZ ;
Anderson, RR ;
Dierickx, C .
PHYSICS IN MEDICINE AND BIOLOGY, 1999, 44 (04) :1003-1023
[3]  
Anderson R R, 1981, Lasers Surg Med, V1, P263
[4]   SELECTIVE PHOTOTHERMOLYSIS - PRECISE MICROSURGERY BY SELECTIVE ABSORPTION OF PULSED RADIATION [J].
ANDERSON, RR ;
PARRISH, JA .
SCIENCE, 1983, 220 (4596) :524-527
[5]   THE OPTICS OF HUMAN-SKIN [J].
ANDERSON, RR ;
PARRISH, JA .
JOURNAL OF INVESTIGATIVE DERMATOLOGY, 1981, 77 (01) :13-19
[6]   A THEORETICAL-STUDY OF THE THERMAL RESPONSE OF SKIN TO CRYOGEN SPRAY COOLING AND PULSED-LASER IRRADIATION - IMPLICATIONS FOR TREATMENT OF PORT-WINE STAIN BIRTHMARKS [J].
ANVARI, B ;
TANENBAUM, BS ;
MILNER, TE ;
KIMEL, S ;
SVAASAND, LO ;
NELSON, JS .
PHYSICS IN MEDICINE AND BIOLOGY, 1995, 40 (09) :1451-1465
[7]  
Apfelberg D B, 1978, Ann Plast Surg, V1, P14, DOI 10.1097/00000637-197801000-00005
[8]   USE OF THE ARGON AND CARBON-DIOXIDE LASERS FOR TREATMENT OF SUPERFICIAL VENOUS VARICOSITIES OF THE LOWER-EXTREMITY [J].
APFELBERG, DB ;
MASER, MR ;
LASH, H ;
WHITE, DN ;
FLORES, JT .
LASERS IN SURGERY AND MEDICINE, 1984, 4 (03) :221-231
[9]  
APFELBERG DB, 1976, WESTERN J MED, V124, P99
[10]   ARGON-LASER THERAPY OF SMALL CUTANEOUS VASCULAR-LESIONS [J].
ARNDT, KA .
ARCHIVES OF DERMATOLOGY, 1982, 118 (04) :220-224