Laser Treatment of Varicose Veins and Spider Telangiectasias
Laser treatment of spider veins on the face laser treatment of leg veins
Varicose veins and spider veins occur in over 40% of women and 15% of men in America. Abnormal veins can appear as superficial spider veins, fine linear vessels called telangiectasias, deeper small veins that feed the spiders (reticular veins), or larger varicose veins that stick out of the skin. The causes may be hereditary, from jobs requiring prolonged standing, being obese, or from pregnancy. They may cause leg fatigue, aching, cramping, throbbing, swelling, skin discoloration and leg ulcers. The most effective therapy has been sclerotherapy. This involves injection of a detergent into the veins that causes them to clot off or scar shut. It is more effective for reticular veins and large spiders. Lasers can be used for very small superficial spiders or telangiectasias <0.5>75% improvement.
The laser can treat vessels <3mm>
Varicose veins and spider veins occur in over 40% of women and 15% of men in America. Abnormal veins can appear as superficial spider veins, fine linear vessels called telangiectasias, deeper small veins that feed the spiders (reticular veins), or larger varicose veins that stick out of the skin. The causes may be hereditary, from jobs requiring prolonged standing, being obese, or from pregnancy. They may cause leg fatigue, aching, cramping, throbbing, swelling, skin discoloration and leg ulcers. The most effective therapy has been sclerotherapy. This involves injection of a detergent into the veins that causes them to clot off or scar shut. It is more effective for reticular veins and large spiders. Lasers can be used for very small superficial spiders or telangiectasias <0.5>75% improvement.
The laser can treat vessels <3mm>
Treatment
For patients with a low pain threshold or when treating larger veins, an anesthetic cream can be applied 30-60 minutes before hand. The area then must be cleaned off with alcohol before treatments begin. Patients may note swelling, redness, or a raised rash around the lasered vessels. The use of ice or steroid creams can help speed recovery and decrease the skin darkening side effect. Side effects of laser treatment include skin damage, blood clots, inflammation (superficial phlebitis), hyperpigmentation (skin darkening), and lack of clearing. Incomplete treatment can be taken care of with further laser or sclerotherapy. Painful blood vessel clotting can be addressed by suctioning out the old blood with a larger needle. Abnormal skin darkening can be avoided using longer wavelength lasers and better skin cooling devices.
Treatment summary
Patient examination
Veins and telangiectasias should be classified prior to treatment according vessel diameter and depth, which can be assessed by micrometer, dermatoscope, venoscope, or a Duplex ultrasound. A pre-treatment photo should be taken to assist in evalulating the effectiveness of the treatment.
Site prep
Shave the area to be treated. Cleanse the area with mild soap and water followed by an alcohol swab to thoroughly remove any residue from lotions, makeup, or shaving. Remove the alcohol with a gauze and plain water leaving the surface of the skin slightly moist. Patients generally lie flat for the procedure. The head may be raised to allow the leg veins to fill so that they are more visible.
Anesthesia
There is a cooling plate that is used with the Sciton laser that helps relieve discomfort. Injectable anesthesia is usually not used. Topical anesthesia is usually not effective but can be tried. Patients will usually feel a sensation like being snapped with a rubber band or mild burning that lets them know the laser is working.
Clinical Endpoints
Vessels may disappear, darken, lighten, or appear unchanged but fade with time. Variations depend on the depth, diameter, and oxygenation of the vessel.
There may be blurring of the vessel margins.
If prolonged blanching of the skin is seen, the fluence or power of the laser should be decreased or the cooling parameters increased. Blanching may lead to blistering.
If a second pass is needed, fluence may be increased by 10 J/cm2.
Contraction, disappearance, lightening or darkening of the vessel will become apparent within 15 seconds after the laser treatment.
Slight amount of hyperemia (redness) in the treated area will occur.
Urticaria (red wheals) may be visible after 1-2 minutes.
When purging (gently rubbing the vessel to push out the blood) after treatment and the vessel neither disappears nor back fills, then the vessel is static and does not have blood flowing through it. This a definite endpoint and further treatments are not necessary.
Some vessels will disappear after purging post treatment. Pruge blood that is trapped. If treatment is successful it will not backfill. This is another common endpoint where no further treatments are necessary.
Post-treatment considerations
Topical treatments to reduce erythema may be applied at the discretion of the physician. Cool compresses can be applied for patient comfort. Any skin breakdown or blistering should be treated with a topical antibiotic ointment to prevent infection. Immediate clinical response to be noted include percentage of vein closure, loss of venin margins, clotting, blanching, erythema, edema, or prupura (bruising).
Compression stockings may be used at the clinician’s discretion. The treated area should be evaluated and documented in the patient’s chart. Urticaria, patient’s tolerance of the procedure or other reactions.
Rexamination and or retreatment can be scheduled at 4 weeks.
For patients with a low pain threshold or when treating larger veins, an anesthetic cream can be applied 30-60 minutes before hand. The area then must be cleaned off with alcohol before treatments begin. Patients may note swelling, redness, or a raised rash around the lasered vessels. The use of ice or steroid creams can help speed recovery and decrease the skin darkening side effect. Side effects of laser treatment include skin damage, blood clots, inflammation (superficial phlebitis), hyperpigmentation (skin darkening), and lack of clearing. Incomplete treatment can be taken care of with further laser or sclerotherapy. Painful blood vessel clotting can be addressed by suctioning out the old blood with a larger needle. Abnormal skin darkening can be avoided using longer wavelength lasers and better skin cooling devices.
Treatment summary
Patient examination
Veins and telangiectasias should be classified prior to treatment according vessel diameter and depth, which can be assessed by micrometer, dermatoscope, venoscope, or a Duplex ultrasound. A pre-treatment photo should be taken to assist in evalulating the effectiveness of the treatment.
Site prep
Shave the area to be treated. Cleanse the area with mild soap and water followed by an alcohol swab to thoroughly remove any residue from lotions, makeup, or shaving. Remove the alcohol with a gauze and plain water leaving the surface of the skin slightly moist. Patients generally lie flat for the procedure. The head may be raised to allow the leg veins to fill so that they are more visible.
Anesthesia
There is a cooling plate that is used with the Sciton laser that helps relieve discomfort. Injectable anesthesia is usually not used. Topical anesthesia is usually not effective but can be tried. Patients will usually feel a sensation like being snapped with a rubber band or mild burning that lets them know the laser is working.
Clinical Endpoints
Vessels may disappear, darken, lighten, or appear unchanged but fade with time. Variations depend on the depth, diameter, and oxygenation of the vessel.
There may be blurring of the vessel margins.
If prolonged blanching of the skin is seen, the fluence or power of the laser should be decreased or the cooling parameters increased. Blanching may lead to blistering.
If a second pass is needed, fluence may be increased by 10 J/cm2.
Contraction, disappearance, lightening or darkening of the vessel will become apparent within 15 seconds after the laser treatment.
Slight amount of hyperemia (redness) in the treated area will occur.
Urticaria (red wheals) may be visible after 1-2 minutes.
When purging (gently rubbing the vessel to push out the blood) after treatment and the vessel neither disappears nor back fills, then the vessel is static and does not have blood flowing through it. This a definite endpoint and further treatments are not necessary.
Some vessels will disappear after purging post treatment. Pruge blood that is trapped. If treatment is successful it will not backfill. This is another common endpoint where no further treatments are necessary.
Post-treatment considerations
Topical treatments to reduce erythema may be applied at the discretion of the physician. Cool compresses can be applied for patient comfort. Any skin breakdown or blistering should be treated with a topical antibiotic ointment to prevent infection. Immediate clinical response to be noted include percentage of vein closure, loss of venin margins, clotting, blanching, erythema, edema, or prupura (bruising).
Compression stockings may be used at the clinician’s discretion. The treated area should be evaluated and documented in the patient’s chart. Urticaria, patient’s tolerance of the procedure or other reactions.
Rexamination and or retreatment can be scheduled at 4 weeks.
1 comment:
I think the Sclerotherapy Treatment is the best for the non-surgical treatment of the varicose vein. The cost of the treatment is quite low compare to the other treatment options.
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