Laser and light therapy of lower extremity telangiectasias, reticular veins and small varicose veins
- Sherry Scovell, MD, FACS
Sherry Scovell, MD, FACS
- Assistant Professor in Surgery
- Massachusetts General Hospital
- Section Editors
- John F Eidt, MD
John F Eidt, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor of Surgery, Texas A&M Health Sciences Center - Dallas Campus
- Vice Chair of Vascular Surgical Services, Baylor Heart and Vascular Hospital at Dallas
- Joseph L Mills, Sr, MD
Joseph L Mills, Sr, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor and Chief
- Division of Vascular Surgery and Endovascular Therapy
- Baylor College of Medicine
- Jeffrey S Dover, MD, FRCPC
Jeffrey S Dover, MD, FRCPC
- Section Editor — Cosmetic Dermatology
- Associate Clinical Professor of Dermatology
- Yale University School of Medicine
Telangiectasias and reticular veins are common venous abnormalities and are often a source of significant distress to the patient whether or not symptoms are present. The treatment of telangiectasias and reticular veins with lasers or light therapy is reviewed here. Other modalities used to treat these entities are discussed separately. (See "Overview and management of lower extremity chronic venous disease" and "Liquid, foam, and glue sclerotherapy techniques for the treatment of lower extremity veins".)
Telangiectasias, reticular veins and varicose veins are the visible signs of chronic venous disease, and can occur in the presence or absence of either symptoms or an underlying functional venous disorder (reflux) . Sclerotherapy is the treatment of choice for the majority of superficial leg veins. When sclerotherapy is administered sequentially from deep to superficial and from larger to smaller veins, over 90 percent of vessels can be successfully treated . Candidates for laser and light therapy are those who do not tolerate or fail sclerotherapy or who have small superficial vessels that are too small to cannulate with a sclerotherapy needle [3,4]. (See "Liquid, foam, and glue sclerotherapy techniques for the treatment of lower extremity veins".)
Asymptomatic patients with telangiectasias or reticular veins often find the cosmetic appearance of their veins distressing. In the absence of signs of venous reflux, laser and light therapy can be performed after physical examination. The clinical evaluation of the patient with chronic venous disease is discussed separately. (See "Clinical manifestations of lower extremity chronic venous disease".)
Because vein recurrence rates are increased in the presence of superficial venous reflux, reflux is managed prior to treatment. Treatment with laser and light therapy is most effective for small vessels (1 to 2 mm in diameter) although vessels up to 5 mm in diameter can be treated. Larger veins do not respond as well [5-7]. (See "Overview and management of lower extremity chronic venous disease", section on 'Diagnosis'.)
Laser and light therapy should not be performed in patients who have signs of acute thrombosis/phlebitis, due to the increased risk of deep venous thrombosis. Pregnant patients should defer until after delivery.
- Chiesa R, Marone EM, Limoni C, et al. Chronic venous disorders: correlation between visible signs, symptoms, and presence of functional disease. J Vasc Surg 2007; 46:322.
- Procedures in Cosmetic Dermatology Series: Treatment of leg veins, Alam, M, Nguyen (Eds), Elsevier Saunders, Philadelphia 2006..
- Lupton JR, Alster TS, Romero P. Clinical comparison of sclerotherapy versus long-pulsed Nd:YAG laser treatment for lower extremity telangiectases. Dermatol Surg 2002; 28:694.
- McCoppin HH, Hovenic WW, Wheeland RG. Laser treatment of superficial leg veins: a review. Dermatol Surg 2011; 37:729.
- Dover JS, Sadick NS, Goldman MP. The role of lasers and light sources in the treatment of leg veins. Dermatol Surg 1999; 25:328.
- Hsu, J. Leg vein management. In: Atlas of Cosmetic Dermatology, 2, Kaminer, MS, Dover, JS, Arndt, KA (Eds), Harcourt Saunders, Philadelphia 2009. p.455.
- Weiss RA, Dover JS. Laser surgery of leg veins. Dermatol Clin 2002; 20:19.
- Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 1983; 220:524.
- Kunishige JH, Goldberg LH, Friedman PM. Laser therapy for leg veins. Clin Dermatol 2007; 25:454.
- Wollina U, Schmidt WD, Hercogova J, Fassler D. Laser therapy of spider leg veins. J Cosmet Dermatol 2003; 2:166.
- Alora MB, Stern RS, Arndt KA, Dover JS. Comparison of the 595 nm long-pulse (1.5 msec) and ultralong-pulse (4 msec) lasers in the treatment of leg veins. Dermatol Surg 1999; 25:445.
- Eremia S, Li C, Umar SH. A side-by-side comparative study of 1064 nm Nd:YAG, 810 nm diode and 755 nm alexandrite lasers for treatment of 0.3-3 mm leg veins. Dermatol Surg 2002; 28:224.
- Levy JL, Berwald C. Treatment of vascular abnormalities with a long-pulse diode at 980 nm. J Cosmet Laser Ther 2004; 6:217.
- Trelles MA, Martín-Vázquez M, Trelles OR, Mordon SR. Treatment effects of combined radio-frequency current and a 900 nm diode laser on leg blood vessels. Lasers Surg Med 2006; 38:185.
- Klein A, Bäumler W, Koller M, et al. Indocyanine green-augmented diode laser therapy of telangiectatic leg veins: a randomized controlled proof-of-concept trial. Lasers Surg Med 2012; 44:369.
- Omura NE, Dover JS, Arndt KA, Kauvar AN. Treatment of reticular leg veins with a 1064 nm long-pulsed Nd:YAG laser. J Am Acad Dermatol 2003; 48:76.
- Occupational Safety and Health Administration. www.osha.gov (Accessed on March 31, 2009).
- Chen JZ, Alexiades-Armenakas MR, Bernstein LJ, et al. Two randomized, double-blind, placebo-controlled studies evaluating the S-Caine Peel for induction of local anesthesia before long-pulsed Nd:YAG laser therapy for leg veins. Dermatol Surg 2003; 29:1012.
- Sadick NS. Long-term results with a multiple synchronized-pulse 1064 nm Nd:YAG laser for the treatment of leg venulectasias and reticular veins. Dermatol Surg 2001; 27:365.
- Trelles MA, Allones I, Martín-Vázquez MJ, et al. Long pulse Nd:YAG laser for treatment of leg veins in 40 patients with assessments at 6 and 12 months. Lasers Surg Med 2004; 35:68.
- Bernstein EF, Kornbluth S, Brown DB, Black J. Treatment of spider veins using a 10 millisecond pulse-duration frequency-doubled neodymium YAG laser. Dermatol Surg 1999; 25:316.
- Sadick NS, Prieto VG, Shea CR, et al. Clinical and pathophysiologic correlates of 1064-nm Nd:Yag laser treatment of reticular veins and venulectasias. Arch Dermatol 2001; 137:613.
- Trelles MA, Weiss R, Moreno-Moragas J, et al. Treatment of leg veins with combined pulsed dye and Nd:YAG lasers: 60 patients assessed at 6 months. Lasers Surg Med 2010; 42:609.
- Trelles MA, Allones I, Alvarez J, et al. The 800-nm diode laser in the treatment of leg veins: assessment at 6 months. J Am Acad Dermatol 2006; 54:282.
- Fournier N, Brisot D, Mordon S. Treatment of leg telangiectases with a 532 nm KTP laser in multipulse mode. Dermatol Surg 2002; 28:564.
- Coles CM, Werner RS, Zelickson BD. Comparative pilot study evaluating the treatment of leg veins with a long pulse ND:YAG laser and sclerotherapy. Lasers Surg Med 2002; 30:154.
- Levy JL, Elbahr C, Jouve E, Mordon S. Comparison and sequential study of long pulsed Nd:YAG 1,064 nm laser and sclerotherapy in leg telangiectasias treatment. Lasers Surg Med 2004; 34:273.
- PATIENT COUNSELING
- LASER/LIGHT PRINCIPLES
- LASER AND LIGHT SOURCES
- Pulse dye laser
- Potassium titanyl phosphate laser
- Diode laser
- Nd:YAG laser
- Alexandrite laser
- Intense pulsed light sources
- FOLLOW-UP CARE
- ADVERSE REACTIONS
- Telangiectatic matting
- Laser versus sclerotherapy
- SUMMARY AND RECOMMENDATIONS