Laser and light therapy of lower extremity telangiectasias, reticular veins, and small varicose veins
- Sherry Scovell, MD, FACS
Sherry Scovell, MD, FACS
- Instructor in Surgery
- Harvard Medical School/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 Science Center
- 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.
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- 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