P-134 - LONG-PULSED 1064NM ND:YAG LASER IN THE TREATMENT OF LEG TELANGIECTASIAS AND RETICULAR VEINS

TOPIC:
Venous Diseases (including Malformations)
AUTHORS:
Baldaia L. (Centro Hospitalar e Universitário de Coimbra ~ Coimbra ~ Portugal) , Dias-Neto M. (Centro Hospitalar São João ~ Porto ~ Portugal) , F Antunes L. (Centro Hospitalar e Universitário de Coimbra ~ Coimbra ~ Portugal) , A Pinto J. (Centro Hospitalar Tâmega e Sousa ~ Penafiel ~ Portugal)
Introduction:
Leg telangiectasias and reticular veins are a very common and prevalent unaesthetic problem. They are often a manifestation of venous hypertension because of valve incompetence. It can be responsible for physical and psychological side effects. Long-pulsed 1064nm Nd:YAG laser can damage vessels with higher diameters and penetrate to a deeper level compared to other laser therapies. We aim to analyze outcomes of the treatment of leg veins with long-pulsed 1064nm Nd:YAG laser regarding intervention protocol, technical success, clinical success, and side effects.
Methods:
A research of the published literature was conducted, using PubMed and Embase database, in August 2021. The key words used in the search engines advanced tool followed the PICO scheme: ((telangiectasia* OR reticular veins*) AND (neodymium yag laser OR Nd:YAG) AND (clearance* OR satisfaction* OR treatment*)).
Results:
We included 26 articles, 23 prospective and 3 retrospective studies, with a total of 1991 patients. The articles were organized in different sections according to the control group (case series of long-pulsed 1064nm Nd:YAG laser without a control group; long-pulsed 1064nm Nd:YAG laser versus sclerotherapy; long-pulsed 1064nm Nd:YAG laser versus other laser therapies; and combined treatments). The four outcomes were analyzed in each section. These studies showed that the long-pulsed 1064nm Nd:YAG laser is a safe and very good option for the treatment of leg veins measuring up to 4mm in diameter, with good clearance rates and patients' satisfaction. Studies comparing long-pulsed 1064nm Nd:YAG laser therapy and sclerotherapy showed similar clearance rates with no significant differences. However, sclerotherapy seemed to be less painful and to have faster clinical improvements. In two articles, Nd:YAG laser had better outcomes in the treatment of smaller vessels with less than 1mm in diameter, when compared with sclerotherapy alone. Treatment with polidocanol microfoam and Nd:YAG laser had better clearance rates than Nd:YAG laser alone in three studies. In the comparison of 1064nm Nd:YAG laser therapy with other lasers and light sources, the studies had contradictory results. The sequential combination of Nd:YAG laser with other lasers seems promising but comparative studies are missing.
Conclusion:
Long-pulsed 1064nm Nd:YAG laser is a valid therapeutic option for leg telangiectasia and reticular veins with great aesthetic outcomes and minor side effects. Nd:YAG laser therapy could be combined with sclerotherapy or other laser therapies or IPL in order to achieve better results. Serious side effects are rare, but the procedure is almost always accompanied by moderate tolerable pain.
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