Abstract
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.
Similar content being viewed by others
References
Robertson L, Evans C, Fowkes FG (2008) Epidemiology of chronic venous disease. Phlebology 23:103–111
Evans CJ, Allan PL, Lee AJ et al (1998) Prevalence of venous reflux in the general population on duplex scanning: the Edinburgh vein study. J Vasc Surg 28:767–776
Ruckley CV, Evans CJ, Allan PL et al (2008) Telangiectasia in the Edinburgh Vein Study: epidemiology and association with trunk varices and symptoms. Eur J Vasc Endovasc Surg 36:719–724
Somjen GM (1995) Anatomy of the superficial venous system. Dermatol Surg 21:35–45
Mellor RH, Brice G, Stanton AW et al (2007) Mutations in FOXC2 are strongly associated with primary valve failure in veins of the lower limb. Circulation 115:1912–1920
Ouvry PA (1989) Telangiectasia and sclerotherapy. J Dermatol Surg Oncol 15:177–181
Sebben JE (1989) Sclerotherapy for telangiectasia of the lower extremity. Dermatol Clin 7:129–135
Neumann HA, Kockaert MA (2003) The treatment of leg telangiectasia. J Cosmet Dermatol 2:73–81
Kern P (2002) Sclerotherapy of varicose leg veins. Technique, indications and complications. Int Angiol 21:40–45
Guex JJ (2010) Complications of sclerotherapy: an update. Dermatol Surg 36(Suppl 2):1056–1063
Lupton JR, Alster TS, Romero P (2002) Clinical comparison of sclerotherapy versus long-pulsed Nd:YAG laser treatment for lower extremity telangiectases. Dermatol Surg 28:694–697
Apfelberg DB, Maser MR, Lash H (1976) Argon laser management of cutaneous vascular deformities. A preliminary report. West J Med 124:99–101
Apfelberg DB, Maser MR, Lash H (1978) Argon laser treatment of cutaneous vascular abnormalities: progress report. Ann Plast Surg 1:14–18
Apfelberg DB, Maser MR, Lash H et al (1984) Use of the argon and carbon dioxide lasers for treatment of superficial venous varicosities of the lower extremity. Lasers Surg Med 4:221–231
Arndt KA (1982) Argon laser therapy of small cutaneous vascular lesions. Arch Dermatol 118:220–224
Anderson RR, Parrish JA (1983) Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 220:524–527
Braverman IM (2000) The cutaneous microcirculation. J Investig Dermatol Symp Proc 5:3–9
Sadick NS (2003) Sclerotherapy and ambulatory phlebectomy. In: Bolognia JL, Jorizzo JL, Rapini RP (eds) Dermatology. Mosby, London, pp 2399–2414
Braverman IM (1989) Ultrastructure and organization of the cutaneous microvasculature in normal and pathologic states. J Invest Dermatol 93:2S–9S
Redisch W, Pelzer R (1949) Localized vascular dilatations of the human skin, capillary microscopy and related studies. Am Heart J 37:106–113
McCoppin HH, Hovenic WW, Wheeland RG (2011) Laser treatment of superficial leg veins: a review. Dermatol Surg 37:729–741
Sommer A, Van Mierlo PL, Neumann HA et al (1997) Red and blue telangiectasias. Differences in oxygenation? Dermatol Surg 23:55–59
Weiss RA, Weiss MA (1993) Doppler ultrasound findings in reticular veins of the thigh subdermic lateral venous system and implications for sclerotherapy. J Dermatol Surg Oncol 19:947–951
Schadeck M (2003) Current status of sclerotherapy of varicose veins. Hautarzt 54:1065–1072
Anderson RR, Parrish JA (1981) The optics of human skin. J Invest Dermatol 77:13–19
Greenwald J, Rosen S, Anderson RR et al (1981) Comparative histological studies of the tunable dye (at 577 nm) laser and argon laser: the specific vascular effects of the dye laser. J Invest Dermatol 77:305–310
Van Gemert M, Welch A (1989) Clinical use of laser–tissue interactions. IEEE Eng Med Biol Mag 8:10–13
Ross EV, Domankevitz Y (2005) Laser treatment of leg veins: physical mechanisms and theoretical considerations. Lasers Surg Med 36:105–116
Garden JM, Tan OT, Kerschmann R et al (1986) Effect of dye laser pulse duration on selective cutaneous vascular injury. J Invest Dermatol 87:653–657
Dierickx CC, Casparian JM, Venugopalan V et al (1995) Thermal relaxation of port-wine stain vessels probed in vivo: the need for 1–10-millisecond laser pulse treatment. J Invest Dermatol 105:709–714
Anderson RR, Parrish JA (1981) Microvasculature can be selectively damaged using dye lasers: a basic theory and experimental evidence in human skin. Lasers Surg Med 1:263–276
Malskat W, Poluektova A, Van der Geld C, et al. (2013) Endovenous laser ablation (EVLA): a review of mechanisms, modeling outcomes and issues for debate. Lasers Med Sci (in press)
Baumler W, Ulrich H, Hartl A et al (2006) Optimal parameters for the treatment of leg veins using Nd:YAG lasers at 1064 nm. Br J Dermatol 155:364–371
Nelson JS, Milner TE, Anvari B et al (1995) Dynamic epidermal cooling during pulsed laser treatment of port-wine stain. A new methodology with preliminary clinical evaluation. Arch Dermatol 131:695–700
Tong AK, Tan OT, Boll J et al (1987) Ultrastructure: effects of melanin pigment on target specificity using a pulsed dye laser (577 nm). J Invest Dermatol 88:747–752
Manuskiatti W, Eimpunth S, Wanitphakdeedecha R (2007) Effect of cold air cooling on the incidence of postinflammatory hyperpigmentation after Q-switched Nd:YAG laser treatment of acquired bilateral nevus of Ota like macules. Arch Dermatol 143:1139–1143
Nelson JS, Milner TE, Anvari B et al (1996) Dynamic epidermal cooling in conjunction with laser-induced photothermolysis of port wine stain blood vessels. Lasers Surg Med 19:224–229
Anvari B, Tanenbaum BS, Milner TE et al (1995) 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. Phys Med Biol 40:1451–1465
Waldorf HA, Alster TS, McMillan K et al (1997) Effect of dynamic cooling on 585-nm pulsed dye laser treatment of port-wine stain birthmarks. Dermatol Surg 23:657–662
Buscher BA, McMeekin TO, Goodwin D (2000) Treatment of leg telangiectasia by using a long-pulse dye laser at 595 nm with and without dynamic cooling device. Lasers Surg Med 27:171–175
Altshuler GB, Zenzie HH, Erofeev AV et al (1999) Contact cooling of the skin. Phys Med Biol 44:1003–1023
Jia W, Tran N, Sun V et al (2012) Photocoagulation of dermal blood vessels with multiple laser pulses in an in vivo microvascular model. Lasers Surg Med 44:144–151
Vincent JR, Jones GT, Hill GB et al (2011) Failure of microvenous valves in small superficial veins is a key to the skin changes of venous insufficiency. J Vasc Surg 54:62S–69S
Fournier N, Brisot D, Mordon S (2002) Treatment of leg telangiectases with a 532 nm KTP laser in multipulse mode. Dermatol Surg 28:564–571
Woo WK, Jasim ZF, Handley JM (2003) 532-nm Nd:YAG and 595-nm pulsed dye laser treatment of leg telangiectasia using ultralong pulse duration. Dermatol Surg 29:1176–1180
West TB, Alster TS (1998) Comparison of the long-pulse dye (590–595 nm) and KTP (532 nm) lasers in the treatment of facial and leg telangiectasias. Dermatol Surg 24:221–226
McMeekin TO (1999) Treatment of spider veins of the leg using a long-pulsed Nd:YAG laser (Versapulse) at 532 nm. J Cutan Laser Ther 1:179–180
Bernstein EF, Kornbluth S, Brown DB et al (1999) Treatment of spider veins using a 10 millisecond pulse-duration frequency-doubled neodymium YAG laser. Dermatol Surg 25:316–320
Massey RA, Katz BE (1999) Successful treatment of spider leg veins with a high-energy, long-pulse, frequency-doubled neodymium:YAG laser (HELP-G). Dermatol Surg 25:677–680
Ozden MG, Bahcivan M, Aydin F et al (2011) Clinical comparison of potassium-titanyl-phosphate (KTP) versus neodymium:YAG (Nd:YAG) laser treatment for lower extremity telangiectases. J Dermatolog Treat 22:162–166
Spendel S, Prandl EC, Schintler MV et al (2002) Treatment of spider leg veins with the KTP (532 nm) laser—a prospective study. Lasers Surg Med 31:194–201
Faurschou A, Olesen AB, Leonardi-Bee J, et al. (2011) Lasers or light sources for treating port-wine stains. Cochrane Database Syst Rev CD007152
Bernstein EF, Lee J, Lowery J et al (1998) Treatment of spider veins with the 595 nm pulsed-dye laser. J Am Acad Dermatol 39:746–750
Hsia J, Lowery JA, Zelickson B (1997) Treatment of leg telangiectasia using a long-pulse dye laser at 595 nm. Lasers Surg Med 20:1–5
Reichert D (1998) Evaluation of the long-pulse dye laser for the treatment of leg telangiectasias. Dermatol Surg 24:737–740
Kono T, Yamaki T, Ercocen AR et al (2004) Treatment of leg veins with the long pulse dye laser using variable pulse durations and energy fluences. Lasers Surg Med 35:62–67
Alora MB, Stern RS, Arndt KA et al (1999) Comparison of the 595 nm long-pulse (1.5 msec) and ultralong-pulse (4 msec) lasers in the treatment of leg veins. Dermatol Surg 25:445–449
Rubin IK, Farinelli WA, Doukas A et al (2012) Optimal wavelengths for vein-selective photothermolysis. Lasers Surg Med 44:152–157
McDaniel DH, Ash K, Lord J et al (1999) Laser therapy of spider leg veins: clinical evaluation of a new long pulsed alexandrite laser. Dermatol Surg 25:52–58
Ross EV, Meehan KJ, Gilbert S et al (2009) Optimal pulse durations for the treatment of leg telangiectasias with an alexandrite laser. Lasers Surg Med 41:104–109
Trelles MA, Allones I, Alvarez J et al (2006) The 800-nm diode laser in the treatment of leg veins: assessment at 6 months. J Am Acad Dermatol 54:282–289
Passeron T, Olivier V, Duteil L et al (2003) The new 940-nanometer diode laser: an effective treatment for leg venulectasia. J Am Acad Dermatol 48:768–774
Eremia S, Li C, Umar SH (2002) 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 28:224–230
Rogachefsky AS, Silapunt S, Goldberg DJ (2002) Nd:YAG laser (1064 nm) irradiation for lower extremity telangiectases and small reticular veins: efficacy as measured by vessel color and size. Dermatol Surg 28:220–223
Omura NE, Dover JS, Arndt KA et al (2003) Treatment of reticular leg veins with a 1064 nm long-pulsed Nd:YAG laser. J Am Acad Dermatol 48:76–81
Munia MA, Wolosker N, Munia CG et al (2012) Comparison of laser versus sclerotherapy in the treatment of lower extremity telangiectases: a prospective study. Dermatol Surg 38:635–639
Levy JL, Elbahr C, Jouve E et al (2004) Comparison and sequential study of long pulsed Nd:YAG 1,064 nm laser and sclerotherapy in leg telangiectasias treatment. Lasers Surg Med 34:273–276
Coles CM, Werner RS, Zelickson BD (2002) Comparative pilot study evaluating the treatment of leg veins with a long pulse ND:YAG laser and sclerotherapy. Lasers Surg Med 30:154–159
Fodor L, Ramon Y, Fodor A et al (2006) A side-by-side prospective study of intense pulsed light and Nd:YAG laser treatment for vascular lesions. Ann Plast Surg 56:164–170
Parlette EC, Groff WF, Kinshella MJ et al (2006) Optimal pulse durations for the treatment of leg telangiectasias with a neodymium YAG laser. Lasers Surg Med 38:98–105
Sadick NS (2003) Laser treatment with a 1064-nm laser for lower extremity class I–III veins employing variable spots and pulse width parameters. Dermatol Surg 29:916–919
Sadick NS (2001) Long-term results with a multiple synchronized-pulse 1064 nm Nd:YAG laser for the treatment of leg venulectasias and reticular veins. Dermatol Surg 27:365–369
Sadick NS, Prieto VG, Shea CR et al (2001) Clinical and pathophysiologic correlates of 1064-nm Nd:Yag laser treatment of reticular veins and venulectasias. Arch Dermatol 137:613–617
Goldman MP, Eckhouse S (1996) Photothermal sclerosis of leg veins. ESC Medical Systems, LTD Photoderm VL Cooperative Study Group. Dermatol Surg 22:323–330
Schroeter C, Wilder D, Reineke T et al (1997) Clinical significance of an intense, pulsed light source on leg telangiectasias of up to 1 mm diameter. Eur J Dermatol 7:38–42
Mordon S, Brisot D, Fournier N (2003) Using a "non uniform pulse sequence" can improve selective coagulation with a Nd:YAG laser (1.06 microm) thanks to Met-hemoglobin absorption: a clinical study on blue leg veins. Lasers Surg Med 32:160–170
Trelles MA, Weiss R, Moreno-Moragas J et al (2010) Treatment of leg veins with combined pulsed dye and Nd:YAG lasers: 60 patients assessed at 6 months. Lasers Surg Med 42:609–614
Tanghetti E, Sherr E (2003) Treatment of telangiectasia using the multi-pass technique with the extended pulse width, pulsed dye laser (Cynosure V-Star). J Cosmet Laser Ther 5:71–75
Kauvar AN, Lou WW (2000) Pulsed alexandrite laser for the treatment of leg telangiectasia and reticular veins. Arch Dermatol 136:1371–1375
Brunnberg S, Lorenz S, Landthaler M et al (2002) Evaluation of the long pulsed high fluence alexandrite laser therapy of leg telangiectasia. Lasers Surg Med 31:359–362
Moreno-Moraga J, Hernandez E, Royo J et al (2013) Optimal and safe treatment of spider leg veins measuring less than 1.5 mm on skin type IV patients, using repeated low-fluence Nd:YAG laser pulses after polidocanol injection. Lasers Med Sci 28:925–933
Goldman MP, Fitzpatrick RE (1990) Pulsed-dye laser treatment of leg telangiectasia: with and without simultaneous sclerotherapy. J Dermatol Surg Oncol 16:338–344
Sadick NS, Trelles MA (2005) A clinical, histological, and computer-based assessment of the Polaris LV, combination diode, and radiofrequency system, for leg vein treatment. Lasers Surg Med 36:98–104
Trelles MA, Martin-Vazquez M, Trelles OR et al (2006) Treatment effects of combined radio-frequency current and a 900 nm diode laser on leg blood vessels. Lasers Surg Med 38:185–195
Chess C (2004) Prospective study on combination diode laser and radiofrequency energies (ELOS) for the treatment of leg veins. J Cosmet Laser Ther 6:86–90
Shafirstein G, Moreno M, Klein A et al (2011) Treatment of leg veins with indocyanine green and lasers investigated with mathematical modelling. Int J Hyperthermia 27:771–781
Klein A, Baumler W, Koller M et al (2012) Indocyanine green-augmented diode laser therapy of telangiectatic leg veins: a randomized controlled proof-of-concept trial. Lasers Surg Med 44:369–376
Klein A, Buschmann M, Babilas P et al (2013) Indocyanine green-augmented diode laser therapy vs. long-pulsed Nd:YAG (1064 nm) laser treatment of telangiectatic leg veins: a randomized controlled trial. Br J Dermatol 169:365–373
Schwartz L, Maxwell H (2011) Sclerotherapy for lower limb telangiectasias. Cochrane Database Syst Rev CD008826
Funding sources
None declared
Conflicts of interest
None declared
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Meesters, A.A., Pitassi, L.H.U., Campos, V. et al. Transcutaneous laser treatment of leg veins. Lasers Med Sci 29, 481–492 (2014). https://doi.org/10.1007/s10103-013-1483-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10103-013-1483-2