Laser Treatment of Leg Veins

Public interest in laser and light treatment of leg veins is high, and, under the right circumstances, excellent results can be achieved with this treatment modality. With any laser or light source treatment, reverse pressure from associated reticular or varicose veins must be recognized and eliminated; otherwise, the treatment is doomed to fail. Many patients benefit from a combination of treatments such as sclerotherapy, ambulatory phlebectomy, and intravascular laser or radiofrequency closure because external lasers and light sources do not effectively treat associated reticular and varicose veins. Lasers can be effective in treating vessels of less than 1-2 mm in diameter that are resistant to sclerotherapy and telangiectatic matting, which can occur postsclerotherapy. However, sclerotherapy remains the criterion standard for the treatment of leg veins and telangiectasias. Not until the development of the pulsed dye lasers (PDLs) in the late 1980s were the first reasonable results achieved on leg veins. [1, 2, 3] Development over the last decade of longer wavelength, longer pulse duration pulsed lasers and light sources has greatly improved outcomes. Basic requirements for a laser or a light source to treat leg veins are a wavelength that is proportionately better absorbed by the target (hemoglobin) than surrounding chromophores and penetration to the full depth of the target blood vessel. Sufficient energy must be delivered to damage the vessel without damaging the overlying skin, and this must be delivered over an exposure time long enough to slowly coagulate the vessel and its lining without damaging surrounding tissue. The choice of wavelength and pulse duration is related to the type and the size of the target vessel. Deeper vessels require a longer wavelength to allow penetration to their depth. Pulse duration must be matched to vessel size; the larger the vessel diameter, the longer pulse duration required to effectively damage the vessel thermally. To be most effective, thermal injury must encompass the full thickness and circumference of the vein wall endothelium, rather than just the most superficial aspect of the vein wall. The relative importance of the hemoglobulin absorption peaks in green (541 nm) and red to infrared (800-1000 nm) shifts as the depth and the size of the blood vessel changes. Absorption by hemoglobin in the long-visible to nearinfrared range appears to become more important for vessels more than 0.5 mm and at least 0.5 mm below the skin surface. The following related Medscape Reference articles may be of interest:  Varicose Vein Treatment With Endovenous Laser Therapy  Varicose Veins and Spider Veins  Radiofrequency Ablation Therapy for Varicose Veins  Complications of Dermatologic Laser Surgery