Laser Treatments in phlebology

1
Laser Treatments in phlebology

• Daniel Cassuto
• Milano,
• Prof. a C. Chirurgia Plastica
• Università di Catania

2
Possible complications treatable by laser Tx

• Surgical scars
• Post skin necrosis
• Matting
• Post inflammatory hyperpigmentation
• Allergic reactions to sclerotherapy

3

• Ingrandimento sotto illuminazione polarizzata
• Strutture superficiali
• Strutture epidermiche

4
Polarized light viewer

• Light source

Head rest
Polaroid filters Magnifying lenses
5
Normal view
Polarized view
6
Post 1
7
After 5 sessions of LBO (scanned and 1000µ) at
various fluences. 18 months follow up
8
Pre
post2
post3
post5
9
Matting of the leg through normal magnifying
illumination Matting of the leg through
polarized light magnification
10
Wavelengths used for leg veins

• Visible (532, 578, 585, 595, 600)
• Infrared (755, 800-810, 940, 980, 1064)
• Intense Pulsed Light (500-1200)

11
Absorption curve of the main chromophores
12
Selective photocoagulation
13
Principles

1. Selective photocoagulation (not
   photothermolysis) longer pulses allow more
   thermal damage to vessel walls (methemoglobin?-
   Mordon S. et al. 2003)
2. Aggressive cooling allows skin protection
3. Both 12 protect darker skin types

14
Materials and methods

• 20 consecutive female patients with
• class I-III red telangiectasias,
• blue venulectasias
• reticular veins were treated with a combination
  of 532 nm (1000µ, 9-12 j/cm2) and 810nm (4mm,
  80-90 j/cm2 ) lasers.
• Patients with significant venous circulatory
  impairment were excluded.
• Both treatments were applied with contact skin
  cooling.
• The results were examined by digital
  macrophotographic imaging and a patient
  evaluation scale.

15
Results

• Significant clearance (at least 66) was obtained
  in 1.8 sessions in 85 of patients.
• The satisfaction was good in 95 of patients.

16
Teleangectasie degli arti inferioriprincipi di
laser-Tx

• Inquadramento flebologico
• Scleroterapia dei vasi iniettabili
• Prevenzione (Reflusso, abuso di UV, moto, calze)
• Visione (luce polarizzata)
• Raffreddamento cutaneo

17
F, 42 ys old.Rt lower lateral thigh matting532
nm, 500µ, ed 22.5 j/cm2, 2 treatments.
1. MATTING
Landmarks
Landmarks
18
47 ys F. Matting lt calf1 pass, 532 nm, 1000
micron, 11 j\cm2, 6 Hz
1. MATTING cont.
Before
After
19
2.SCARRING43 ys, F. - rt thigh
Post sclerotherapy
Before
After
20
3.ALLERGY
33 ys old.Left popliteal area. 810 nm, 4mm, ed 90
j/cm2,1pass
21

• Case description Lt popliteal area (i.e. back of
  the knee) of a 56 ys old woman with varices. (The
  rt leg has also been treated later and youll get
  the pictures in a few weeks). Parameters 800 nm
  ed 45 j/cm2, 50 msec, 1 Hz, chilled tip, 1
  session.
• Treatment slight pressure on the skin with the
  handpiece. Treat until the vein shrinks and
  disappears within a few seconds. Stop before you
  see the skin turning grayish thats a burn.
  10-20 days after treatment the veins are still
  present and full of coagulated blood, that I
  remove by squeezing it through small punctures in
  the skin and vein wall that are absolutely
  painless. This patient only used a mild cream
  after treatment no bandages, compressive
  stockings nor activity limitations were adopted.
• The preexisting little white scar is shown as a
  landmark

21.11.2001
Landmark
23.1..2002
22
24 ys old women, 2 ys after RA with multiple
trauma and multiple orthopedic procedures
including scar revisions.

• 2 months after
• 5 monthly Tx with LBO 532nm, scanner, 2.5
  msec, 5W.
• Daily use of silicon sheath 2 mm

23
Conclusioni

• Indicazioni per laserterapia vascolare degli arti
  inferiori
• Assolute
• matting
• agofobia
• allergia
• malformazioni capillari
• angiomi
• Relative
• vasi fra 0,7 mm e 1,5 mm
• sclero-laserterapia combinata

24
Thank you for your attention