Yachroma-Med Treatment of Leg Telangiectasia
Pavel Vlasov,
vascular surgeon,
Head of the Perm City Center for Vascular Surgery (Russia).
Ectatic red or blue vessels on legs occur rather often. Norman skin vessels are so small that human eyes can't see them. Abnormal skin vessels, which can be seen, called telangiectasies. Leg's telangiectasies may cause by varicose decease. They can be classified as arterial, venous and arterio-venous. On legs venous telangiectasies occur more often.
Main factors responsible for appearing the telangiectasies are chronic sun exposure, genetic predisposition, chronic venous insufficiency, liver disease, surgical trauma, chronic steroid use, hormone therapy, radiotherapy and complications after sclerotherapy.
This pathology occurs in 30-40% of population. This is hereditary, chronic and progressive disease appears for the first time in teen age then enhances during pregnancy. Telangiectasies appear more often in women - 80% - in compare with men - 20% - due to affect of estrogen and progesterone hormones.
Compressive sclerotherapy is a common method for the
treatment of varicose disease.
The method includes obliteration of abnormal vessel by injection in it the sclerosunt and consequence elastic compression. Method seems easy and permits to achieve quickly desirable result and high cosmetic effect. It not prevents social activity and everyday work. That advantages make it attractive for patients as well as for physicians.
However there are come restrictions:
- Sclerotherapy can be applied, when a vessel size isn't very small - no less than 0.5 mm in diameter.
- Some vessels are resistant to sclerotherapy.
- Application of sclerotherapy for bright-red vessels may cause skin necroses.
- In some cases sclerotherapy can't be applied due to small size of vessels or allergic reaction in some patients after microsclerotherapy.
Application of electrocautery for ectatic vessels of legs shows it's low efficiency and often complications such as atrophy scars and pigmentation changes.
Selective laser coagulation, which based on the principle of selective photothermolysis, seems a good method for the treatment of lower extremity telangiectasias. The method is used for facial telangiectasies during 20 years and provides very good results. It is effective and has minimal risk of complications. Some years had past until physicians attempted to use this method for ectatic vessels of legs. The first attempts didn't give optimistic results due to higher speed of blood in leg's vessels and more depth of the vessels. Then method has been modified and indications for the laser treatment have been determined more exactly.
Now selective laser coagulation is applied rather successful for the treatment of leg veins but effectiveness is not so high as in a case of facial telangiectasias and more treatment sessions are need.
Selective laser coagulation is used for ectatic vessels no more 0.5 mm in diameter and red or dark-cherry in color, for which application of sclerotherapy is sophisticated and have a high risk of adverse effects. The treatment procedure is tracing
of an ectatic vessel with laser pulses. End point of the treatment is disappear of the ectatic vessel.
Shot laser pulse selectively heat an abnormal vessel and coagulate it without inguring or damaging of the surrounding skin.
During a month after selective laser coagulation procedure it's recommended to avoid sun expose of the skin which have been treated.
Last years variety laser systems with different wavelength, output power, light spot size and expose time are used for the treatment of leg veins. In our clinic we used Yachroma-Med the copper vapor laser system. It emits two wavelengths - 511 nm (green) and 578 nm (yellow) and seems to be an ideal device for the treatment of vascular lesions of skin. Laser beam is focused in a light spot with size about vessel diameter. Yachroma-Med is convenient and
reliable for using.
For the treatment of low extremity veins we use a combined method. We treat small red telangiectasias with Yachroma-Med, then we introduce into vessels, which are more than 0.5 mm in diameter,
one of the up-to-date sclerosants such as aethoxysklerol, then the bandage is applied. From 3 to 5 treatment session are usually applied for each patient with 3-7 days interval between them. Sclerotherapy may cause hiperpigmentation, which can be successfully treated by Yachroma-Med.
Our experience in the treatment of more than 500 patients permits to make a conclusion that notable removing of the ectatic veins (75-100%) is achieved in 96% of patients after 3 to 4 treatment sessions.
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