Comparative study in leg telangiectasias treatment with Nd:YAG laser and sclerotherapy

Gabriel Ianosi, Simona Ianosi, Madalina Xenia Calbureanu-Popescu, Cristina Tutunaru, Daniela Calina, Daniela Neagoe, Gabriel Ianosi, Simona Ianosi, Madalina Xenia Calbureanu-Popescu, Cristina Tutunaru, Daniela Calina, Daniela Neagoe

Abstract

Telangiectasias and reticular veins of the lower extremities are common lesions. Sclerotherapy is considered the gold standard for treatment. The aim of our prospective randomized study was to compare the efficacy and safety of hypertonic 20% saline/2% lignocaine (HS) versus polidocanol 0.5% (POL) versus long-pulsed neodymium:ytrium aluminium garnet (Nd:YAG) laser (LAS) treatments of leg telangiectasias in women, using each patient as her own control. We included in this study 285 women with primary leg telangiectasias and reticular veins (C1AEpAS1PN) in order to be treated with sclerotherapy or laser. One leg was treated with either LAS, POL or HS. The other leg received, randomly, one other of these treatments. At the end there were 190 legs treated with each method. There were two sessions at 8-week interval. Assessment of vessel clearing and complications was conducted 2 months after each session using before and after photographs of the leg vessels using a six-point scale from 0 (no change) to 5 (100% cleared). For telangiectasias under 1 mm diameter LAS was better (RR=9.72, P<0.0001) than HS and also POL was better (RR=2.70, P=0.003); for telangiectasias over 1 mm diameter LAS and POL were better too (RR=2.70, P=0.003) respectively (RR=1.44, P=0.00756). For telangiectasias under 1 mm LAS treatment is clearly superior to POL treatment. For telangiectasias over 1 mm the hazard regression model showed a hazard ratio of 3.97 (P=0.047) for LAS and 4.96 (P=0.486) for POL vs. HS treatment. In conclusion, telangiectasias and reticular veins of the lower extremities can be successfully treated with Nd:YAG laser or sclerotherapy. Nd:YAG laser is recommended in treating small telangiectasias (under 1 mm diameter) while sclerotherapy with polidocanol is more efficient as long as telangiectasias diameter is growing.

Keywords: laser; sclerotherapy; telangiectasias treatment.

Figures

Figure 1.
Figure 1.
(A) The hazard function for the good effect of the 3 treatments in telangiectasias under 1 mm - Diam.1 (B) The hazard function for the good effect of the 3 treatments in telangiectasias over 1 mm - Diam.2 (LAS, laser group; POL, polidocanol group; HS, hypertonic saline group).

References

    1. Van der Velden SK, Shadid NH, Nelemans PJ, Sommer A. How specific are venous symptoms for diagnosis of chronic venous disease? Phlebology. 2014;29:580–586. doi: 10.1177/0268355513515859.
    1. Tudoraşcu I, Sfredel V, Riza AL, Miulescu Dănciulescu R, Ianoşi SL, Dănoiu S. Motor unit changes in normal aging: A brief review. Rom J Morphol Embryol. 2014;55:1295–1301.
    1. Breu FX, Wollmann JC. Clinical and technical follow-up after sclerotherapy. Dermatol Surg. 2010;36(Suppl 2):1004–1009. doi: 10.1111/j.1524-4725.2009.01404.x.
    1. Heck M, Faulhaber J, Breu FX, Schneider SW. Foam sclerotherapy. Uses and indications in dermatology and phlebology. Hautarzt. 2012;63:493–505. (In German)
    1. Perrin M, Eklof B, VAN Rij A, Labropoulos N, Vasquez M, Nicolaides A, Blattler W, Bouhassira D, Bouskela E, Carpentier P, et al. Venous symptoms: The SYM Vein Consensus statement developed under the auspices of the European Venous Forum. Int Angiol. 2016;35:374–398.
    1. Hamel-Desnos C, Ouvry P, Benigni JP, Boitelle G, Schadeck M, Desnos P, Allaert FA. Comparison of 1% and 3% polidocanol foam in ultrasound guided sclerotherapy of the great saphenous vein: A randomised, double-blind trial with 2 year follow-up. ‘The 3/1 Study’. Eur J Vasc Endovasc Surg. 2007;34:723–730. doi: 10.1016/j.ejvs.2007.07.014.
    1. Chen CH, Chiu CS, Yang CH. Ultrasound-guided foam sclerotherapy for treating incompetent great saphenous veins - results of 5 years of analysis and morphologic evolvement study. Dermatol Surg. 2012;38:851–857. doi: 10.1111/j.1524-4725.2012.02408.x.
    1. Prieto V, Zhang P, Sadick NS. Comparison of a combination diode laser and radiofrequency device (Polaris) and a long-pulsed 1064-nm Nd:YAG laser (Lyra) on leg telangiectases. Histologic and immunohistochemical analysis. J Cosmet Laser Ther. 2006;8:191–195. doi: 10.1080/14764170600999302.
    1. Caruntu C, Negrei C, Boda D, Constantin C, Caruntu A, Neagu M. Biotechnological advances for diagnosis of peripheral diabetic neuropathy. Rom Biotech Lett. 2014;19:9846–9858.
    1. Breu FX, Guggenbichler S, Wollmann JC. 2nd European Consensus Meeting on foam sclerotherapy 2006, Tegernsee, Germany. Vasa. 2008;37(Suppl 71):1–29. doi: 10.1024/0301-1526.37.1.90.
    1. Goldman MP, Guex JJ, Weiss RA, editors. Treatment of Varicose and Telangiectatic Leg Veins. 5th. Saunders; Philadelphia: 2011. Sclerotherapy; pp. 1–416.
    1. Ianosi S, Neagoe D, Calbureanu M, Ianosi G. Investigator-blind, placebo-controlled, randomized comparative study on combined vacuum and intense pulsed light versus intense pulsed light devices in both comedonal and papulopustular acne. J Cosmet Laser Ther. 2013;15:248–254. doi: 10.3109/14764172.2013.814464.
    1. Nijsten T, van den Bos RR, Goldman MP, Kockaert MA, Proebstle TM, Rabe E, Sadick NS, Weiss RA, Neumann MH. Minimally invasive techniques in the treatment of saphenous varicose veins. J Am Acad Dermatol. 2009;60:110–119. doi: 10.1016/j.jaad.2008.07.046.
    1. Guex JJ, Schliephake DE, Otto J, Mako S, Allaert FA. The French polidocanol study on long-term side effects: A survey covering 3,357 patient years. Dermatol Surg. 2010;36(Suppl 2):993–1003. doi: 10.1111/j.1524-4725.2009.01407.x.
    1. Sadick NS. Laser treatment of leg veins. Skin Therapy Lett. 2004;9:6–9.
    1. Rabe E, Breu FX, Cavezzi A, Coleridge Smith P, Frullini A, Gillet JL, Guex JJ, Hamel-Desnos C, Kern P, Partsch B, et al. Guideline Group: European guidelines for sclerotherapy in chronic venous disorders. Phlebology. 2014;29:338–354. doi: 10.1177/0268355513483280.
    1. Branisteanu DE, Nichifor M, Dorobat CM, Branisteanu DC, Petrariu FD, Molodoi AD, Radu DC, Boda D. Use of textile biomaterials for the topic treatment of chronic venous disease. Rom Biotechnol Lett. 2015;20:10618–10625.
    1. Rabe E, Schliephake D, Otto J, Breu FX, Pannier F. Sclerotherapy of telangiectases and reticular veins: A double-blind, randomized, comparative clinical trial of polidocanol, sodium tetradecyl sulphate and isotonic saline (EASI study) Phlebology. 2010;25:124–131. doi: 10.1258/phleb.2009.009043.
    1. Uncu H. Sclerotherapy: A study comparing polidocanol in foam and liquid form. Phlebology. 2010;25:44–49. doi: 10.1258/phleb.2009.008064.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe