Current Concepts: Laser Treatment of Adult Vascular Lesions

 

 Buy Article Permissions and Reprints

ABSTRACT

Patients frequently seek treatment of cutaneous vascular lesions for both medical and cosmetic reasons. Advances in the use of lasers and light sources enable physicians to effectively treat vascular lesions that were previously untreatable. Given the plethora of devices available, selecting the appropriate laser system and treatment parameters can be confusing for the laser surgeon. This article reviews current concepts in the treatment of adult vascular conditions. It highlights the different types of lasers and the most common vascular lesions amenable to therapy. Also, the article offers several pearls regarding selection of the laser and of the treatment parameters.

REFERENCES

• 1 Anderson R R, Parrish J A. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation.  Science. 1983;  220 524-527
  CrossrefPubMedGoogle Scholar
• 2 Nelson J S, Milner T E, Anvari B, Tanenbaum B S, Svaasand L O, Kimel S. Dynamic epidermal cooling in conjunction with laser-induced photothermolysis of port wine stain blood vessels.  Lasers Surg Med. 1996;  19 224-229
  CrossrefPubMedGoogle Scholar
• 3 Gonzalez E, Gange R W, Momtaz K T. Treatment of telangiectases and other benign vascular lesions with the 577 nm pulsed dye laser.  J Am Acad Dermatol. 1992;  27(2 Pt 1) 220-226
  PubMedGoogle Scholar
• 4 Ruiz-Esparza J, Goldman M P, Fitzpatrick R E, Lowe N J, Behr K L. Flash lamp-pumped dye laser treatment of telangiectasia.  J Dermatol Surg Oncol. 1993;  19 1000-1003
  PubMedGoogle Scholar
• 5 Adrian R M, Tanghetti E A. Long pulse 532-nm laser treatment of facial telangiectasia.  Dermatol Surg. 1998;  24 71-74
  CrossrefPubMedGoogle Scholar
• 6 Goldberg D J, Meine J G. A comparison of four frequency-doubled Nd:YAG (532 nm) laser systems for treatment of facial telangiectases.  Dermatol Surg. 1999;  25 463-467
  CrossrefPubMedGoogle Scholar
• 7 Angermeier M C. Treatment of facial vascular lesions with intense pulsed light.  J Cutan Laser Ther. 1999;  1 95-100
  CrossrefPubMedGoogle Scholar
• 8 Eremia S, Li C Y. Treatment of face veins with a cryogen spray variable pulse width 1064 nm Nd:YAG laser: a prospective study of 17 patients.  Dermatol Surg. 2002;  28 244-247
  CrossrefPubMedGoogle Scholar
• 9 Clark S M, Lanigan S W, Marks R. Laser treatment of erythema and telangiectasia associated with rosacea.  Lasers Med Sci. 2002;  17 26-33
  CrossrefPubMedGoogle Scholar
• 10 Lowe N J, Behr K L, Fitzpatrick R, Goldman M, Ruiz-Esparza J. Flash lamp pumped dye laser for rosacea-associated telangiectasia and erythema.  J Dermatol Surg Oncol. 1991;  17 522-525
  PubMedGoogle Scholar
• 11 Tan S R, Tope W D. Pulsed dye laser treatment of rosacea improves erythema, symptomatology, and quality of life.  J Am Acad Dermatol. 2004;  51 592-599
  CrossrefPubMedGoogle Scholar
• 12 Tanghetti E, Sherr E. Treatment of telangiectasia using the multi-pass technique with the extended pulse width, pulsed dye laser (Cynosure V-Star).  J Cosmet Laser Ther. 2003;  5 71-75
  CrossrefPubMedGoogle Scholar
• 13 Alam M, Dover J S, Arndt K A. Treatment of facial telangiectasia with variable-pulse high-fluence pulsed-dye laser: comparison of efficacy with fluences immediately above and below the purpura threshold.  Dermatol Surg. 2003;  29 681-684 discussion 685
  CrossrefPubMedGoogle Scholar
• 14 Jasim Z F, Woo W K, Handley J M. Long-pulsed (6-ms) pulsed dye laser treatment of rosacea-associated telangiectasia using subpurpuric clinical threshold.  Dermatol Surg. 2004;  30 37-40
  CrossrefPubMedGoogle Scholar
• 15 Mark K A, Sparacio R M, Voigt A, Marenus K, Sarnoff D S. Objective and quantitative improvement of rosacea-associated erythema after intense pulsed light treatment.  Dermatol Surg. 2003;  29 600-604
  CrossrefPubMedGoogle Scholar
• 16 Taub A F. Treatment of rosacea with intense pulsed light.  J Drugs Dermatol. 2003;  2 254-259
  PubMedGoogle Scholar
• 17 Wheeland R G, Applebaum J. Flashlamp-pumped pulsed dye laser therapy for poikiloderma of Civatte.  J Dermatol Surg Oncol. 1990;  16 12-16
  PubMedGoogle Scholar
• 18 Haywood R M, Monk B E. Treatment of poikiloderma of Civatte with the pulsed dye laser: a series of seven cases.  J Cutan Laser Ther. 1999;  1 45-48
  CrossrefPubMedGoogle Scholar
• 19 Weiss R A, Goldman M P, Weiss M A. Treatment of poikiloderma of Civatte with an intense pulsed light source.  Dermatol Surg. 2000;  26 823-827 discussion 828
  CrossrefPubMedGoogle Scholar
• 20 Weiss R A, Goldman M P, Weiss M A. Treatment of poikiloderma of Civatte with an intense pulsed light source.  Dermatol Surg. 2000;  26 823-827 discussion 828
  CrossrefPubMedGoogle Scholar
• 21 Scheepers J H, Quaba A A. Treatment of nevi aranei with the pulsed tunable dye laser at 585 nm.  J Pediatr Surg. 1995;  30 101-104
  CrossrefPubMedGoogle Scholar
• 22 Geronemus R G. Treatment of spider telangiectases in children using the flashlamp-pumped pulsed dye laser.  Pediatr Dermatol. 1991;  8 61-63
  PubMedGoogle Scholar
• 23 Jacobs A H, Walton R G. The incidence of birthmarks in the neonate.  Pediatrics. 1976;  58 218-222
  PubMedGoogle Scholar
• 24 Smoller B R, Rosen S. Port-wine stains. A disease of altered neural modulation of blood vessels?.  Arch Dermatol. 1986;  122 177-179
  CrossrefPubMedGoogle Scholar
• 25 Geronemus R G, Ashinoff R. The medical necessity of evaluation and treatment of port-wine stains.  J Dermatol Surg Oncol. 1991;  17 76-79
  PubMedGoogle Scholar
• 26 van der Horst C M, Koster P H, de Borgie C A, Bossuyt P M, van Gemert M J. Effect of the timing of treatment of port-wine stains with the flash-lamp-pumped pulsed-dye laser.  , [see comment] N Engl J Med. 1998;  338 1028-1033
  CrossrefPubMedGoogle Scholar
• 27 Hansen K, Kreiter C D, Rosenbaum M, Whitaker D C, Arpey C J. Long-term psychological impact and perceived efficacy of pulsed-dye laser therapy for patients with port-wine stains.  Dermatol Surg. 2003;  29 49-55
  CrossrefPubMedGoogle Scholar
• 28 Troilius A, Wrangsjo B, Ljunggren B. Patients with port-wine stains and their psychosocial reactions after photothermolytic treatment.  Dermatol Surg. 2000;  26 190-196
  CrossrefPubMedGoogle Scholar
• 29 Fitzpatrick R E, Lowe N J, Goldman M P, Borden H, Behr K L, Ruiz-Esparza J. Flashlamp-pumped pulsed dye laser treatment of port-wine stains.  J Dermatol Surg Oncol. 1994;  20 743-748
  PubMedGoogle Scholar
• 30 Sommer S, Seukeran D C, Sheehan-Dare R A. Efficacy of pulsed dye laser treatment of port wine stain malformations of the lower limb.  Br J Dermatol. 2003;  149 770-775
  CrossrefPubMedGoogle Scholar
• 31 Algermissen B, Berlien H P, Haas N. Basal cell carcinomas in port-wine stains treated with thorium X.  Acta Derm Venereol. 2004;  84 475
  CrossrefPubMedGoogle Scholar
• 32 Jasim Z F, Woo W K, Walsh M Y, Handley J M. Multifocal basal cell carcinoma developing in a facial port wine stain treated with argon and pulsed dye laser: a possible role for previous radiotherapy.  Dermatol Surg. 2004;  30 1155-1157
  CrossrefPubMedGoogle Scholar
• 33 Shah M, Lewis F M, Palmer I R. Three cases of multiple basal cell carcinoma arising in port-wine stains previously treated with thorium X.  Br J Dermatol. 1996;  135 861-862
  PubMedGoogle Scholar
• 34 Wharton S M, Cole R P. Basal cell carcinomata in port wine stains.  Br J Plast Surg. 2001;  54 156-158
  CrossrefPubMedGoogle Scholar
• 35 Tan O T, Murray S, Kurban A K. Action spectrum of vascular specific injury using pulsed irradiation.  J Invest Dermatol. 1989;  92 868-871
  CrossrefPubMedGoogle Scholar
• 36 Tan S T, Bialostocki A, Armstrong J R. Pulsed dye laser therapy for rosacea.  Br J Plast Surg. 2004;  57 303-310
  CrossrefPubMedGoogle Scholar
• 37 Alora M B, Anderson R R. Recent developments in cutaneous lasers.  , [review] Lasers Surg Med. 2000;  26 108-118
  CrossrefPubMedGoogle Scholar
• 38 Yung A, Sheehan-Dare R. A comparative study of a 595-nm with a 585-nm pulsed dye laser in refractory port wine stains.  Br J Dermatol. 2005;  153 601-606
  CrossrefPubMedGoogle Scholar
• 39 Laube S, Taibjee S, Lanigan S W. Treatment of resistant port wine stains with the V Beam pulsed dye laser.  Lasers Surg Med. 2003;  33 282-287
  CrossrefPubMedGoogle Scholar
• 40 Bjerring P, Christiansen K, Troilius A. Intense pulsed light source for the treatment of dye laser resistant port-wine stains.  J Cosmet Laser Ther. 2003;  5 7-13
  PubMedGoogle Scholar
• 41 Cliff S, Misch K. Treatment of mature port wine stains with the PhotoDerm VL.  J Cutan Laser Ther. 1999;  1 101-104
  CrossrefPubMedGoogle Scholar
• 42 Raulin C, Goldman M P, Weiss M A, Weiss R A. Treatment of adult port-wine stains using intense pulsed light therapy (PhotoDerm VL): brief initial clinical report.  Dermatol Surg. 1997;  23 594-597
  CrossrefPubMedGoogle Scholar
• 43 Chowdhury M M, Harris S, Lanigan S W. Potassium titanyl phosphate laser treatment of resistant port-wine stains.  Br J Dermatol. 2001;  144 814-817
  CrossrefPubMedGoogle Scholar
• 44 Yang M U, Yaroslavsky A N, Farinelli W A et al.. Long-pulsed neodymium:yttrium-aluminum-garnet laser treatment for port-wine stains.  J Am Acad Dermatol. 2005;  52(3 Pt 1) 480-490
  CrossrefPubMedGoogle Scholar
• 45 Woo W K, Jasim Z F, Handley J M. Evaluating the efficacy of treatment of resistant port-wine stains with variable-pulse 595-nm pulsed dye and 532-nm Nd:YAG lasers.  Dermatol Surg. 2004;  30(2 Pt 1) 158-162 discussion 162
  CrossrefPubMedGoogle Scholar
• 46 Jay H, Borek C. Treatment of a venous-lake angioma with intense pulsed light.  Lancet. 1998;  351 112
  PubMedGoogle Scholar
• 47 Coles C M, Werner R S, Zelickson B D. Comparative pilot study evaluating the treatment of leg veins with a long pulsed Nd:YAG laser and sclerotherapy.  Lasers Surg Med. 2002;  30 154-159
  CrossrefPubMedGoogle Scholar
• 48 Levy J L, Elbahr C, Jouve E. Comparison and sequential study of long pulsed Nd:YAG 1,064 nm laser and sclerotherapy in leg telangiectasias treatment.  Lasers Surg Med. 2004;  34 273-276
  CrossrefPubMedGoogle Scholar
• 49 Bernstein E F, Lee J, Lowery J et al.. Treatment of spider veins with the 595 nm pulsed-dye laser.  J Am Acad Dermatol. 1998;  39(5 Pt 1) 746-750
  PubMedGoogle Scholar
• 50 Reichert D. Evaluation of the long-pulse dye laser for the treatment of leg telangiectasias.  Dermatol Surg. 1998;  24 737-740
  CrossrefPubMedGoogle Scholar
• 51 Fournier N, Brisot D, Mordon S. Treatment of leg telangiectases with a 532 nm KTP laser in multipulse mode.  Dermatol Surg. 2002;  28 564-571
  CrossrefPubMedGoogle Scholar
• 52 Adrian R M. Treatment of leg telangiectasias using a long-pulse frequency-doubled neodymium:YAG laser at 532 nm.  Dermatol Surg. 1998;  24 19-23
  CrossrefPubMedGoogle Scholar
• 53 McMeekin T O. Treatment of spider veins of the leg using a long-pulsed Nd:YAG laser (Versapulse) at 532 nm.  J Cutan Laser Ther. 1999;  1 179-180
  CrossrefPubMedGoogle Scholar
• 54 Schroeter C A, Wilder D, Reineke T et al.. Clinical significance of an intense pulsed light source on leg telangiectasias of up to 1 mm diameter.  Eur J Dermatol. 1997;  7 38-42
  PubMedGoogle Scholar
• 55 Green D. Photothermal removal of telangiectases of the lower extremities with the PhotodermVL.  J Am Acad Dermatol. 1998;  38 61-68
  CrossrefPubMedGoogle Scholar
• 56 Kauvar A N, Lou W W. Pulsed alexandrite laser for the treatment of leg telangiectasia and reticular veins.  Arch Dermatol. 2000;  136 1371-1375
  CrossrefPubMedGoogle Scholar
• 57 Wollina U, Konrad H, Schmidt W D, Haroske G, Astafeva L G, Fassler D. Response of spider leg veins to pulsed diode laser (810 nm): a clinical, histological and remission spectroscopy study.  J Cosmet Laser Ther. 2003;  5 154-162
  CrossrefPubMedGoogle Scholar
• 58 Passeron T, Olivier V, Duteil L, Desruelles F, Fontas E, Ortonne J P. The new 940-nanometer diode laser: an effective treatment for leg venulectasia.  J Am Acad Dermatol. 2003;  48 768-774
  CrossrefPubMedGoogle Scholar
• 59 Sadick N S. Laser treatment with a 1064-nm laser for lower extremity class I-III veins employing a variable spots and pulse width parameters.  Dermatol Surg. 2003;  29 916-919
  CrossrefPubMedGoogle Scholar
• 60 Eremia S, Li C, Umar S H. 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.  , [see comment] Dermatol Surg. 2002;  28 224-230
  CrossrefPubMedGoogle Scholar
• 61 Goldman M P. Intravascular lasers in the treatment of variose veins.  J Cosmet Dermatol. 2004;  3 162-166
  PubMedGoogle Scholar
• 62 Proebstle T M, Gul D, Kargl A, Knop J. Endovenous laser treatment of the lesser saphenous vein with a 940-nm diode laser: early results.  Dermatol Surg. 2003;  29 357-361
  CrossrefPubMedGoogle Scholar
• 63 Proebstle T M, Gul D, Lehr H A, Kargl A, Knop J. Infrequent early recanalization of greater saphenous vein after endovenous laser treatment.  J Vasc Surg. 2003;  38 511-516
  CrossrefPubMedGoogle Scholar
• 64 Chang C J, Chua J J. Endovenous laser photocoagulation (EVLP) for varicose veins.  Lasers Surg Med. 2002;  31 257-262
  CrossrefPubMedGoogle Scholar
• 65 Merchant R F, Pichot O, Myers K A. Four-year follow-up on endovascular radiofrequency obliteration of great saphenous reflux.  Dermatol Surg. 2005;  31 129-134
  PubMedGoogle Scholar
• 66 Merchant R F, DePalma R G, Kabnick L S. Endovascular obliteration of saphenous reflux: a multicenter study.  J Vasc Surg. 2002;  35 1190-1196
  CrossrefPubMedGoogle Scholar
• 67 Nicolini P. Treatment of primary varicose veins by endovenous obliteration with the VNUS closure system: results of a prospective multicentre study.  Eur J Vasc Endovasc Surg. 2005;  29 433-439
  CrossrefPubMedGoogle Scholar
• 68 Bush R G. Regarding “Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: thrombolytic occlusion after endoluminal thermal damage by laser-generated steam bubbles”.  J Vasc Surg. 2003;  37 242
  PubMedGoogle Scholar
• 69 Goldman M P, Mauricio M, Rao J. Intravascular 1320-nm laser closure of the great saphenous vein: a 6- to 12-month follow-up study.  Dermatol Surg. 2004;  30 1380-1385
  CrossrefPubMedGoogle Scholar
• 70 Dierickx C, Farinelli W A, Anderson R R. Multiple-pulse photocoagulation of portwine stain blood vessels with a 585-nm pulsed dye laser.  Lasers Surg Med. 1995;  S7 261
  PubMedGoogle Scholar
• 71 Mordon S, Brisot D, Fournier N. Using a “non-uniform pulse sequence” can improve selective coagulation with a Nd:YAG laser (1.06 um) thanks to Met-hemoglobin absorption: a clinical study on blue leg veins.  Lasers Surg Med. 2003;  32 160-170
  CrossrefPubMedGoogle Scholar
• 72 Alves O C, Wajnberg E. Heat denaturation of methemoglobin and oxyhemoglobin. Evidence for the existence of a new hemochrome.  Int J Biol Macromol. 1993;  15 273-279
  CrossrefPubMedGoogle Scholar
• 73 Kuenster J, Nerris K. Spectrophotometry of human hemoglobin in the near infrared region from 1000 to 2500 nm.  J Near Infrared Spectrosc. 1994;  2 59-65
  PubMedGoogle Scholar

Tomi L WallM.D. 

3300 Webster Street, Suite 1106

Oakland, CA 94609