KTP 532nm Laser treatment of leg telangiectases resistant to sclerotherapy (Follow-up after one year)

摘要

Leg telangiectasias are venous, arterial and arteriovenous capillary dilatations of the subpapillary dermal plexus, which is directly connected to the deep dermal plexus and indirectly through perforating to the subfascial saphenic and deep venous circulation. These angectasias are almost always indicators of varicose pathology. After accurate history taking and precise diagnosis they should be treated by sclerosis, but only after having verified possible saphenous ostial refluxes which must be eliminated first by surgical means. Laser photosclerosis is aimed at the small (red) residual, resistant, relapsing and matting vessels. The 532nm lasers are irreplaceable because of the surface delicacy with which they vaporise selectively the telangiectatic and vascular malforming lesions of the face. The aim of this study was to verify the effectiveness of the 532nm on leg angectasiae resistant to sclerotherapy. We used a laser 532nm Combi Zeiss, Jena in 20 cases selected for residual, resistant, relapsing and matting leg telangiectasias (0,1 -1mm) on a total of 64 angectatic areas. The areas were cooled down with ice cubes for at least two minutes. 15-40 J/sq cm fluences, 10-50 msec, pulse durations and 1,5 mm spots were applied. As soon as the vessel blanched, it was cooled down for two further minutes. Four patients had positive results after one session only, twelve patients asked for a second session after 20 days, four patients were retouched for a third time. Follow up examinations were performed after 7-30 days and one year. In all cases the treatment was reported as painless. The immediate erythema was followed by microcrusting in 52 areas, which disappeared in 15-20 days. The one-year follow-up evidenced partial relapses in six patients and complete relapses in four on a total of 30 areas (48%). Two patients had hypo-chromic micro-scars in three areas; two patients had four residual dyspigmented areas. Our results suggest that the use of the 532nm laser is justified in the treatment of residual, resistant, relapsing and matting after sclerotherapy telangiectases.