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

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 (C 1A E p A S1 P N) 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.

Editor's Choice – European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs

“…269,270 Comparing sclerotherapy with transcutaneous laser (TCL), sclerotherapy has been shown to be as effective as 1064 nm Nd:YAG TCL, especially in treatment of reticular veins > 1 mm, but markedly less painful. 271,272 One RCT demonstrated statistically significant lower efficacy of sclerotherapy with POL compared with 1064 nm Nd:YAG in the treatment of telangiectasias < 1 mm (95% vs. 53%; p < .001), 268 whereas two other trials did not confirm these results and found no statistically significant difference in disappearance of veins with a diameter of 0.2 e 2.9 mm and no difference in patient satisfaction between sclerotherapy and Nd:YAG. 271,272 Sclerotherapy related adverse events have been described in detail in subsection 4.2.2.2.…”

Global guidelines trends and controversies in lower limb venous and lymphatic disease

“…205 In the same year, a randomized comparative study assessing hypertonic saline, polidocanol and Nd:YAG concluded that sclerotherapy remains the gold standard in vessels >1 mm, while Nd:YAG can have a role in smaller vessels. 206 Always in 2019, the feasibility of combining 532 and 808 nm multi-wavelength emissions for <1 mm vessels was demonstrated. 207…”

Pharmacological Properties of Chalcones: A Review of Preclinical Including Molecular Mechanisms and Clinical Evidence

“…The main symptoms in moderate stages are heavy legs, tension in the lower limbs, varicose veins dilated, followed in severe stages by swelling of the lower limbs, skin changes, and the appearance of venous ulcer ( Lichota et al, 2019 ). A therapeutic option is represented by laser therapy, sclerotherapy, and venoactive drugs ( Ianosi et al, 2019 ). These venoactive drugs are a heterogeneous group of substances from plant or synthetic origin that modulate the venous tone, attenuates the blood rheology, improves micro- and macrocirculation, regulates capillary permeability, have anti-inflammatory effects by inhibiting leukocyte–endothelial interaction, and reduces the oxidative stress ( Salehi et al, 2020b ).…”