Hyperpigmentation after sclerotherapy: modern possibilities for prevention and treatment

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Review authors consider the current possibilities of percutaneous laser coagulation for telangiectasias and reticular veins, which are the most common cosmetic defects of vascular genesis, occurring in more than 80% of women of different age groups. This vascular pathology constituting an aesthetic defect and causing local physical discomfort is one of the most common indications for phlebosclerosing therapy and percutaneous laser coagulation. The authors present the most effective and safe guidelines for percutaneous laser coagulation based on analyses of a large volume of specialized literature. Due to the use of state-of-the-art Nd:YAG lasers, percutaneous laser coagulation is increasingly used in patients with various types of intradermal vein lesions and, owing to high efficiency and safety, has advantages over compression sclerotherapy by several criteria. Nd:YAG lasers can be divided into long- and short-pulse ones according to their technical characteristics. Long-pulse lasers provide coagulation of the target vessel due to a single pulse with a high energy density (fluence), while short-pulse lasers, on the contrary, generate a series of pulses to the target vein with a running time of fractions of a millisecond, which ensures the conversion of hemoglobin into methemoglobin with a ten-fold increased ability to absorb laser energy and convert it to heat. As the duration of the pulses generated by the device is a priori shorter than the thermal relaxation time, the risk of burns to the skin and paravasal structures almost completely disappears. The authors provide clinical examples of the application of Aerolase Neo device that utilizes MicroPulse technology to confirm the effectiveness and safety of shortpulse Nd:YAG lasers.

Percutaneous laser coagulation of dilated intradermal veins: from theory to practice

Bogachev,

Manjikian,

Alukhanyan

2023

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The effectiveness of minimally invasive surgical techniques for treating patients with chronic venous insufficiency in the stage of trophic disorders: comparative study

Khitaryan,

Veliev

2024

Introduction. Despite the active introduction of minimally invasive techniques into modern phlebology, the problem of surgical treatment of chronic venous insufficiency (CVI) in the stage of trophic disorders is still far from being finally resolved, especially problems of horizontal reflux.Aim. Тo comparatively evaluate the results of using various tactics of minimally invasive surgical treatment in patients with lower extremitiesʹs CVI in the stage of trophic disorders.Materials and methods. A study at 139 patients with CVI at the stage of trophic disorders was carried out. Group 1 (n = 79) included patients who underwent endovasal laser coagulation of the trunks of the great and small saphenous veins (GSV and SSV) with microfoam sclerotherapy of varicose perforating veins. In group 2 (n = 60) – method of intervention was determined by the diameter of Cockettʹs perforants.Results. Indicators of the early postoperative period in the study groups were comparable. After 2 months, no cases of relapse in the GSV and SSV were registered. Recurrence of horizontal reflux was observed only in 6 (7.6%) people in group 1. In long-term postoperative follow-up, decrease in the severity of the disease according to the VCSS scale was found in both groups (p < 0.001). The persistence of pathological reflux along was observed in 16 (22.5%) patients of group 1. Moreover, in 62.5% and 68.75% cases of relapses, the perforants had, respectively, a large diameter and high blood flowʹs speed.Discussion. In general, minimally invasive techniques used demonstrated comparable clinical results and high efficiency. At the same time, the importance of preoperative assessment and taking into account the properties of perforants has been proven.Conclusion. The claimed method should be considered as an effective and safety method of obliteration of incompetent perforating veins at severe forms of CVI.

Laser treatment of dilated periorbital veins

Bogachev,

Lobanov,

Abdosh

2024

Delated periorbital veins causing cosmetic discomfort are one of the most common reasons why patients seek treatment at clinics specializing in aesthetic phlebology. The etiology and pathogenesis of the expansion of once-normal veins on the lower and upper eyelids, as well as in the temporal region have not been established. The potential risk factors include various injuries, invasive cosmetic procedures, intake of female sex hormones, exposure to unfavourable environmental conditions, natural skin ageing, heavy sports activities, and sudden body weight loss. It should be noted that dilated periorbital veins can not only cause aesthetic discomfort, but also induce spontaneous haemorrhages into nearby soft tissues. Initially, dilated periorbital veins were treated using various sclerotherapy options or radiofrequency coagulation with a hair-thin electrode. In recent years, owing to the advent of latest laser platforms, especially neodymium activated yttrium-aluminum-garnet (Nd:YAG) ones, percutaneous laser coagulation (PLC) has become the first-choice technique for treating dilated facial veins. The modern long-pulsed Nd:YAG lasers generate 1064 nm laser radiation, which ensures the achievement of target veins located at different depths under the skin's surface, and also demonstrates high affinity towards haemoglobin and its derivatives. In other words, Nd:YAG lasers are the optimal option to treat dilated facial veins, including those in the periorbital region, in patients with any skin phototypes. The multi-application XEO (Cutera) platform designed for photo and laser therapy is the most successful representative of Nd:YAG lasers. The case reports presented in this article highlight the successful treatment of dilated periorbital veins.