A. Campo Voegeli
Introduction: The technical improvements of the long pulsed Nd:YAG lasers in the last decade has made possible to face the treatment of different vascular conditions that were not treatable before. It has also permitted to achieve better results in the management of some of the previously treated vascular conditions. With appropriate protocols high efﬁ cacy and safety rates are now a real fact.
Background: The high penetration (6–8 mm) of the 1064 nm wavelength makes this lasers able to reach allvisible vascular lesions. The problems in safety and efﬁ cacy associated to the technical design of the ﬁ rst equipments have been solved in the last decade. A control of the penetration through spot size changes, multiple pulse durations to adjust thermal damage to vessel size, the square-shaped pulses that relate to an homogeneous deliverance of the energy, the auto-calibration that ensures the output parameters and the improvement in the cooling systems contribute to a high rate of efﬁ cacy and safety.
Material and methods: We retrospectively analyze our 8
years of experience using a 1064 nm variable long pulsed
Nd:YAG laser in the treatment of vascular conditions and
compare our results with those presented in the literature
using the same or other wavelengths. Clinical ﬁ les and pictures
were used to assess results. Some of the presented results were obtained in a prospective clinical study (rosacea). Patients are classiﬁ ed according to diagnosis or type of vascular lesions, starting from the most superﬁ cial to the most deep ones.
ere used to assess results. Some of the presented results were obtained in a prospective clinical study (rosacea). Patients are classiﬁ ed according to diagnosis or tyof vascular lesions, starting from the most superﬁ cial to themo deep ones.
Results: Facial telangiectasia and rosacea: 210 patients with facial vascular disorders were treated. The 3 or 5 mm spot size, 8–30 ms pulse durations and 105–140 J/cm 2 were used for visible telangiectasia and the 5 mm, 0.3 ms, 16 J/ cm 2 for facial redness. A mean 0f 2.87 treatments were needed to achieve complete control of ﬂ ushing in 88% and of ﬂ air ups of papules and pustules in 86% of symptomatic rosacea patients. A clearance of more than 75% of visible vessels was achieved in more than 91% of them. Poikiloderma of Civatte: similar settings but with higher ﬂ uences (115–155 J/cm 2 ) were used in 16 patients. Clear- ance of more than 75% of vessels and redness were achieved in 87% of the cases. Vascular tumors: 32 venous lakes, 27 childhood hemangiomas and 55 patients with cherry hemangiomas were treated. The 5 or 7 mm spot sizes, 15 to 60 ms and 65 to 150 J/cm 2 were used. A complete resolution of 100% of venous lakes and cherry hemangiomas and of 81% of childhood hemangiomas was accomplished after a mean of 1.8 treatments. Vascular malformations: thick venous malformations (n = 4), the nodular component of capillary and venous malformations (n = 5) and superﬁ cial capillary malformations (n = 5) were treated with the 5 or 7 mm spot size, 5 to 60 ms pulse duration and 65 to 135 J/cm 2 . Complete resolution of the nodular or tuberous lesions and partial clearance of the superﬁ cial component was observed in all the patients. Leg veins: 89 patients with visible leg veins were treated after an eco-doppler ultrasonography that conﬁ rmed the absence of venous insufﬁ ciency. 7 mm, 35 to 60 ms, and 135 to 160 J/cm 2 , were used for reticular veins; 5 mm, 8–25 ms, 160 to 210 J/cm 2 , for superﬁ cial venules and telangiectasia; and 5 mm, 5–10 ms, 95–120 J/cm for superﬁ cial matting. A mean of 3.1 treatments performed every 2 months were required to clear a 75–95% of all the vessels. Secondary reactions to the treatment with Nd:YAG in all these indications included redness (100%), transient facial edema (11%), persistent pain (2% face, 2% vascular tumors of malformations, 3% leg veins), bruising (face 7%, 33% leg veins), blisters (1%), transient hyperpigmentation (35% leg veins), scarring (< 1%) and atrophic skin areas (35% hemangioimas). Discussion: Similar results were obtained with the variable long pulsed Nd:YAG laser compared to the traditionally used systems (Pulsed Dye, KTP, IPL) in the treatment of visible facial telangiectasia. However less treatment sessions were needed with the Nd:YAG lasers and thicker vessels were targeted. In rosacea, improvement in ﬂ ushing and inﬂ ammatory ﬂ air-ups which have not responded to traditional wavelengths were constantly achieved with the 1064 nm Nd:YAG laser. Thick vascular tumors (hemangio- mas, venous lakes, venous malformations) that are not treatable with the low penetrating wavelengths were suitable for this deep penetrating light source. All types of visible leg veins responded when pretreatment studies conﬁ rmed absence of venous insufﬁ ciency. A low incidence of generally transient secondary effects was described. Conclusion: The new variable long pulsed Nd:YAG lasers permit us to treat a very wide range of vascular disorders. From the superﬁ cial to the very deep vessels can be targeted. A right parameter selection (based on experience) and strict cooling and pre-treatment protocols help to decrease the incidence and severity of secondary effects.