Treatment Techniques in Vascular Lesion Therapy with the 1064nm Laser

The treatment of vascular lesions, such as telangiectasias or spider veins, with a 1064nm Nd:YAG laser requires a precise approach to ensure optimal results and minimize side effects. This post will outline the treatment methodology and the clinical end points that guide the process.

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Treatment Methodology

1. Single Pulse vs. Multiple Pulses:
   • Idealmente, a single pulse of laser energy is administered to each point on the targeted vessel. This method is preferred for its precision and safety, as it avoids excessive heat accumulation and reduces the risk of epidermal damage and pain.
   • If the vessel does not show a significant change in color or constriction after a single pulse, it may indicate the need for adjusted energy parameters or additional treatments.
2. Special Cases for Multiple Pulses:
   • For deeper or larger vessels, multiple pulses may be necessary to fully disrupt the vessel. This is done by administering 2-3 pulses at each point, with a few seconds between each pulse to observe the vessel’s response.
   • The goal is to avoid rapid consecutive pulses that could lead to excessive heat buildup.
3. Clinical End Points:
   • The end points of treatment are the signs that indicate the effectiveness of the laser therapy. These include:
     1. Color Change in Vessels:
        • The vessel changes from red or purple to a darker purple, grayish-white, or disappears, signaling successful coagulation.
     2. Vessel Constriction:
        • The targeted vessel visibly constricts or becomes less distinct, indicating successful thermal coagulation of the vessel wall.
     3. Absence of Adverse Reactions:
        • There should be no significant burns, excessive redness, or severe pain in the treated area.
4. Importance of Energy Control:
   • The energy settings must be precise, regardless of whether a single or multiple pulses are used. Insufficient energy may result in ineffective treatment, while excessive energy or over-pulsing can lead to epidermal burns, pigmentazione, or patient discomfort.
   • Recommended settings include:
     • Densita 'energia: 80-150 J/cm², adjusted based on vessel diameter and depth.
     • Durata dell'impulso: 20-50SM.
     • Dimensione del punto: 1.5-3mm.

Conclusione

The standard practice is to administer a single pulse of laser energy at each point on the targeted vessel, observing for the desired response before moving to the next point. For deeper or larger vessels, 2-3 pulses may be appropriate, with care taken to avoid excessive heat accumulation. The clinical end points, such as color change and constriction of the vessel, serve as the criteria for determining whether further pulsing is necessary, while also guiding the adjustment of treatment parameters based on the treatment response.