الفهرس 
TELANGIECTASIA AND RETICULAR VEINSOnly 14 pages are availabe for public view
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Abstract
T
elangiectasias and reticular veins of the lower limbs is one of the most commonly reported cosmetic complaint especially in women. Telangiectasia are dilated venules and arterioles measuring less than 1 mm in diameter while reticular veins are 1-4 mm in diameter. They are mostly asymptomatic but some women have symptoms of pain and edema especially with prolonged standing and the severity of these symptoms is totally out of proportion to the size of the involved veins.
The eradication of telangiectasia and reticular veins has been understudy for many years where sclerotherapy proved to be the gold standard for treating leg veins but for patients who are allergic to sclerosant material or needle phobic another treatment method had to emerge. Lasers are presently available to achieve this goal.
Laser therapy has offered effective and non-scarring treatment modalities to patients with vascular lesions including telangiectasia. In vascular lesions the targeted chromophore is oxyhemoglobin and deoxyhemoglobin. There are three peaks of absorption for oxyhemoglobin and deoxyhemoglobin, they are at 524 nm, between 577nm and 585 nm and at 1064 nm. The most commonly used laser devices for these treatments include the 532 nm potassium titanyl phosphate (KTP), 595 nm pulsed dye laser (PDL), the 755 nm alexandrite laser, intense pulsed light (IPL), and the 1064-nm neodymium yttrium-aluminum-garnet laser (Nd:YAG). Their mechanism of action is selective phtothermolysis.
The long wavelength of Nd:YAG laser allows it to penetrate deep into tissue which makes it very suitable for treating deeper vessels which are commonly blue colored. Whereas the shorter wavelength of Intense pulsed light is more effective in treating the more superficial red telangiectasia.
The aim of current work was to compare the effectiveness of Nd:Yag versus combined sequential IPL and Nd:Yag in treatment of lower limb telangiectasia and reticular veins in 2 different lesions of the same anatomical site.
The patients received 3 sessions each one month apart. They were photographed by a digital Nikon D5100 and a Nikon dx af-s nikkor 18-55mm lens before and after each session. They also were photographed by Antera 3D camera using hemoglobin mode before and 3 weeks after last session. Also patients were interviewed and asked about their satisfaction in both sides and given a score accordingly whether they were satisfied (=2) or somewhat satisfied(=1) or not satisfied(=0).
The obtained data were tabulated and statistically analyzed. Our results showed significant difference between Nd:YAG plus IPL treated sites versus Nd:YAG only treated sites as regards patient satisfaction and physician’s assessment, Nd:YAG plus IPL treated sites showed better improvement compared to Nd:YAG only treated sites. However no significant difference between Nd:YAG and IPL treated sites versus Nd:YAG only treated sites as regard Hemoglobin variation measured by Antera 3D camera, although the change in hemoglobin variation after treatment was higher in Nd:YAG plus IPL treated sites, it did not reach a statiscally significant level. There was no significant difference between Nd:YAG plus IPL treated sites versus Nd:YAG only treated sites as regards occurrence of side effects; Hyper pigmentation, Edema and Purpura.
In conclusion, the sequential delivery of Nd:YAG plus IPL is a superior method compared to Nd:YAG laser alone in treatment of telangiectasia and reticular veins. Although the difference between the two modalities is slight but since side effect incidence is the same in both modalities, therefore sequential delivery of Nd:YAG plus IPL can represent a valuable and effective modality for treating telangiectasia and reticular veins of lower limbs.