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Neil S. Sadick, MD; Victor G. Prieto, MD; Christopher R. Shea, MD; Judith Nicholson, RN; Tim McCaffrey, PhD

Arch Dermatol. 2001;137:613-617.

Background  The goal of sclerotherapy, laser therapy, and intense pulsed-light therapy is to produce long-term, cosmetically significant elimination of disfiguring leg veins. This study examines the histologic and clinical effects of using a 1064-nm Nd:YAG laser system on lower extremity vessels.

Design  A single treatment using the following parameters: wavelength, 1064 nm (multiple synchronized pulsing); spot size, 6 mm; pulse duration, 14 milliseconds (single pulse); and fluence, 130 J/cm².

Setting  Private dermatology practice.

Patients  Thirteen women (mean age, 38.5 years) with blue venulectasia, 0.5 to 1.5 mm in diameter (class 2), and reticular veins, 1.5 to 3.0 mm in diameter (class 3), on the thighs.

Main Outcome Measures  Examination of treated and untreated areas by 2 masked observers using macrophotography (1, 2, 3, and 6 months after treatment), Doppler, and optical chromatographic changes. Findings from three 2-mm punch biopsies from treated (immediately and 4 weeks after treatment) and untreated sites. Routine histologic examination; special stains (for elastic and connective tissue and for mucopolysaccharides); and immunohistochemical analysis for expression of the heat shock protein hsp70, tie2 (an endothelial cell–specific receptor tyrosine kinase), and transforming growth factors 1 and 2.

Results  Eight patients (62%) manifested 75% to 100% clearing of treated vessel surface area. Treated areas revealed perivascular hemorrhage, thrombi, fragmentation and homogenization of elastic fibers, and eosinophilia of vessel walls. Expression of hsp70 and transforming growth factor was increased in treated vessels.

Conclusions  Our data confirm the effectiveness of 1064-nm Nd:YAG laser treatment in clearing dilated lower extremity veins, probably by heat-induced vessel damage and subsequent fibrosis. Maintenance of clearing was achieved for up to 6 months. However, the presence of recanalized thrombi in some of the specimens suggests the potential for long-term vessel reappearance.

From the Department of Dermatology (Dr Sadick) and the Division of Hematology/Oncology, Department of Medicine (Dr McCaffrey), Weill Medical College of Cornell University, New York, NY; the Division of Dermatopathology, Departments of Pathology and Medicine, University of Texas–M. D. Anderson Medical Center, Houston (Dr Prieto); the Division of Dermatopathology, Departments of Pathology and Medicine, Duke University Medical Center, Durham, NC (Dr Shea); and ESC Sharplan, Norwood, Mass (Ms Nicholson).

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