๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Introduction
CHAPTER 64 Lasers for Vascular
Lesions
Rie Takahashi Stephanie J. Martin Gary Lask
SUMMARY
Laser therapy for vascular lesions targets oxyhemoglobin as the chromophore,
with absorption peaks at 418, 542, and 577 nm.
Blood vessel depth, thickness, and skin type are factors that are often considered
for each patient.
Beginner Pearls
Several types of lasers are available for the treatment of vascular lesions, including
the pulsed dye laser (PDL); potassium titanyl phosphate (KTP) laser; neodymium:yttrium aluminum garnet (Nd:YAG) laser; CO2 laser; argon laser; copper vapor laser; and intense pulsed light (IPL).
PDL is currently the treatment of choice for PWS due to the low risk of scarring and
acceptable complication rates, despite a relatively modest degree of total clearance, at approximately 15% to 20%.
Expert Pearls
Rosacea and diffuse erythema have been successfully treated with PDL, IPL, and long-
pulsed Nd:Yag (532 nm) lasers.
A combination of lasers, phlebectomy and sclerotherapy may be the best long-term
approach for treating leg veins, though as a monotherapy, sclerotherapy remains the gold standard treatment for leg veins.
Donโt Forget!
Purpuric settings consist of a single pass with shorter pulse durations (0.45, 1.5 ms)
and higher fluences.
Nonpurpuric settings require multiple passes with longer pulse durations (6 ms) and
lower fluences.
Pitfalls and Cautions
Given the widespread use and high success rates with using topical and oral beta
blockers, laser treatment for HOI is becoming less common.
When KTP lasers are used for leg veins, hyper- and hypopigmentation have been
reported to occur in 20% to 40% of patients.
Caution must be taken with multiple passes, which can result in vessel rupture with
subsequent hemosiderin deposition with long-pulsed Nd:Yag lasers.
Patient Education Points
Patients should understand the risks of laser treatment, including dyspigmentation.
It is important that patients understand that most laser treatments involve multiple
visits.
Billing Pearls
Almost all insurers in the United States exclude laser treatments from coverage.
Patients may benefit from committing to a series of treatments, as this may allow
significant cost savings.
Pre-treatment with occluded topical anesthesia can be started at home, and
prescription plans may cover the cost of this medication.
CHAPTER 64 Lasers for Vascular