Leg
telangiectasias and reticular veins are a common complaint affecting more than 80% of the population to some extent. To date, the gold standard remains
sclerotherapy for most patients. However, there may be some specific situations, where
sclerotherapy is contraindicated such as needle
phobia,
allergy to certain
sclerosing agents, and the presence of vessels smaller than the diameter of a 30-gauge needle (including telangiectatic matting). In these cases, transcutaneous
laser therapy is a valuable alternative. Currently, different
laser modalities have been proposed for the management of leg veins. The aim of this article is to present an overview of the basic principles of transcutaneous
laser therapy of leg veins and to review the existing literature on this subject, including the most recent developments. The 532-nm
potassium titanyl phosphate (
KTP) laser, the 585-600-nm
pulsed dye laser, the 755-nm
alexandrite laser, various 800-983-nm
diode lasers, and the 1,064-nm
neodymium yttrium-aluminum-garnet (
Nd:YAG) laser and various intense pulsed light sources have been investigated for this indication. The KTP and
pulsed dye laser are an effective treatment option for small vessels (<1 mm). The side effect profile is usually favorable to that of longer wavelength modalities. For larger veins, the use of a longer wavelength is required. According to the scarce evidence available, the
Nd:YAG laser produces better clinical results than the
alexandrite and
diode laser. Penetration depth is high, whereas absorption by
melanin is low, making the
Nd:YAG laser suitable for the treatment of larger and deeply located veins and for the treatment of patients with dark skin types. Clinical outcome of
Nd:YAG laser therapy approximates that of
sclerotherapy, although the latter is associated with less
pain. New developments include (1) the use of a nonuniform pulse sequence or a dual-wavelength modality, inducing
methemoglobin formation and enhancing the optical absorption properties of the target structure, (2) pulse stacking and multiple pass
laser treatment, (3) combination of
laser therapy with
sclerotherapy or radiofrequency, and (4) indocyanin green enhanced
laser therapy. Future studies will have to confirm the role of these developments in the treatment of leg veins. The literature still lacks double-blind controlled clinical trials comparing the different
laser modalities with each other and with
sclerotherapy. Such trials should be the focus of future research.