الفهرس 
Venous Diseases of Lower ExtremitiesOnly 14 pages are availabe for public view
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Abstract
Reticular leg veins are abnormally dilated subcutaneous veins that are blue, non-bulging, measure 1mm to 4mm in diameter as follow: from 1.1 to 2 mm called venulectasia and from 2.1 to 4mm called reticular veins , and are directly associated with telangiectsia. They are called reticular veins as they are present in the reticular dermis. These reticular veins are seen most commonly over the posterolateral aspects of the thigh and the lateral aspect of the calf.
Many classifications are present to classify leg veins but the most important is CEAP classification which is a classification of venous disease of lower extremities according to Clinical, Etiologic, Anatomic and Pathophysiological bases. It is understood that telangiectasias, reticular varicosities, and true varicose veins are physiologically similar and etiologically identical. The four main influences causing these abnormalities are heredity, female sex, gravitational hydrostatic forces, and homodynamic muscular compartment pressure, also pregnancy hormones have a great role in the development of abnormal leg veins. This explain why females are affecting more than males
The diagnosis of reticular leg veins is done by good history taking, full examination general and local. Also there are multiple investigations that give idea about the deep system, the conditions of valves and the presence of old obstructive thrombus. These investigations are doppler scan, duplex scan, plethymography.
There are multiple therapeutic modalities, however, none of them gives satisfactory results. They are in the form of medical treatment, electrocoagulation treatment which often results in scarring and sclerotherapy which is known to create inflammatory effects as well as hyperpigmentary changes and ulceration. Additionally, it is not unusual to run across needle phobia in some patients, hypersensitivity reaction, pain, matting of veins, thrombus formation and many other side effects.
Many types of lasers are used in the treatment of reticular leg veins. Also the use of longer wavelengths such as (Nd: YAG 1064) nm have been explored for the treatment of larger leg telangiectasia.
The aim of our study was to study the effects and the side effects of long pulsed Nd: YAG 1064 nm on the treatment of reticular leg veins ranging from 1.5 to 4 mm in diameter and in color from red to purple in color.
We selected twenty five patients with Fitzpatrick skin type (III – IV) complain of reticular leg veins. The study was done at Dermatology department at Ain Shams university hospital. We have chosen leg vessels that range in size from 1 to 4mm in diameter. While the depth of vessels was determined by the color changing from red to purple to blue. Vessels locations were randomly chosen. Every patient was evaluated by good history taking general examination, local examination and duplex scan in case of extensive leg veins.
The treatment was preceded by local anesthetic cream in half of the cases and shaving of treated area. The parameters used were spot size 3mm, fluences ranging from 200 J/cm² to280 J/cm² and pulse duration ranging from 40msec to 60msec. For the larger vessel (2.1 - 4mm) in diameter we use moderate fluences (200J/cm² -220 J/cm²) with long pulse width 60msec using spot size 3mm. While the smaller vessels (1-2mm) in diameter we use high fluences)(240 J/cm² -280 J/cm²) with pulse width 40msec using spot size 3mm. The postoperative care was in the form of post treatment cold compressor.
The evaluations of our study was done by two methods first by clinical evaluations as we compared the photographs of the patients at 1, 2, 4 months treatment. These revealed that no patients (0%) showed no improvement scale (0) no improvement, two patients(8%) showed poor response scale (1) poor (25% clearance), three patients(12%) showed moderate improvement scale (2) moderate (25%-50%), eight patients (32%) showed good response scale (3) good (50%-75%) and twelve patients (48%) showed excellent improvement scale (4)excellent (75%-100%). The need of second session is determine by the effect of the first session. If response was less than 50% a second session was needed and it occurred in 56% of cases. While the other needed only one session.
The second method of evaluation was through patients’ satisfaction. Our scale was as follow no patients (0%) express any satisfaction, four patients (16%) express minimal satisfaction, nine patients (28%) expressed moderate satisfaction and twelve patients (48%) expressed greatly satisfaction. The satisfaction was related to both pain relief and improvement of cosmetic appearance.
The most common complication was purpura formation. This was observed in six patients representing 24%. It resolved completely after two weeks. The second complication was the hyperpigmentation representing 16%. None of our patients developed long term post laser hyperpigmentation. Two of patients were complicated by crustation representing 8% which resolved after 1week with the use of topical antibiotic.
The use of Nd: YAG 1064 nm was a safe and effective method of treatment of leg vein. The advantages of laser treatment of leg veins were that was less painful than comparing with other methods as sclerotherapy, absence of puncture of skin and less morbidity as the patient can practice his activity completely after the treatment. Also the absence of post treatment pain, lack of postoperative stocking, mild short term complications encourage for laser treatment while the disadvantage of laser being expensive compared to other methods, having late effect not immediate effect and some time need more than one session, not effective if there is underlying valve incompetence.