Laser treatments of capillaries of the lower limbs

Foot Telangectasia - A. Crippa, MD
Leg Telangectasia - L. Tessari, MD
Leg telangectasia - A. Crippa, MD

What are “dilated” capillaries?

The network of visible capillaries are defined as telangiectasia, with red to blue coloration. Their appearance depends on the dilation of smaller blood vessels on the surface. They appear on the lower limbs above all.
They often represent the segmental suffering of microcirculation, due to several causes.

What kind of capillaries affects the legs?

There are several types:
  • Congenital: they arise at birth (for example, angiomas) and may be associated with various malformations.
  • Primary: they arise at young age (capillary fragility).
  • Secondary: they can arise at all ages (various causes).

Do secondary “dilated” capillaries exist?

Yes, secondary “dilated” capillaries exist or are associated with:
  • Dermatologic or systemic pathologies (livedo reticularis, scleroderma, lupus, mastocytosis, hyperthyroidism, etc.)
  • PFES or cellulitis
  • Traumas, vein stripping, scars, sclerotherapy
  • Fractures treated with a cast
  • Acute and chronic inflammations
  • Radiochemotherapies
  • Deep vein thrombosis and superficial thrombophlebitis
  • Infiltrations with corticosteroids
  • Pathological alterations to insoles
  • Varicose vein refluxes
  • Deep venous hypertension.

What causes the problem?

There can be several causes: excessive sun exposure or too much heat, female hormones (especially linked to pregnancies and contraceptives), overweight, alcohol, vasodilators, hypotensives, tight-fitting clothes, hair removal strips, microtraumas, hereditary.

Do “dilated” capillaries of different colours exist?

Yes, “dilated” capilliaries are discerned by three different colours:
  • Blue: wide and deep with static venous flow. With the passing of years, the blue capillaries come to surface. Their walls get increasingly thinner and may rupture, causing bleeding;
  • Red: thin with fast internal flow;
  • Purple: intermediate with diameter, depth and flow speed.

What are the types of “dilated” capillaries?

There are four different types:
  • Simple or linear;
  • Arborized or branched like a birch (caused by a main vein);
  • Star and reticular;
  • Punctiform.

Where do they most frequently appear and what are their symptoms?

Primary capillaries do not have specific locations. However they often appear between the knees:
  • Fan-shaped varices form on the outer side of the thighs
  • Secondary capillaries are observed in the course of the varices
In the summer and before menstruation, they may cause tension, burning sensation, formication and heaviness.

How and when do they have to be treated?

Once the right diagnosis is made, autumn, winter and early spring are the most suitable seasons for the treatments. Primary capillaries can be treated by administering phlebotonic medication in the summer and by using elastic restraints in the winter. Secondary capillary refluxes must be treated after the varices are removed, by controlling the main veins with a transillumination device. The conventional therapy is still microsclerosis, whilst patients allergic to needles or suffering from needle phobia can be treated with several laser-assisted solutions.

What are the different solutions for laser-assisted vascular treatments?

The external laser (both transcutaneous and transdermal) is the best solution for supporting, improving and refining chemical microsclerosis. Capillaries that are red, have a deep reflux and are resistant to chemical sclerosis, can be treated through two further solutions: endovenous laser or endo-perivenous laser.

How does the transdermal laser work?

The laser is a selective electromedical instrument as it affects the “sick” blood vessels without causing damage to the surrounding tissue. The laser beam arrives at the capillaries in the form of coagulating heat, as a result of thermal damage. The complete removal of the vein is noted after about 15 days, one month following treatment.

How long does the treatment last?

It depends on the size of the area to be treated, but usually ranges from 30 minutes to one hour. On average, one session requires 2-4 sessions (depending on the amount of vessels to be treated).

Is it painful?

The treatment is not painless. It is an unpleasant but bearable discomfort that can be resolved and alleviated with skin cooling before laser treatment.

After the laser treatment?

Immediately after being treated, a redness is observed that includes the area, a redness that tends to disappear within 2-3 days. Moreover, the formation of scabs is likely in the following days,.
After the laser session, it is mandatory to completely protect the treated area from sunlight with screening products. You cannot undergo treatment with tanned skin or in the summer.

What are potential complications and relapses?

Whilst the most common complications from chemical sclerotherapy may be: hyperpigmentation, allergic reactions, haematomas, eschars and matting; laser-induced complications are: impact pain, micro-scabs and skin dyschromias which disappear within 3-4 weeks. Capillary fragility and a predisposition to form other capillaries remain, even after flawless treatments. Varicose veins are multifactorial and evolving. Relapses occur when preventive measures are not taken.

How can we prevent relapses?

  • by walking and regulating weight
  • by eating fruits rich in antioxidants (vitamins A, C, E)
  • by wearing suitable socks and shoes (with insoles)
  • by wearing comfortable clothes
  • by using phlebotonic medication and anti-oedema cream in the summer
To be avoided:
  • inactivity
  • alcohol - hormone intake
  • prolonged sun exposure, wide temperature ranges, sun beds, saunas, etc.
  •  

Flebolaser on Teleangectasias - LASEmaR® 800 | Courtesy of P.A. Bacci MD 

 

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