THE APPLICATION OF CUTTING-EDGE TECHNOLOGIES IN THE TREATMENT OF THE EARLY STAGES OF CHRONIC VENOUS DISEASES
Authors: Shchykin S.P. , Honcharov V .L. 
Published: December 2024

Background. The vascular network of the legs presents a significant and complex issue that still lacks a reliable solution. Cosmetic defects, such as unwanted or unsightly vessels, are commonly observed in individuals with chronic venous diseases as well as in those without these conditions. According to global guidelines, sclerotherapy is considered the "gold standard" treatment for reticular veins and telangiectasias. However, the high incidence of hyperpigmentation (11-80%) and matting (5-75%) has prompted the exploration of new methods to eliminate these vessels.
The goal of this study is to explore the effectiveness of combining percutaneous laser coagulation and sclerotherapy for the treatment of reticular veins and telangiectasias in the lower extremities.
Materials and methods. Since 2017, we have utilized the CLaCS technique (cryo-laser, cryo-sclerotherapy) to address the vascular network of the legs. The treatment involves a neodymium laser with a wavelength of 1064 nm (Fotona XP Dynamis), a VeinViewer (Christie Medical, USA), a Syris 900v polarized light 4x forehead loupe, and a Zimmer Cryo 6 cryocooler. Protocol for treating reticular veins: spot size – 6-9 mm; fluence – 50 J/cm²; pulse duration – 35-50 ms; ethoxysclerol 0.3% injections; visualization with a thermal imager and cooling using the cryocooler (-20 °C). Protocol for treating telangiectasias: spot size – 4-2 mm; fluence – 160-360 J/cm²; pulse duration – 5-10 ms; cooling with a cryocooler (-20 °C). Following each procedure, patients are prescribed a class 2 compression stocking for one day. From November 2017 to June 2023, we performed 5,535 procedures (4,146 errors) using a combination of CLC and sclerotherapy to treat reticular veins and telangiectasias. We followed up with 3,875 cases to assess the final results, which were evaluated using a Likert scale.
Results. 5 points were found in 1782 (46%) patients, 4 points in 1434 (37%) patients, 3 points in 465 (12%), 2 points in 116 (3%), and 1 point was assessed in 78 (2%) patienys. For patients with 2 and 3 points, reticular varicose veins were initially significantly pronounced, requiring more than two sessions (3-5). Six months after the second session, a decision was made to schedule additional CLaCS sessions. In patients with a score of 1 point, reflux in the superficial veins was detected via ultrasound duplex scan. These patients were offered procedures for vein elimination, including endovenous laser treatment or radiofrequency ablation.
Conclusions. The use of percutaneous laser coagulation with a neodymium laser significantly reduces the volume and concentration of sclerosant, as well as the number of side effects (such as pigmentation and matting). Eliminating reticular veins is crucial for the success of treating telangiectasias. All patients should undergo ultrasound examination. If reflux is detected in the superficial veins, the first step is to perform endovenous laser treatment or radiofrequency ablation to correct phlebohemodynamics.