Vascular lesions include a range of conditions. Whether it be leg veins, facial veins, angiomas, venous lakes or rosacea, laser and light-based devices have become a viable treatment option to safely and effectively remove and diminish unwanted vascular concerns.

The Vascular Market

Vascular lesions are a type of common skin concern, affecting up to 50% of women aged 18 years and older.1 Spider veins, telangiectasias, and diffuse redness may be systemic but are often a result of aging, sun damage or pregnancy. Today, more than 45M individuals are affected by rosacea2, a chronic skin condition. Often mistaken for a sunburn or rosy skin, rosacea presents with redness, visible blood vessels and tiny red bumps that can be compared to acne and often worsens over time.

Cutera Solutions for Unwanted Reds, Browns, Blues, and Purples

Lasers and light-based devices enable providers to effectively treat superficial and deep vascular lesions on the face and body. Cutera’s vascular solutions – excel V and xeo – provide a non-invasive, fast and effective treatment to target unwanted blue, red and purple lesions while sparing the surrounding skin.

The Cutera, Inc. Nd:YAG 1064nm is FDA-cleared for:

• Coagulation and hemostasis of benign vascular lesions such as:
  • Telangiectasia
  • Venous lakes
  • Leg veins
  • Poikiloderma of Civatte
  • Hemangiomas
  • Port-wine stains
  • Warts
  • Scars

PREREQUISITE

Review Operator Manual and Clinical CD with Laser Physics, Safety and Maintenance presentations prior to operating the laser.

REFLUXING OR INCOMPETENT VEINS

• Veins have valves that act as one-way flaps that prevent blood from flowing backwards as blood is returned to the heart.
• Venous reflux or incompetence is a diseased or abnormal valve that is no longer able to close when subjected to pressure. This failure to close prevents the valve from stopping the backward flow of blood. In response to gravity, blood pours backward (like a waterfall), overloading the vein with volume and pressure which leads to the development of varicose veins.
• Ultrasound may be ordered to diagnose possible reflux of the Greater or Lesser Saphenous Vein which is usually treated surgically.

VASCULAR TREATMENT PROCESS

• The purpose of the treatment is to selectively treat the target of hemoglobin (chromophore) without causing thermal damage to the surrounding tissue.
• Laser light is absorbed by hemoglobin in the veins and the heat produced causes photocoagulation.
• This heat is transferred to the vessel wall which affects the collagen and ultimately helps to destroy the vessel and prevent recanalization.
• The laser treats individual veins but new veins may appear due to an underlying disorder

TYPES OF VEINS

• Varicose veins – usually requires surgery
  • Vary in diameter
  • Bulging and twisting veins of the lower extremity caused by increased venous pressure as a result of venous incompetence
  • Bulging varicose veins should be evaluated by a vascular surgeon
• Reticular veins or “feeder veins” – treated by laser
  • 1 – 3. mm in diameter
  • Superficial collecting veins that are blue green
• Telangectasias or spider veins – treated by laser
  • Up to <1 mm in diameter
  • Superficial, small veins; pink to purple in color

PATIENT ASSESSMENT

Contraindications for this device are Pregnancy and Skin Cancer

Obtain a medical history and signed consent.

Determine ethnicity and skin type by using the attached Fitzpatrick Skin Type scale

• Re-evaluate patient prior to each treatment
• Treatment settings may need to be decreased due to sun exposure
  • Sun exposure may increase melanin content of the skin

Patient Considerations including but not limited to are below.

• Current Medications (both routine and occasional use)
  • Accutane – do not treat if taken in the last 6 months
  • Gold Therapy – may cause blue-gray discoloration
  • Photosensitizing drugs (Tetracycline, etc) – may have to adjust treatment parameters according to clinical response from the test are(s)
  • Anticoagulants – may increase risk of purpura or bruising
• Vitiligo – heat from the treatment could induce a flare-up
• Herpes – pre-treatment with an antiviral may be indicated
• Wound infections
• History of coagulopathies
• History of keloid or hypertrophic scarring
• Diabetes – may impede wound healing
• Do not treat dysplastic nevi or questionable pigmented lesions.
  • Online Melanoma resources include (www.aad.org), (www.cancer.org)

Avoiding Complications:

• Pre-cooling is essential to prevent burns!
• Darker skin types have an increased risk of complications and/or pigmentary issues
• Always treat outside the orbital rim of the eye aiming the beam away from the orbit
• Do not treat over or close to tattoos or permanent make-up
• No self-tanners for at least 2-4 weeks prior to treatment.
• The Nd:YAG can crack a tooth if teeth are exposed.
  • Moist gauze may be placed between the lips and teeth.
• Implants
  • Avoid metal implants in thin skinned areas; clavicle, jaw, orbit
  • Ask about surgical implants and threads
  • Do not treat over Pacemaker implant
  • Reaction to fillers and neurotoxins unknown
• Ice should NEVER be applied to a suspected burn as it may cause unwanted side effects. Frozen gel packs or cool compresses can be used.

POST-TREATMENT CARE

• Cold compresses or chilled gel-packs may be applied post treatment.
• Compression stockings (30-40 mm Hg Pressure) are optional and may increase patient comfort and help reduce bruising.
• Avoid heat for a minimum of 24 hours – hot tubs, saunas, etc.
• Avoid sun exposure and apply sunscreen to the treated area
• The recommended time interval between treatments is 6 weeks or longer, depending on the rate of clearance.
• Larger reticular vessels may take months to resolve and should not be re-treated before then.

POSSIBLE REACTIONS

• Erythema and bruising are common and resolve with time.
• An urticarial (hive-like) reaction may occur with smaller vessels
• If a blister or crusting develops, treat as a wound
• Hemosiderin staining (iron leaking into tissue from blood breakdown) may occur and usually resolves over time
• Dark coagulum in larger vessels can be removed 1 to 2 weeks post treatment by nicking the vessel with a needle and applying pressure to force out the coagulum.