The development of lasers using deeper-penetrating, near-infrared wavelengths with millisecond pulse durations and skin-cooling methods has produced safer and more predictable results for the treatment of leg veins less than 1 mm in diameter and depth. Recent prospective studies of the near-infrared lasers show comparable efficacy and side effect profiles to those observed with sclerotherapy.
Treatment of reticular and varicose veins is effective with these wavelengths but is limited by patient discomfort when compared with sclerotherapy. Visible light lasers (such as the pulsed dye and KTP) and intense pulsed-light sources are reproducibly effective only for superficial, nonarborizing pink-to-red telangiectasia, in the absence of points of proximal reflux. Because most lower-extremity vascular ectasias comprise a heterogeneous group of vessel sizes and depths, many patients achieve the best results using a combination of techniques. This article reviews the fundamentals of laser tissue interactions for the treatment of leg veins and details the recent clinical experience with the newer near-infrared devices.