Histopathological evaluation of lower limb reticular veins treated with Nd:YAG 1064 nm laser: a prospective cohort pilot study.

BACKGROUND The 1064 nm Nd:YAG transdermal laser is commonly used in the ambulatory treatment of lower limb reticular veins and telangiectasias. However, optimal laser parameters, particularly fluence and pulse duration, remain a subject of debate. In this prospective cohort pilot study, we evaluated the histopathological effects of different Nd:YAG 1064 nm laser settings on reticular veins to identify the parameter combinations most associated with vein wall damage.

METHODS Patients scheduled for ambulatory phlebectomy received transdermal laser therapy 24 hours prior to surgery, using different combinations of fluence and pulse duration. A total of 15 vein segments were collected during phlebectomy, 12 treated with the laser and 3 untreated controls. All samples were stained with hematoxylin and eosin and independently analyzed by two blinded pathologists for neutrophilic infiltration, luminal thrombosis, and wall fibrosis.

RESULTS Laser parameters of 70 J/cm2 with pulse durations of 15 ms and 30 ms were significantly associated with the presence of inflammatory infiltrates (P<0.05). No statistically significant differences were found when comparing fixed fluence with variable pulse durations or fixed pulse duration with variable fluences (P>0.05).

CONCLUSIONS Nd:YAG 1064 nm transdermal laser induces histopathological inflammation in reticular veins, particularly when using fluence of 70 J/cm2 combined with pulse durations of 15-30 ms.