Laser Photocoagulation in Hereditary Hemorrhagic Telangiectasia

Abstract

Recurrent epistaxis is usually the main symptom found in patients with hereditary hemorrhagic telangiectasia (HHT)—Osler Rendu Weber syndrome. Therapies have included intranasal cautery, septal dermoplasty, intra-arterial embolization, and arterial ligation. These procedures have met with limited success. Laser photocoagulation has achieved early success in the gastrointestinal (GI) telangiectatic lesions. In this report, cutaneous and intranasal lesions of eight HHT patients have been treated with laser photocoagulation using a flexible fiber delivery system connected to 3 W argon and 55 W neodymium:yttrium-aluminum-garnet (Nd:YAG) laser sources. The patients noted a great reduction in the frequency and severity of epistaxis, reduction in the need for blood transfusion, and reduction in iron therapy necessary to maintain adequate hemoglobin levels. Previously, five of these patients were considered treatment failures after extensive surgical therapy. No serious complications have been encountered. Laser photocoagulation of HHT patients appears to be a promising therapeutic advance. The progressive nature of HHT necessitates close follow-up and retreatment of new lesions as they appear.