Cryo-laser and cryo-sclerotherapy guided by Augmented Reality

Abstract

SummaryBackground: This study is about CLaCS, a new technique to treat telangiectasias and feeder veins.Method: A series of 140 cases were treated under Augmented Reality guidance in a completely different way. Sclerosis was achieved by combination of thermal and chemical agents: laser and dextrose. Patients were classified according to two questions: presence of varicose veins and/or reflux on the saphenous vein; presence of telangiectasias and/or feeder veins (Score 9–1). Duplex ultra-sound and Augmented Reality (VeinViewer) were used to detect reflux and feeder veins, respectively. Feeder veins and telangiectasias were treated the same way, in the same procedure, by a combination of Nd:YAG 1064 nm with spot sizes of 6mm, 15 msec pulse and fluence of up to 80 J/cm2 followed by injection sclerotherapy of Dextrose 75%. Both techniques were done under forced air skin cooling (Cryo5). A thorough photodocumentation was done prior and after each procedure and results were obtained by comparing before and after photos on two iPads. Response to the treatment was rated on: total or partial improvement with patient satisfaction (Group 1); partial improvement or lack of resolution, without patient satisfaction (Group 2).Results: A total of 466 patients visited the clinic during the study and exclusion criteria left a total of 140 patients for analysis. Mean age of patients was 37 years (16 to 72), with prevalence of women (98 %). No allergic reactions, systemic reactions, skin burns, post-sclerotherapy mattings, infections or crustings were observed. Temporary ecchymosis were observed in 30 % of the cases, and intravenous coagula in 14 % of them. No frostbite was registered due to cold air blowing. Partial or total lesion improvement was obtained in 121 patients (86 %), with satisfactory cosmetic results. Unsatisfactory outcome was observed in 19 patients (14 %) due to no response or lesion worsening, thus crochet hook phlebectomy was indicated.Conclusion: CLaCS guided by Augmented Reality is a very effective option to treat telangiectasias, reticular and feeder veins. It is a safe method based on the employment of technology and an organic sclerosing agent. It dispenses the use of any other medication, thus being free of risk of anaphylaxis or embolism.