Nd:YAG Laser Combined With Injection Sclerotherapy Versus Diode Laser in the Treatment of Reticular Veins and Telangiectasias Using CLaCS Technique

Reticular veins and telangiectasias (spider veins) represent common chronic venous disorders affecting a large proportion of the adult population, particularly women.

The Cryo-Laser and Cryo-Sclerotherapy (CLaCS) technique has emerged as an innovative method combining transdermal laser therapy, injection sclerotherapy, and skin cooling. This multimodal approach enhances visualization of feeder veins using augmented reality or vein illumination systems, allowing precise targeting and improved clearance rates. Cooling reduces pain and protects the epidermis, making the procedure more tolerable and safer.

Nd:YAG laser (1064 nm) is considered the cornerstone of the CLaCS technique due to its deeper penetration and selective photothermolysis of hemoglobin. It effectively targets deeper reticular veins (up to 3-4 mm depth), induces vessel wall contraction, and facilitates subsequent sclerotherapy.

• Nd:YAG laser (Device): Patients will receive Nd:YAG laser (1064 nm) + injection sclerotherapy (CLaCS).
• Diode laser (Drug): Patients will receive Diode laser (980 nm) + injection sclerotherapy (CLaCS).

Primary outcomes

• Degree of vein clearance [6 months postoperatively]: Degree of vein clearance will be assessed by immediate endpoint response during laser application, defined as either instantaneous disappearance of the vein or an immediate change in vein color.

Secondary outcomes

• Degree of pain [6 months postoperatively]: Each patient will be instructed about postoperative pain assessment with VAS. VAS (0 represents "no pain" while 10 represents "the worst pain imaginable").
• Degree of patient satisfaction [6 months postoperatively]: Degree of patient satisfaction will be assessed on a 5-point Likert scale patient satisfaction (1, extremely dissatisfied; 2, unsatisfied; 3, neutral; 4, satisfied; 5, extremely satisfied).
• Incidence of complications [6 months postoperatively]: Incidence of complications such as hyperpigmentation, burns, and matting will be recorded.
• Number of treatment sessions required [6 months postoperatively]: Number of treatment sessions required will be recorded.
• Recurrence rate [6 months postoperatively]: Recurrence rate will be recorded.

Sex: All, ages: 18 Years to 60 Years

Inclusion Criteria:

* Patients aged 18-60 years.
* Both sexes.
* Presence of reticular veins and/or telangiectasias (CEAP classification C1).
* Fitzpatrick skin types II-V.
* Patients seeking cosmetic treatment.

Exclusion Criteria:

* Pregnancy or lactation.
* History of deep vein thrombosis.
* Coagulation disorders.
* Allergy to sclerosant agents.
* Active skin infection at treatment site.
* Previous treatment of target veins within 6 months.
* Great saphenous vein or short saphenous vein incompetence.
* Deep venous insufficiency or thrombosis.
* Abnormal venous duplex findings.