asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2023-035asurgery-383Research ArticleФЛЕБОЛОГИЯPHLEBOLOGYЧрескожная лазерная коагуляция расширенных внутрикожных вен: от теории к практикеPercutaneous laser coagulation of dilated intradermal veins: from theory to practicehttps://orcid.org/0000-0002-3940-0787БогачёвВ. Ю.BogachevV. Yu.

Богачёв Вадим Юрьевич, д.м.н., профессор кафедры факультетской хирургии №2 лечебного факультета; научный руководитель 

117997, Москва, ул. Островитянова, д. 1;117447, Москва, ул. Дмитрия Ульянова, д. 31

Vadim Yu. Bogachev, Dr. Sci. (Med.), Professor of the Department of Faculty Surgery No. 2; Scientific Supervisor 

1, Ostrovityanov St., Moscow, 117997;31, Dmitry Ulyanov St., Moscow, 117447

vadim.bogachev63@gmail.comhttps://orcid.org/0000-0002-7281-7939МанджикянО. П.ManjikianH. P.

Манджикян Овсеп Петросович, сердечно-сосудистый хирург, руководитель флебологической службы; соискатель 

129327, Москва, ул. Ленская, д. 15;117997, Москва, ул. Большая Серпуховская, д. 27

Hovsep P. Manjikian, Cardio-Vascular Surgeon, Head of Vein Clinic; Applicant 

15, Lenskaya St., Moscow, 129327;27, Bolshaya Serpukhovskaya St., Moscow, 117997

manjikyan@yahoo.comhttps://orcid.org/0000-0001-8982-7095АлуханянО. А.AlukhanyanO. A.

Алуханян Овик Арменович, д.м.н., профессор кафедры кардиохирургии и кардиологии факультета повышения квалификации и профессиональной переподготовки специалистов 

350063, Краснодар, ул. Митрофана Седина, д. 4

Ovik A. Alukhanyan, Dr. Sci. (Med.), Professor of the Department of Cardiac Surgery and Cardiology, Faculty of Vocational Education and Professional Retraining of Specialists 

4, Mitrofan Sedin St., Krasnodar, 350063

alovik@yandex.ruРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; Первый флебологический центрРоссияPirogov Russian National Research Medical University; First Phlebological CenterRussian FederationГородская клиническая больница имени А.К. Ерамишанцева; Национальный медицинский исследовательский центр хирургии имени А.В. ВишневскогоРоссияEramishantsev Moscow State Hospital; Vishnevsky National Medical Research Center of SurgeryRussian FederationКубанский государственный медицинский университетРоссияKuban State Medical UniversityRussian Federation2023201120232021726Copyright © Богачёв В.Ю., Манджикян О.П., Алуханян О.А., 20232023Богачёв В.Ю., Манджикян О.П., Алуханян О.А.Bogachev V.Y., Manjikian H.P., Alukhanyan O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/383

В обзоре авторы рассматривают современные возможности чрескожной лазерной коагуляции телеангиэктазий и ретикулярных вен, которые служат самым распространенным косметическим дефектом сосудистого генеза, встречающимся более чем у 80% женщин разных возрастных групп. Выступая в качестве эстетического дефекта и вызывая локальный физический дискомфорт, данная сосудистая патология является одним из наиболее частых показаний к флебосклерозирующему лечению и чрескожной лазерной коагуляции. На основании анализа большого объема специальной литературы авторы представляют наиболее эффективный и безопасный регламент чрескожной лазерной коагуляции. Последняя благодаря применению современных Nd:YAG-лазеров все шире используется у пациентов с различными типами поражения внутрикожных вен и в силу высокой эффективности и безопасности по ряду критериев имеет преимущества перед компрессионной склеротерапией. Nd:YAG-лазеры по своим техническим характеристикам могут быть разделены на длинно- и короткоимпульсные. Длинноимпульсные лазеры обеспечивают коагуляцию сосуда-мишени за счет единичного импульса с высокой плотностью энергии (флюенса), а короткоимпульсные, напротив, генерируют серию вспышек по целевой вене длительностью в доли миллисекунды, что обеспечивает конвертацию гемоглобина в метгемоглобин c десятикратным повышением способности поглощать лазерную энергию и трансформировать ее в тепло. Поскольку продолжительность импульсов, генерируемых аппаратом, априори меньше времени термической релаксации, то риск ожога кожи и паравазальных структур практически полностью нивелируется. В качестве подтверждения эффективности и безопасности короткоимпульсных Nd:YAG-лазеров авторы приводят клинические примеры с использованием аппарата Aerolase Neo, созданного на основе технологии MicroPulse.

Review authors consider the current possibilities of percutaneous laser coagulation for telangiectasias and reticular veins, which are the most common cosmetic defects of vascular genesis, occurring in more than 80% of women of different age groups. This vascular pathology constituting an aesthetic defect and causing local physical discomfort is one of the most common indications for phlebosclerosing therapy and percutaneous laser coagulation. The authors present the most effective and safe guidelines for percutaneous laser coagulation based on analyses of a large volume of specialized literature. Due to the use of state-of-the-art Nd:YAG lasers, percutaneous laser coagulation is increasingly used in patients with various types of intradermal vein lesions and, owing to high efficiency and safety, has advantages over compression sclerotherapy by several criteria. Nd:YAG lasers can be divided into long- and short-pulse ones according to their technical characteristics. Long-pulse lasers provide coagulation of the target vessel due to a single pulse with a high energy density (fluence), while short-pulse lasers, on the contrary, generate a series of pulses to the target vein with a running time of fractions of a millisecond, which ensures the conversion of hemoglobin into methemoglobin with a ten-fold increased ability to absorb laser energy and convert it to heat. As the duration of the pulses generated by the device is a priori shorter than the thermal relaxation time, the risk of burns to the skin and paravasal structures almost completely disappears. The authors provide clinical examples of the application of Aerolase Neo device that utilizes MicroPulse technology to confirm the effectiveness and safety of shortpulse Nd:YAG lasers.

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The authors declare that there are no conflicts of interest present.