Чрескожная лазерная коагуляция расширенных внутрикожных вен: от теории к практике

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.

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