Laser and Sclerosing Treatments
In the not too extensive angiomas and in particular in the more superficial ones the technique of sclerotization through endovascular LASER has been demonstrated.
LASER mediated sclerotization is not very painful. The intervention can be practiced in fact under local anaesthesia (except for the smaller patients). Another advantage concerns the characteristics of the immediate post-operative. Swelling and pain are usually negligible and resolve after about ten days after treatment. There are several types of LASER that can be used in a similar way. My experience is based on the use of LASER diodes, but good effectiveness is demonstrated for example also through the use of LASER neodymium. The technique that I use every day involves the use of a LASER diode, whose fiber is inserted directly into the venous lesion. At the end of the fiber there is a light source, which is visible from the outside of the lesion through transillumination, allowing to constantly monitor the position of the fiber inside the lesion and therefore to direct it to the best. The LASER acts from within the lesion causing, through a thermal effect, intravascular coagulation and consequent sclerotization of the lesion.
Sclerotherapy (or sclerotization) of venous malformations (venous or cavernous angiomas) has found a good diffusion in recent years and has led to excellent results in many recent studies. With this technique the capillaries of the lower limbs, the varicose veins (of reduced dimensions) both at the level of the legs and of any other part of the body (before and after a single treatment of sclerotization of the venous angioma) are successfully treated.Sclerotherapy is a minimally invasive technique.
In our daily life we use various sclerosing means in relation to the characteristics, the anatomical site and the extent of the malformation. 1,2,3 Both in the most superficial lesions and in the deep ones sclerotherapy can be carried out by direct percutaneous way ie by directly pricking the angioma. If we want to focus our attention on the techniques used in our practice, we will analyze in more detail the technique of sclerotization with Atossisclerol (Lauromacrogol).
Treatment is performed under local anaesthesia. The technique is so little invasive and painful enough to even allow us to avoid local anaesthesia. The substance is injected at a dose proportional to the size of the angioma. It is the surgeon’s experience that allows to dose the drug correctly. The injected drug creates a sort of blood coagulation present inside the angioma and provokes a healing of the angioma walls. In other words, if we imagine the cavernous angioma (or venous, etc.) as a sac that contains blood, the phenomenon of sclerotization is as if it dried up the contents and healed the walls between them. These processes that occur inside the angioma do not give pain but a slight swelling that resolves in a couple of days. The sclerotization technique respects the surrounding healthy tissues and preserves their function. Surgery can thus be reserved only for more complex cases and / or those that do not respond to minimally invasive techniques such as sclerotization.
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