Laser Ablation of Unwanted Hand Veins

Abstract

Many patients express dissatisfaction with prominent and bulging hand veins. Abolishing these veins with sclerotherapy requires higher concentrations of sclerosing agents than are used for leg veins and often results in a tender, phlebitic cord. Phlebectomy is another treatment option. Endovenous occlusion and shrinkage techniques have been used successfully to treat varicose veins of the lower extremities. The authors demonstrate a new and unique endovenous laser technique to abolish unwanted hand veins. Fifty-four hands (28 patients) with prominent hand veins were treated using a 600-microm laser fiber. The Dornier MedTech 940-nm diode laser system was used. The laser fiber was introduced through a 4-French sheath, which tracked as a coaxial system over an 0.018-inch guidewire. Initial entry into the treated vein was accomplished with a 20-gauge angiocatheter percutaneously. On average, four veins were treated in each hand. Tumescent anesthesia was infiltrated around the laser fiber/sheath unit before activating the laser, and all procedures were performed in an office setting. A compressive dressing was used postoperatively. All but one of the unwanted hand veins were cannulated successfully. The uncannulated vein was treated with sclerotherapy and eventually required phlebectomy. Hand swelling occurred in all treated hands and lasted 2 weeks or less. There was one skin burn of approximately 3 mm at a laser exit site. All 28 patients were satisfied with their results during follow-up, which ranged from 2 weeks to 31 months. This is the first report of endovenous treatment of unwanted hand veins. Laser ablation of unwanted hand veins can be performed in an office setting. These cosmetically conscious patients were satisfied with their results.