Vascular lesion removal

Vascular Lesion Removal

A vascular lesion is a very broad subject and can refer to a lot of conditions. It is basically described as an abnormal growth or the change in a blood vessel.

Vascular lesions can be benign and also malignant.

Because of the definition of a vascular lesions there are lots of different types of vascular lesions such as:

• Aneurysms – Bulges in the wall of a blood vessel
• Angiomas – Benign tumours of the vessels
• Varicose veins – Enlarged and twisted veins often found in legs and caused by weakened or damaged walls of the veins. 
• Atherosclerosis – a condition that causes a build of plaque in the artery walls leading to narrowing and reduced blood flow
• Blood clots- This is where the blood becomes coagulated in the vessel and again runs the risk of damage to blood or tissues. 

Vascular lesions regardless of what they are called cause a variety of symptoms such as:

• Pain
• Discomfort
• Swelling
• Bleeding
• Skin discolouration 

Causes of vascular lesions

There are a variety of causes of vascular lesions, including:

Age.  As we get old the blood vessels will become less elastic in nature. This can lead to the formation of small, benign vascular lesions such as a cherry angioma.

Increased Sun exposure. This can lead to damage to the skin and blood vessels and causes vascular lesions such as thread veins and port-wine stains.

Hormones. A fluctuation in hormones due to age or things like pregnancy can all cause the development of vascular lesions.

Genetics. Some forms of vascular lesions are inherited such as hereditary haemorrhagic telangiectasia (HHT).  A genetic disorder that causes the formation of abnormal blood vessels throughout the body.   

Medical. Certain conditions like liver disease can also cause vascular lesions

Treatments for Vascular Lesions

The treatment for a vascular lesion depends upon its:

• Type
• Size
• Location
• The patient

There are of course types of vascular lesions that are easier to treat with conventional methods such as over the counter creams and laser treatments.

These types of vascular lesions are such as Benign vascular lesions and are such as.

• Port wine stains – Flat, red birthmarks present at birth
• Haemangiomas- Benign tumours of the blood vessel 
• Telangiectasias -small, dilated blood vessels appearing on the face or the leg. 
• Rosacea – A skin condition causes redness and flushing of the face

Malignant Vascular lesions 

examples of which are

• Angiosarcoma – a type of cancer that affects blood vessels (suitable for laser therapy). 

Vascular lesions treatment/removal can be split into two sections non-surgical treatments and surgical treatments

Non-Surgical Treatments

• Observation - Sometimes it is best to leave a vascular lesion alone and monitor it 
• Laser treatment - Laser can be used to destroy the blood vessels of the vascular lesions. Light energy from the laser is absorbed by the blood vessels, causing them to coagulate and disappear.
• Sclerotherapy - This involves injecting a chemical into the affected blood vessel, causing it to collapse and disappear. Involves injecting a solution into the blood vessel to cause it to collapse and fade. This method is commonly used for spider veins and varicose veins. As the treatment has minimal downtime, but some bruising and swelling may occur. Though multiple treatment sessions may be necessary.   
• Electrocautery - Uses a heated probe to destroy the blood vessel. Often used for small, raised vascular lesions with Minimal downtime, but some scarring is possible.   
• Light therapy - Intense pulsed light (IPL) can be used to treat conditions like rosacea and telangiectasias.
• Topical medications - In some cases, topical creams or ointments can help manage the symptoms of vascular lesions, such as redness or itching. 

For example, to treat varicose eczema a combination of emollients (Moisturiser) and topical corticosteroids can be a great combination. 

For example, treating Rosacea with topical Azelaic acid can reduce redness and inflammation alongside topical niacinamide. 

For example treatment of other vascular lesions will include things like Topical beta-blockers.

• Radiofrequency ablation (RF) - A minimally invasive procedure for the treatment of varicose veins and other vascular lesions. A catheter is inserted into the vein via a small incision. Radiofrequency energy is delivered through the catheter, heating the vein wall and causing it to collapse and scar.  The blood is then redirected via healthy veins and the vascular lesions fades and disappears. This method can be done as an outpatient with minimal downtime. It also carries minimal risk.

Surgical Treatments

• Excision - Surgical removal of the lesion may be necessary for large or complex lesions, or those that are causing significant symptoms.
• Embolization -  This procedure involves injecting a substance into the blood vessel to block blood flow to the lesion.
• Ligation - This involves tying off the affected blood vessel to prevent blood flow.

Note: The best treatment for a vascular lesion will vary depending on the individual case. It's essential to consult with a healthcare professional to discuss your specific situation and determine the most appropriate treatment options.   

Risks of vascular lesion treatments

The level of risk is determined by the type of vascular lesion, the treatment and the individual. Some general risk factors are such as

• Pain – Most treatments will come with some form of pain which is easily managed by pain medication.
• Bruising – A common side effect of most vascular lesion treatments which will normally resolve within a few weeks.
• Scarring – This is rare but possible. The more aggressive the technique the greater the risk.
• Infections – A small risk but always a risk with any procedure that breaks the skin
• Pigmentation – Some treatments can lead to temporary pigment changes in the skin. More common on darker skin types.

Benefits of vascular lesions treatments

There are several benefits to treating vascular lesions such as:

• Appearance - the appearance of vascular lesions can be unsightly and negatively affect a person. Treatment can improve the appearance and give the person a self confidence boost.
• Less pain - Some vascular lesions cause pain and discomfort so treatment can relive these symptoms.
• Prevention - If left untreated vascular lesions can lead to further medical complications so prompt treatment can avoid these.
• Life - By improving the appearance and comfort the quality of life can be improved.

Cost of vascular lesion removal

The cost of the treatment will vary and depends on

• Type of lesion as this will determine the treatment
• Size and location as the larger more complex vascular lesions will require a more intensive treatment plan and increase costs
• Number of treatments maybe needed to achieve the outcome desired so increase costs
• Location and type of practice will influence costs from more expensive doctor led medical clinics to aesthetics practices in different areas of the country.

Vascular lesions treatment will range from a few hundred pounds to several thousands.

Vascular lesions removal procedure, recovery and aftercare

As discussed, there are several procedures for removing a vascular lesion each with its plus side and each with its negative side.

Light based treatments such as laser and IPL are very common and one of the most popular.

Both laser and IPL treatment use:

1. Light energy (focused for laser) (broader for IPL) to destroy the blood vessels causing the lesion
2. Laser used for vascular lesions such as spider veins, port-wine stains and rosacea
3. IPL is used for superficial lesions and sun damage as well as vascular lesions such as rosacea
4. Both Laser and IPL have minimal downtime and only a few days of recovery.
5. Both Laser IPL can cause discomfort during the procedure but this is managed by topical anaesthetics. 
6. Both laser and IPL may require multiple treatments

Considerations with treatments with laser and IPL 

1. Recovery Time: This is impacts by the type of lesions and size with most recovery within a few days and weeks.
2. Aftercare: One of the most important factors to consider as it is crucial for optimal results and risk of complications such as:
   1. Avoiding sun
   2. Avoiding saunas, hot tubs etc
   3. Using Topical ointments

Results: The results of vascular lesion removal can be very satisfying, with significant improvement in the appearance of the skin. However, it's important to have realistic expectations and understand that multiple treatment sessions may be necessary for optimal results.   

Types of lasers used in vascular lesion treatments

The most common types of lasers used for the treatment of vascular lesions are

• Pulsed Dye laser - This uses an emission of a 585nm wavelength that is strongly absorbed in haemoglobin (blood) so is very popular and effective for the treatment of port-wine stain and haemangiomas. A pulse dye laser also delivers its energy directly to the blood vessels so avoids damage to surrounding tissues. 
• Nd:YAG lasers - This emits light energy at 1064nm which penetrates deeper into the skin and is used for targeting deeper vascular lesions such as varicose veins and venous lakes. It can deliver energy in both pulsed and continuous wave modes for this reason.
• Diode lasers -  These are less commonly used for vascular lesions but emit light at 810nm and can be used to target vascular lesions such as spider veins and rosacea. 
• Alexandrite laser - Emits energy at 755nm and is effective for the treatment of superficial lesions such as spider veins. It also delivers short pulses of energy for high power treatments. 

Common vascular lesions and optimal treatments

Haemangiomas (Birthmarks) 

Common birthmarks that typically appear as red or purple, raised bumps on the skin. Most are harmless and will shrink and disappear over time.

Options for treatments include:

• Observation
• Topical medicines
• Oral medicines
• Surgery
• Laser 

Laser is an effective option especially if the marking is superficial. The laser will target the blood vessels that form the haemangioma and the energy causes the blood vessels to heat up, coagulate the blood and destroy the blood vessels. This reduces supply of blood causes the haemangioma to shrink over time and fade.

The types of lasers used for this are

• Pulsed dye laser
• Nd:YAG lasers

Venous lake removal

Venous lakes are harmless but can be unsightly. Treatments can be such as: 

• Cryotherapy - which involves applying liquid nitrogen to the venous lasers which freezes and destroys the tissue. 
• Electrocautery - This involves using a heated probe to destroy the venous lake
• Sclerotherapy - This involves injecting a solution into the venous lake to cause it to collapse and disappear. 

Laser is an effective option and the most common. The laser will target the blood vessels that form the venous lake and the energy causes the blood vessels to heat up, coagulate the blood and destroy the blood vessels. This reduced supply of blood causes the venous lake to shrink over time and fade.

The types of lasers used for this are

• Pulsed dye laser
• Nd:YAG lasers

Spider Angioma

Spider angiomas typically don't require treatment because they often go away on their own. Treatment options if required include. 

• Electrocautery - This involves using a heated probe to destroy the angioma
• Sclerotherapy - This involves injecting a solution into the angioma to cause it to collapse and disappear. 

Laser is an effective and most common treatment. The laser will target the blood vessels that form the spider angioma and the energy causes the blood vessels to heat up, coagulate the blood and destroy the blood vessels. This reduced supply of blood causes the spider angioma to shrink over time and fade.

The types of lasers used for this are mostly 

• Pulsed dye laser

Cherry Angioma 

Cherry angiomas are benign, harmless bright red, raised bumps that typically don't require treatment. You can however opt for treatment to reduce the appearance or if they are frequently bleeding. Treatment options include. 

• Electrocautery - This involves using a heated probe to destroy the cherry angioma.
• Cryotherapy – which involves applying liquid nitrogen to the angioma which freezes and destroys the tissue   
• Shave Excision- Involves shaving off the angioma with a surgical blade

Laser is an effective and most common for removing cherry angioma. The laser will target the blood vessels that form the cherry angioma and the energy causes the blood vessels to heat up, coagulate the blood and destroy the blood vessels. This reduced supply of blood causes the cherry angioma to shrink over time and fade.

The types of lasers used for this are mostly 

• Pulsed dye laser

Vascular malformation

Treatment for vascular malformation will depend upon its

• Size
• Location
• Severity 

Some vascular malformations require treatment, some may benefit from a combination therapy approach.

Popular treatment options include

• Observation - Small vascular malformations that do not cause any issues are best treated by just observing. A regular monitoring system can assess any growth or changes that may require further action.
• Sclerotherapy - Injecting a sclerosing agent into the malformation causes the blood vessels to collapse and scar.
• Embolization - Minimally invasive procedure involves injecting substances into the blood vessels that feed the malformation. This caused the blood flow to be blocked and the malformation to shrink.   Surgery - It is sometimes possible that the malformation will need to be surgically removed but is reserved by complex and large malformations. 
• Radiotherapy - Very rare but sometimes radiation therapy may be used to shrink or destroy the malformation. Only used if the severe or possible life endangering. 

Lasers can be used to target the blood vessels in the malformation, causing them to coagulate and disappear. This is often used for superficial vascular malformations. Lasers emit specific wavelengths of light that are absorbed by the haemoglobin in the blood vessels that make up the malformation. The absorbed light energy causes the blood vessels to heat up and coagulate, effectively destroying them. With the blood supply reduced, the malformation shrinks and fades over time.

Types of Lasers Used

• Pulsed Dye Laser (PDL): This laser is commonly used for superficial vascular malformations, such as port-wine stains and capillary malformations.
• Nd:YAG Laser: This laser can be used for deeper vascular malformations, such as venous malformations. It emits a longer wavelength of light (1064 nm) that penetrates deeper into the skin.