Transdermal 1064-NM ND:YAG laser for reticular veins larger than 4 mm: ONE-YEAR outcomes and seven-year follow-up

Objectives To evaluate the efficacy, safety, and long-term durability of transdermal 1064-nm Nd:YAG laser treatment, alone or combined with liquid sclerotherapy, for varicose veins ≥4 mm in diameter. Methods This prospective cohort study included 25 patients treated between May 2017 and November 2024. Assessment and follow-up were performed using Doppler ultrasound, augmented reality, phleboscopy, and standardized photography. Treatment was delivered with a 1064-nm Nd:YAG laser using 6- or 9-mm spot sizes, fluences of 50–100 J/cm 2 , and pulse durations of 40–60 ms. Adjunctive liquid sclerotherapy was used when complete vein obliteration was not achieved. Outcomes were evaluated up to 1 year and, when available, at 7 years. Results Twenty-five patients were included, 88% of whom were women. Mean pre-treatment vein diameter was 5.66 mm. At 1 year, complete vein occlusion was achieved in 44% of patients, while 44% showed diameter reduction and absence of reflux. Persistent reflux was observed in 12%, although all remained asymptomatic. Mean vein diameter decreased from 5.66 mm to 2.16 mm ( p < 0.05). Hyperpigmentation occurred in 24% of patients and matting in 8%; no burns, ulcerations, deep vein thrombosis, or other major adverse events were observed. All patients reported symptomatic improvement, and 94% were satisfied or very satisfied with the aesthetic outcome. Seven-year follow-up was available for nine patients. Mean vein diameter decreased from 6.1 mm to 2.34 mm ( p = 0.0016), and 88.9% had no reflux in the treated vein. Conclusions Transdermal 1064-nm Nd:YAG laser treatment, alone or combined with liquid sclerotherapy, was associated with significant and durable reduction in vein diameter, high patient satisfaction, and a low complication rate. These findings support its use as a treatment option for selected large varicose veins.