TREATMENT of VARICOSE VEINS USING the CLAF TECHNIQUE (Crio Laser After Foam): CASE REPORT and LITERATURE REVIEW

This report presents a case of varicose vein treatment using the combined use of transdermal laser and sclerotherapy with dense foam polidocanol.

Methods:

CASE REPORT

A 55-year-old female patient, Fitzpatrick II skin type, non-smoker, sedentary, without comorbidities or drug allergies, and regularly using oral contraceptives, complained of aesthetic issues caused by telangiectasias, reticular veins, and combined varicose veins on the anterior aspect of the right leg. Surgical treatment (phlebectomy) was recommended, but the patient refused and sought alternative treatment. An ultrasound examination was performed, which did not identify saphenous reflux or perforating veins, with the largest venous diameter being 3.9 mm in an upright position (Figure 01). Detailed photo documentation was performed (Figure 02), and the patient received informed consent with detailed information about the treatment and possible complications. The patient underwent marking of the target veins using augmented reality (VeinViewer Flex equipment) and evaluation of various venous calibers using an ultrasound device. After vein marking, needle puncture was performed with subsequent injection of 0.5% polidocanol foam with a total volume of 8 ml, followed immediately by transdermal laser application using a 6 mm spot size, fluence of 80 J/cm, and pulse duration of 40 ms, with a single pass and the use of skin cooling device (Siberian Fit - Vydence Medical). Compression with 20-30 mmHg elastic stockings was applied for 24 hours. The patient was followed up for a period of 60 days. After this period, another treatment session was performed using the same parameters. At the end of the 120-day period, final photo documentation was obtained (Figure 03).

Results:

The Crio Laser After Foam technique (CLAF) is a procedure that combines transdermal Nd:YAG 1064 laser and dense foam sclerotherapy with polidocanol, applied in sequence, to treat reticular veins in the lower extremities.

Conclusions:

We observed good efficacy in the association between transdermal laser and foam sclerotherapy with polidocanol, with a potentially drastic reduction in phlebectomies and improved results that can be achieved with fewer CLAF sessions. Furthermore, we suggest that it can be used for veins larger than 3 mm. Preliminary studies have not identified an increase in hyperchromic spots and matting, although it is a new technique, and little is known about its limitations.