Cryo Laser and Cryo Sclerotherapy (CLaCS)
Surekha Varicose Veins Clinic now offers the CLaCS procedure – Cryo Laser and Cryo Sclerotherapy.It is being introduced in India for the first time and until now it was available only at 3 other places in Asia (Singapore, South Korea, Dubai). CLaCS is a revolutionary treatment for spider veins and small varicose veins of the leg. It has been pioneered by Prof. Kasuo Miyake of Sao Paulo, Brazil in 1999. Over the years, CLaCS has been used to treat thousands of patients with extremely good and long lasting results.
FAQs in relation to CLaCS
1)What is CLaCS?
CLaCS stands for ‘Cryo Laser and Cryo Sclerotherapy’.
2)What does CLaCS comprise of?
There are 4 essential elements in CLaCS :
a)Vigorous COOLING OF THE SKIN to reduce discomfort from laser and injections.
b)The use of AUGMENTED REALITY to visualize feederveins so that they can be treated.
c)The application of a TRANSDERMAL LASER to thefeeder veins and spider veins.
d)INJECTION OF THE FEEDER VEINS AND SPIDER VEINS with a chemical sclerosant (sclerotherapy).
3)What is ‘Augmented reality’ in CLaCS?
‘Augmented reality’ in CLaCS is the technology used to visualise ‘feeder veins’ /’reticular veins’ (which cause spider veins); these are not visible to the ‘naked eyes’ in many instances. And if these remain untreated, the spider vein treatment fails. In CLaCS, augmented reality is provided by the VeinViewer (Christie, USA) – a device that images veins up to 1.0 centimeter beneath the skin using infrared sensing. The image is then projected back on to the skin in real time. This enables the phlebologist to see the feeder/reticular veins that would not be otherwise visible.
4)What type of laser is used in CLaCS?
1064 nm Nd:Yag transdermal laser is used. This laser causes a visible heat injury to the veins. Because of the wavelength of the laser, the energy is absorbed more by blood than skin. This allows selective damage to the vein (photothermolysis) without damage to the skin. At Surekha Varicose Veins Clinic, we use one of the best laser in the class – ‘Harmony Pro XL’ from Alma Laser, Israel.
5)What is the ‘sclerotherapy’ element in CLaCS?
The feeder veins, after being damaged by the laser, are then injected with a chemical sclerosant, again using the Vein Viewer images to guide the sclerotherapy injections. Following this the overlying spider veins of the skin are also treated with laser and injected. The sclerosant used is a mild one. It does not produce any post sclerotherapy matting/ pigmentation and is extremely safe since it does not cause anaphylaxis.
6)What is ‘cryo cooling’ in CLaCS?
The whole procedure of CLaCS is done using a cryo unit that produces a continuous flow of cold air to the sites of application of the transdermal laser and sclerotherapy injections. The skin cooling serves to provide surface numbness during the procedure. We use the latest and one of the best cooling unit -Cryo 6 from Zimmer, Germany.
7)Is CLaCS painful?
No. The high flow of ice cold air directed onto the skin at the site of laser or needle application removes most of the discomfort, and most patients have little discomfort from the treatment. In patients who are especially sensitive, prior application of a skin numbing cream about an hour before treatment may be done.
8)Do I need to get admitted for CLaCS? When can I resume work?
No. It is a ‘walk-in, walk-out’ OPD procedure. The patient can return to his/her routine activities within few hours.
9)After how much time can I see the effect (result) of CLaCS on my spider veins?
The veins begin to clear after 2 to 3 weeks. A full response may take up to 2 months. Please note that for the first 1-2 weeks the veins in the treated area may appear darker. As the veins begin to disappear the normal skin color returns.
10)How much result can I expect after the 1st session of CLaCS?
Typically, about 50 % – 70% clearing of veins is usual after the first session of CLaCS. Sometimes almost all are cleared.
11)How many sessions of CLaCS are required to treat the spider veins?
It depends on the extent of the spider veins and how much the patient wants to be treated.To give an example, for spider veins involving an area 10 cm × 10 cm, 2 to 3 sessions of CLaCS may be needed with each session at an interval of 3 weeks.
12)How much time does 1 session of CLaCS require?
On an average, each CLaCS session lasts for an hour.
13)Can spider veins come back (recur) after CLaCS?
Since CLaCS targets the feeder veins, the developers of CLaCS and we at Surekha Varicose Veins Clinic believe strongly that the improvement after CLaCS will endure over time in the area which is treated. However, new spider veins can always develop in a different area.
14)Do I need to take any precautions after CLaCS treatment?
There are no specific precautions after treatment. A patient may return to work and usual activities with 4 -6 hrs. Exercise is permitted as well after 24 hrs.
15)Do I need to wear stockings after CLaCS treatment?
Ideally stockings are not needed after CLaCS treatment. However, it also depends on the extent of spider veins. If multiple sessions are required due to extensive spider veins, it is advisable to use the graduated compression stockings in between the treatment sessions till all the required sessions are complete.
16)What are the complications of CLaCS?
-Tiny clots may develop in the spider veins or feeder veins that are treated. These pose no risk, will not travel in the circulation, and are limited to these veins. There is no increased risk for deep vein thrombosis.The risk for skin staining from the iron in clots does exist but is less than for traditional sclerotherapy.
-Blistering of the skin from the laser application is very rare.
17)Why is CLaCS not available elsewhere in India?
Why is it available only at few places in Asia?
The problem of spider veins, though seemingly harmless, can affect an individual not only in terms of cosmesis but it can also cause pain, burning, fatigue, spontaneous subcutaneous bleeding. Apart from this, spider veins could be a result of underlying venous reflux, thereby leading to classical varicose veins and subsequent problems. It is with this thought that CLaCS was developed and studied extensively in Brazil by some innovative vascular surgeons over many years. And it with the same viewpoint that, Surekha Varicose Veins Clinic has introduced CLaCS for the 1st time in India – to offer an early and complete solution to the problem of ‘Varicose Veins -Spider Veins complex’. As this viewpoint about ‘Varicose veins – Spider Veins complex’ and the CLaCS results are appreciated, the treatment will be adopted more and it will be available widely.
18)Why is CLaCS better than sclerotherapy alone or laser treatment alone?
CLaCS is superior in outcome to other spider vein treatments for the following reasons :
a)The combination of laser and sclerotherapy (chemical injection of the spider veins) is synergistic, that is, together they work better than each done alone. Thus, CLaCS results are more effective.
b)The feeder veins/reticular veins, which when present, are seen using augmented reality and are targeted for treatment. The presence of untreated feeder veins is the principal reason spider veins fail to respond to either laser or sclerotherapy alone. The untreated feeder veins are also often responsible for the return of the spider veins after treatment with either laser or sclerotherapy. Thus, CLaCS results are long term.
c)Since the transdermal laser used is more specific for blood and the sclerosant is mild, there are minimal/no complications of matting/pigmentation. Thus, the CLaCS results are more aesthetic.
d)Since underlying venous reflux is evaluated by venous colour doppler in all patients of CLaCS, it helps to identify and treat the same (by Endovenous Laser Ablation) if present. Thus, CLaCS is more scientific, rational in its approach.