Dual PDL 595 nm-Nd:YAG 1064 nm Laser as an Alternative to Surgery in Acquired Digital Arteriovenous Malformations: A 26-Patient Retrospective Cohort.

IMPORTANCE

Acquired digital arteriovenous malformations (ADAVMs) are rare vascular anomalies traditionally managed with surgery, which may lead to morbidity, recurrence, and functional impairment. Evidence regarding laser therapy-historically considered contraindicated in arteriovenous malformations-is extremely limited, and no large cohort has been reported to date.

OBJECTIVES

To report the largest cohort of ADAVMs treated with laser therapy and to determine whether dual sequential pulsed dye (595 nm) and Nd:YAG (1064 nm) laser therapy is an effective and safe alternative to surgery for Schöbinger stage I ADAVMs.

METHODS

A retrospective case series (2010-2025) including 26 patients with ADAVMs was conducted. Schöbinger stage I lesions were treated using dual sequential 595-nm pulsed dye and 1064-nm Nd:YAG laser (Multiplex mode). Clinical characteristics, treatment parameters, outcomes, and satisfaction were analyzed.

RESULTS

Laser therapy achieved complete lesion clearance after a mean of 1.5 sessions, with a median clinical improvement of 100% and no recurrences over a median follow-up of 85.5 months. Three patients with previous surgical failure also achieved full resolution. No bleeding episodes, adverse effects, or procedural complications were observed. The most commonly used parameters included a 7-mm spot size, 595 nm PDL at 6-8 J/cm² and 10 ms, followed by 1064 nm Nd:YAG at 70-100 J/cm² and 15 ms.

CONCLUSIONS AND RELEVANCE: Dual sequential PDL/Nd:YAG laser therapy appears to be a highly effective, safe, and minimally invasive alternative to surgery for Schöbinger stage I ADAVMs, supporting its potential role as a first-line therapeutic option.