Double pulse mode is the preferred standard for treating large veins (specifically those exceeding 6mm in diameter) because it fundamentally changes how thermal energy is delivered to the tissue. Rather than relying on a single, massive spike of energy, this mode splits the delivery into two distinct bursts separated by a calculated delay, optimizing heat transfer for larger tissue volumes.
By releasing energy in two consecutive bursts with a set delay, double pulse mode extends the duration of therapeutic heat within the vessel. This ensures heat penetrates thoroughly to the thick vessel walls for complete coagulation while significantly reducing the risk of ruptures and skin burns associated with single, high-intensity pulses.
The Mechanics of Heating Large Vessels
Overcoming Wall Thickness
Large veins present a specific physical challenge: they have significantly thicker walls and a larger volume of blood compared to smaller vessels.
A standard single pulse often lacks the duration required to transfer heat all the way to the outer layers of these thick walls.
Double pulse mode addresses this by maintaining high temperatures within the vessel for a longer total duration.
The Function of the Delay
This mode typically introduces a specific delay, such as 7ms, between the two energy bursts.
This interval is not an arbitrary pause; it acts as a thermal bridge. It allows the heat generated by the first pulse to begin transferring outward before the second pulse arrives.
This "staggered" delivery ensures the target temperature is sustained long enough to effect physical change throughout the entire vessel structure.
Safety and Efficacy Advantages
Ensuring Complete Coagulation
For a vein to be successfully ablated, the collagen in the vessel wall must be thermally destroyed.
Because double pulse mode extends the heat interaction time, it allows for effective heat transfer from the center of the vessel to the periphery.
This results in uniform coagulation of the vessel wall, minimizing the chance of recanalization (the vein opening back up).
Reducing Vessel Ruptures
A single pulse requires a very high peak energy to treat a large vein in one shot.
This intense spike in pressure and temperature can cause the vessel to explode or rupture (purpura) rather than collapse.
Double pulse mode achieves the same cumulative heating effect without the dangerous peak intensity, preserving the structural integrity of the treatment area.
Preventing Skin Burns
High-energy single pulses generate rapid heat that can dissipate unpredictably into surrounding tissues.
By controlling the release over two stages, the thermal profile remains more contained within the target vessel.
This drastically lowers the risk of epidermal injury or burns to the skin surface, which is a critical safety metric in cosmetic and medical procedures.
Common Pitfalls to Avoid
The Risk of Single Pulse on Large Diameters
Using a single pulse mode on a vein larger than 6mm often forces the operator to increase the fluence (energy level) to dangerous levels.
While this might coagulate the blood instantly, it frequently fails to seal the vein wall properly.
Misunderstanding the Energy Profile
Operators may mistakenly believe that a single, stronger pulse equates to a "stronger" treatment.
In reality, energy density combined with duration is what determines success in vascular ablation.
Relying on intensity alone (single pulse) often leads to superficial tissue damage without resolving the underlying vascular issue.
Making the Right Choice for Your Procedure
To ensure patient safety and procedure success, select your laser mode based on the specific vascular anatomy you are treating.
- If your primary focus is treating veins >6mm: Utilize double pulse mode to ensure heat penetrates the thick vessel walls for permanent closure.
- If your primary focus is patient safety: Rely on double pulse mode to lower peak energy intensity, preventing vessel rupture and protecting the surrounding skin.
Ultimately, double pulse mode transforms a high-risk, high-energy procedure into a controlled, sustained thermal treatment that ensures durable results for large vessels.
Summary Table:
| Feature | Single Pulse Mode | Double Pulse Mode (Preferred) |
|---|---|---|
| Energy Delivery | High-intensity single spike | Two staggered bursts with a delay |
| Heat Penetration | Superficial; often fails on thick walls | Deep and uniform heat transfer |
| Safety Profile | Higher risk of vessel rupture & burns | Controlled thermal profile; safer for skin |
| Clinical Outcome | Higher chance of recanalization | Durable vessel closure and coagulation |
| Target Vessel | Best for small, thin capillaries | Optimized for large veins > 6mm |
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References
- Aristides Arellano Huacuja, Anja Arellano Montalvo. Treatment of Varicose Veins with Neodymium: Yag Laser. DOI: 10.33425/2690-537x.1017
This article is also based on technical information from Belislaser Knowledge Base .
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