940-nm Laser for Treatment of Saphenous Insufficiency: Histological Analysis and Long-Term Follow-Up

Bush, Ronald G.; Shamma, H. Nicholas; Hammond, Karin A.

doi:10.1089/pho.2005.23.15

Cited by 35 publications

(19 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The procedure is painless, and a surrounding fascial envelope of the tumescent solution provides a margin of safety so heat damage to surrounding structures does not occur. 24 The principal finding in this study is that ELT with a 980-nm diode laser system, when performed under tumescent local anesthesia, is a clinically feasible and well-tolerated technique. Because vein access is with a 21-gauge needle, it is truly minimal procedure that leaves a nearly invisible scar on the patient's skin.…”

Section: Discussionmentioning

confidence: 85%

Endovenous 980-nm laser treatment of saphenous veins in a series of 500 patients

Desmyttère¹,

Grard²,

Wassmer³

et al. 2007

Journal of Vascular Surgery

105

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 85%

Endovenous 980-nm laser treatment of saphenous veins in a series of 500 patients

Desmyttère¹,

Grard²,

Wassmer³

et al. 2007

Journal of Vascular Surgery

105

View full text Add to dashboard Cite

show abstract

“…To be included in the study, the saphenous vein in the distal thigh had to be within 1-1.5 cm of the skin level and measure between 8 and 12 cm. Specimens were obtained post-procedure as has been previously described [3], at 4-6 weeks and at 4 months. Patients were assigned to one category only.…”

Section: Methodsmentioning

confidence: 99%

Histological changes occurring after endoluminal ablation with two diode lasers (940 and 1319 nm) from acute changes to 4 months

Bush¹,

Shamma

Hammond

2008

Lasers Surg Med

Self Cite

View full text Add to dashboard Cite

show abstract

“…23 However, histological studies at 3 and 6 months following EVLA indicate failure of endothelial regeneration and progressive damage to the muscle layers of the vein wall, resulting in further shrinkage and occlusion. 24 Studies had shown that between 30% and 99% of patients receiving EVLA require subsequent treatment for non-trunk varicosities. 22 It had been shown that successful occlusion was dependent on the energy used and could be achieved in all veins treated with ≥ 70 J/cm.…”

Section: Endovenous Laser Ablationmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins: results from the Comparison of LAser, Surgery and foam Sclerotherapy (CLASS) randomised controlled trial

Brittenden

Cotton

Elders

et al. 2015

Health Technology Assessment

View full text Add to dashboard Cite

BackgroundFoam sclerotherapy (foam) and endovenous laser ablation (EVLA) have emerged as alternative treatments to surgery for patients with varicose veins, but uncertainty exists regarding their effectiveness in the medium to longer term.ObjectivesTo assess the clinical effectiveness and cost-effectiveness of foam, EVLA and surgery for the treatment of varicose veins.DesignA parallel-group randomised controlled trial (RCT) without blinding, and economic modelling evaluation.SettingEleven UK specialist vascular centres.ParticipantsSeven hundred and ninety-eight patients with primary varicose veins (foam,n = 292; surgery,n = 294; EVLA,n = 212).InterventionsPatients were randomised between all three treatment options (eight centres) or between foam and surgery (three centres).Primary outcome measuresDisease-specific [Aberdeen Varicose Vein Questionnaire (AVVQ)] and generic [European Quality of Life-5 Dimensions (EQ-5D), Short Form questionnaire-36 items (SF-36) physical and mental component scores] quality of life (QoL) at 6 months. Cost-effectiveness as cost per quality-adjusted life-year (QALY) gained.Secondary outcome measuresQuality of life at 6 weeks; residual varicose veins; Venous Clinical Severity Score (VCSS); complication rates; return to normal activity; truncal vein ablation rates; and costs.ResultsThe results appear generalisable in that participants’ baseline characteristics (apart from a lower-than-expected proportion of females) and post-treatment improvement in outcomes were comparable with those in other RCTs. The health gain achieved in the AVVQ with foam was significantly lower than with surgery at 6 months [effect size −1.74, 95% confidence interval (CI) −2.97 to −0.50;p = 0.006], but was similar to that achieved with EVLA. The health gain in SF-36 mental component score for foam was worse than that for EVLA (effect size 1.54, 95% CI 0.01 to 3.06;p = 0.048) but similar to that for surgery. There were no differences in EQ-5D or SF-36 component scores in the surgery versus foam or surgery versus EVLA comparisons at 6 months.The trial-based cost-effectiveness analysis showed that, at 6 months, foam had the highest probability of being considered cost-effective at a ceiling willingness-to-pay ratio of £20,000 per QALY. EVLA was found to cost £26,107 per QALY gained versus foam, and was less costly and generated slightly more QALYs than surgery. Markov modelling using trial costs and the limited recurrence data available suggested that, at 5 years, EVLA had the highest probability (≈ 79%) of being cost-effective at conventional thresholds, followed by foam (≈ 17%) and surgery (≈ 5%).With regard to secondary outcomes, health gains at 6 weeks (p < 0.005) were greater for EVLA than for foam (EQ-5D,p = 0.004). There were fewer procedural complications in the EVLA group (1%) than after foam (7%) and surgery (8%) (p < 0.001). Participants returned to a wide range of behaviours more quickly following foam or EVLA than following surgery (p < 0.05). There were no differences in VCSS between the three treatments. Truncal ablation rates were higher for surgery (p < 0.001) and EVLA (p < 0.001) than for foam, and were similar for surgery and EVLA.ConclusionsConsiderations of both the 6-month clinical outcomes and the estimated 5-year cost-effectiveness suggest that EVLA should be considered as the treatment of choice for suitable patients.Future workFive-year trial results are currently being evaluated to compare the cost-effectiveness of foam, surgery and EVLA, and to determine the recurrence rates following each treatment. This trial has highlighted the need for long-term outcome data from RCTs on QoL, recurrence rates and costs for foam sclerotherapy and other endovenous techniques compared against each other and against surgery.Trial registrationCurrent Controlled Trials ISRCTN51995477.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 27. See the NIHR Journals Library website for further project information.

show abstract

940-nm Laser for Treatment of Saphenous Insufficiency: Histological Analysis and Long-Term Follow-Up

Abstract: Laser treatment of the saphenous vein was associated with no complications in our series of patients. The vein remained closed in 95% of those treated. This technique may replace other treatment modalities in up to 90% of patients.

Cited by 35 publications

References 9 publications

Endovenous 980-nm laser treatment of saphenous veins in a series of 500 patients

Endovenous 980-nm laser treatment of saphenous veins in a series of 500 patients

Histological changes occurring after endoluminal ablation with two diode lasers (940 and 1319 nm) from acute changes to 4 months

Clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins: results from the Comparison of LAser, Surgery and foam Sclerotherapy (CLASS) randomised controlled trial

Contact Info

Product

Resources

About