Endoluminal laser delivery mode and wavelength effects on varicose veins in an <i>Ex vivo</i> model

Massaki, Ane; Kiripolsky, Monika G.; Detwiler, Susan P.; Goldman, Mitchel P.

doi:10.1002/lsm.22069

Cited by 23 publications

(10 citation statements)

References 28 publications

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“…The majority of the published studies used 980-nm wavelength lasers with bare fibers, which are better absorbed by the blood. Higher wavelengths, such as 1320 and 1470 nm, have more effect in water and show less bruising [6,7]. Laser beams emitted directly from the tip of bare fibers lead to higher penetrations of the vessel wall.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, EVLA with the 1470-nm laser and radial fiber system produced a relatively low LEED (58.5 J/cm) with a very high occlusion rate. In some studies, bruising and pain was less frequent with this combination when compared to lasers with lower wavelengths and a bare tip [7,8]. We combined the higher wavelengths with a radial tip fiber, which homogeneously distributes the energy.…”

Section: Discussionmentioning

confidence: 99%

“…The 1470-nm wavelength does not cause the carbonization of the blood. In addition, histological studies have shown that treatment with the 1320-nm laser causes occlusions without perforation of the vessel wall [12], which is the reason why 1320-and 1470-nm EVLA could be more effective in anticoagulated patients [7]. LEED is another factor that can affect the success of EVLA.…”

Section: Discussionmentioning

confidence: 99%

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Comparing 1470- and 980-nm diode lasers for endovenous ablation treatments

et al. 2015

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The purpose of this study was to compare the effectiveness of 1470- and 980-nm lasers with regard to power output, complications, recanalization rates, and treatment response. We prospectively evaluated the effectiveness of endovenous laser ablation (EVLA) in a total of 152 great and small saphenous veins from 96 patients. Lasers were randomly used based on the availability of the units. Patients were clinically evaluated for Clinical Etiologic Anatomic Pathophysiologic (CEAP) stage and examined with Doppler ultrasound. Treatment response was determined anatomically by occlusion of the vein and clinically by the change in the venous clinical severity score (VCSS). Seventy-eight of the saphenous veins underwent EVLA with a 980-nm laser and 74 underwent EVLA with a 1470-nm laser. Treatment response was (68) 87.2 % in the 980-nm group and (74) 100 % in the 1470-nm group (p = 0.004). The median VCSS decreased from 4 to 2 in the 980-nm group (p < 0.001) and from 8 to 2 (p < 0.001) in the 1470-nm group. At 1-year follow-up, seven veins treated with 980 nm and two veins treated with 1470 nm were recanalized (p = 0.16); the average linear endovenous energy density (LEED) was 83.9 (r, 55-100) J/cm and 58.5 (r, 45-115) J/cm, respectively (p < 0.001). Postoperative minor complications occurred in 23 (29.4 %) limbs in the 980-nm group and in 19 (25.6 %) limbs of the 1470-nm group (p = 0.73). EVLA with the 1470-nm laser have less energy deposition for occlusion and better treatment response.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparing 1470- and 980-nm diode lasers for endovenous ablation treatments

et al. 2015

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“…The treatment temperature is 120°C (248°F) created by the proximal coiling 7 cm segment of the catheter [ 1 ]. If treatment were to be performed by continuous pull-back, the treatment temperature could change [ 14 – 16 ]. Thirdly, ablation at the proximal segment was started 2 cm distal from the SFJ or SPJ in all patients.…”

Section: Discussionmentioning

confidence: 99%

Effect of Diameter of Saphenous Vein on Stump Length after Radiofrequency Ablation for Varicose Vein

Kim

Cho

Joh

et al. 2015

VSI

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Purpose:Radiofrequency ablation (RFA) has gained popularity for treatment of varicose veins. The diameter of the saphenous vein should be considered before RFA because occlusion of the vein may differ depending on its diameter. Until now, however, there have been few data about the correlation between the diameter of the saphenous vein and the stump length after RFA. The purpose of our study was to investigate its correlation.Materials and Methods:A retrospective review was performed from prospectively collected data of RFA patients between March 2009 and December 2011. Preoperatively, the saphenous vein diameter was measured. Ablation was initiated 2 cm distal from the junction. Postoperatively, stump length was measured at 1 week and 6 months. After 2 years, we measured the length from the saphenofemoral junction to the leading point of occlusion for great saphenous vein, and length from the saphenopopliteal junction to the leading point of occlusion for small saphenous vein. The paired t-test, independent t-test, and correlation analysis were used for statistical analysis. P-value <0.05 was considered statistically significant.Results:During the study period, RFA was performed in 201 patients. Endovenous heat-induced thrombosis developed in 3 patients (1.5%). After 2 years, the stump length was obtained in 74 limbs. The mean diameter and stump length of the saphenous vein were 6.7±1.8 mm and 12.5±8.5 mm, respectively. Correlation analysis showed that the Pearson correlation coefficient of these factors was −0.017.Conclusion:There was no correlation between the diameter of saphenous vein and stump length.

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“…Pulsed wave (PW) lasers have reported fewer side effects and higher occlusion rates using lower energy settings than continuous wave (CW) lasers. 9,[28][29][30] Using a LEED of 60 J/cm, Kansaku et al reported no perforations or ulcers using a 1320 nm PW laser when compared with a 1470 nm CW laser. 30 The authors proposed that PW delivery, using a sufficiently high energy but a sufficiently long thermal relaxation time, may help avoid excess energy delivery which might lead to vein wall perforation.…”

Section: Pulsed Vs Continuous-wave Lasersmentioning

confidence: 99%

Factors affecting optimal linear endovenous energy density for endovenous laser ablation in incompetent lower limb truncal veins – A review of the clinical evidence

2016

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Objectives The objective is to identify the factors that affect the optimal linear endovenous energy density (LEED) to ablate incompetent truncal veins. Methods We performed a literature review of clinical studies, which reported truncal vein ablation rates and LEED. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flow diagram documents the search strategy. We analysed 13 clinical papers which fulfilled the criteria to be able to compare results of great saphenous vein occlusion as defined by venous duplex ultrasound, with the LEED used in the treatment. Results Evidence suggests that the optimal LEED for endovenous laser ablation of the great saphenous vein is >80 J/cm and <100 J/cm in terms of optimal closure rates with minimal side-effects and complications. Longer wavelengths targeting water might have a lower optimal LEED. A LEED <60 J/cm has reduced efficacy regardless of wavelength. The optimal LEED may vary with vein diameter and may be reduced by using specially shaped fibre tips. Laser delivery technique and type as well as the duration time of energy delivery appear to play a role in determining LEED. Conclusion The optimal LEED to ablate an incompetent great saphenous vein appears to be >80 J/cm and <95 J/cm based on current evidence for shorter wavelength lasers. There is evidence that longer wavelength lasers may be effective at LEEDs of <85 J/cm.

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Endoluminal laser delivery mode and wavelength effects on varicose veins in an Ex vivo model

Cited by 23 publications

References 28 publications

Comparing 1470- and 980-nm diode lasers for endovenous ablation treatments

Comparing 1470- and 980-nm diode lasers for endovenous ablation treatments

Effect of Diameter of Saphenous Vein on Stump Length after Radiofrequency Ablation for Varicose Vein

Factors affecting optimal linear endovenous energy density for endovenous laser ablation in incompetent lower limb truncal veins – A review of the clinical evidence

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