Endovenous Laser Ablation of Incompetent Perforating Veins with 1470 nm, 400 μm Radial Fiber

Abstract

Especially in the case of liposclerotic or ulcerated skin in the affected region, EVLA of IPVs with 1470 nm diode laser is highly effective and safe, and appears to be feasible. Additionally, repeat treatment can easily be performed should recurrence of IPVs arise.

Authors’ own method of diathermic thermal ablation of venous perforators – surgery with protective tumescence

“…It has also been reported that ablation of incompetent perforators in patients presenting with class C3-4 is associated with disappearance of varicosities connected to these veins. Currently, incompetent perforators are preferentially managed using minimally invasive techniques [29], such as RF and laser thermal ablations [30,31], foam sclerotherapy, and closure with cyanoac- Roman Sławomir Kuśnierczyk, Przemysław Nowakowski rylate glue [32]. Except for foam sclerotherapy, ablation of perforators with other methods is performed through an introducer (a sheath or a needle).…”

Current state of the treatment of perforating veins

“…Several studies have shown that EVLA PAPs is safe and feasible. 16,32,33 TECHNICAL CHALLENGES Closure of pathologic perforating veins is technically challenging compared with ablation of saphenous veins, regardless of technique. Whereas saphenous thermal ablation thrombosis has been reported to be 96% to 98%, perforator closure ranges from 59% to 90%, even in centers of excellence.…”

Minimally invasive treatments for perforator vein insufficiency

“…Rare systemic complications include DVT and pulmonary emboli (6,32,33). For laser energy, commercially available 940-nm diode, 1,320 nm Nd:YAG and 1,470-nm microfibers can be used for perforator vein ablation (34)(35)(36)(37). Commercially available radiofrequency probes are also available for perforator ablation treatment (Covidien, Mansfield, MA, USA).…”

“…EVTA is technically more challenging than USGS; however, several studies have shown highly effective and durable closure rates, with closure rates ranging between 61% and 95% (37)(38)(39)(40). A recent comparison between minimally invasive techniques for perforator ablation showed EVTA had better early closure rates when compared to USGS; however, this rate narrowly missed significance (40).…”