Endovenous laser therapy for occlusion of incompetent saphenous veins using 1940nm

Abstract

Objective:Several studies indicate that ELT using wavelengths of high water absorption showed advantages compared to conventional ELT. Thulium-Lasers emit nearby the local absorption maximum of water at 1940nm. In this clinical study the effectiveness, safety and the feasibility of 1940nm-ELT is proven. Materials and Method:A single centric, prospective observational study was performed. 1940nm-laserenergy was applied using radial emitting fibres with continuous pullback (1mm/s). Treatment was performed under anesthesia (general, spinal, tumescent) thus simultaneous miniphlebectomy and ligation of perforators could be applied. Patient and technical details were systematically collected. Evaluation included: standardized questionnaire, clinical examination, color-duplex ultrasonography preoperatively, 3d, 4w, 6m postoperatively, statistic. Results:The 1940nm-ELT study include 55 patients (female/men=34/21, mean age 55y, range 23-90y) treating n=72 vessels. The mean maximum diameter of great saphenous veins (GSV, n=59) was 7.5mm (range 3.7-11.3mm) and of small saphenous veins (SSV, n=13) was 5.3mm (3.0-10.0mm). The mean applied longitudinal endovenous energy density (LEED) was 64.3J/cm (40.3-98.2J/cm) in GSVs and 51.0J/cm (37.6-72.7J/cm) in SSVs. Complete occlusion of the vein without sign of reflux was achieved in 100%. The mean length of non-occluded stump at the sapheno-femoral junction was 6.0mm (1.0-20.0mm). Postoperative reduction of the diameter of GSV was 1.6mm (21.3%) and 2.0mm (37.7%) in SSV. One (1.4%) endovenous heat induced thrombus (EHIT) was observed. Further adverse events were: paresthesia 10/72 (13.9%), ecchymosis 1/72 (1.4%), lymphocele 1/72 (1.4%), hyperpigmentation 1/72 (1.4%). The mean postoperative pain intensity was 1.3 and 1.8 single doses of analgesics were administered. Normal physical activity was reached after 3d (1-21d).Conclusion: 1940nm-ELT using radial light application effectively eliminates the reflux in insufficient saphenous veins by a significant diameter reduction. The risk profile correlates with other endothermal treatment options. Low postoperative pain and analgesic requirements with rapid convalescence indicate a high level of patient comfort.

Comparison of Short-Term Outcomes Between Endovenous 1,940-nm Laser Ablation and Radiofrequency Ablation for Incompetent Saphenous Veins

“…According to previous literatures, the required energy for good outcomes is about 80-100 LEED (J/cm) with the 1,470nm EVLA (11,13,14). And to date, a few studies have investigated EVLA using the 1,940-nm laser, and this treatment has generally produced good outcomes, even with energy < 50 LEED (J/cm) (19)(20)(21)(22)(23)(24).…”

Resultados de médio e longo prazo do tratamento endovenoso de varizes com laser de diodo em 1940 nm: análise crítica e considerações técnicas

“…[19][20][21][22] In addition to the well-established diode laser with emission wavelength of 1470nm (active medium: InGaAsP), new semiconductor diode-based lasers with wavelengths of interest have been emerging, including emission wavelengths centered on 1908nm, 1920nm, and 1940nm (active medium: AlGaIn). 8,23 The practical advantages of these wavelengths are also because of the high degree of absorption of laser light by the interstitial water in the vein walls, which can be illustrated by their respective absorption coefficients (μ A water ) for this chromophore (Table 7). 24 It can be considered that delivering laser light to the vein wall via a radial fiber at a λ in the region of 1940nm is an incremental development over the current state-of-the-art technique for laser endovenous thermoablation, which is the 1470nm laser with irradiation via a radial fiber.…”

“…Many different wavelengths and different types of optical fibers have been tested in attempts to achieve this objective. [1][2][3][4][5][6][7][8] Several authors have demonstrated that all of the wavelengths employed to treat varicose veins are equally capable of producing the desired anatomic results. The fundamental differences between different wavelengths are related to occurrence of adverse events.…”

Initial outcomes of endovenous laser ablation with 1940 nm diode laser in the treatment of incompetent saphenous veins

“…[10][11][12][13] However, there are few studies on the effective power or LEED at a longer wavelength of 1940 nm, and all have focused on radial fibers. 6,[14][15][16] In addition, no studies have specifically investigated the Asian population.…”