Endovenous laser with miniphlebectomy for treatment of varicose veins and effect of different levels of laser energy on recanalization. A single center experience

Abstract

Varicose veins, associated with great saphenous vein (GSV) incompetence, are traditionally treated with conventional surgery. In recent years, minimally invasive alternatives to surgical treatment such as the endovenous laser ablation (EVLA) and radiofrequency (RF) ablation have been developed with promising results. Residual varicose veins following EVLA, regress untouched, or phlebectomy or foam sclerotherapy can be concomitantly performed. The aim of the present study was to investigate the safety and efficacy of EVLA with different levels of laser energy in patients with varicose veins secondary to saphenous vein reflux. From February 2006 to August 2011, 740 EVLA, usually with concomitant miniphlebectomies, were performed in 552 patients. A total of 665 GSV, 53 small saphenous veins (SSV), and 22 both GSV and SSV were treated with EVLA under duplex USG. At 84 patients, bilateral intervention is made. In addition, miniphlebectomy was performed in 540 patients. A duplex ultrasound (US) is performed to patients preoccupying chronic venous insufficiency (with visible varicose veins, ankle edema, skin changes, or ulcer). Saphenous vein incompetence was diagnosed with saphenofemoral, saphenopopliteal, or truncal vein reflux in response to manual compression and release with patient standing. The procedures were performed under local anesthesia with light sedation or spinal anesthesia. Endovenous 980-nm diode laser source was used at a continuous mode. The mean energy applied per length of GSV during the treatment was 77.5 ± 17.0 J (range 60-100 J/cm). An US evaluation was performed at first week of the procedure. Follow-up evaluation and duplex US scanning were performed at 1 and 6 months, and at 1 and 2 years to assess treatment efficacy and adverse reactions. Average follow-up period was 32 ± 4 months (3-55 months). There were one patient with infection and two patients with thrombus extension into the femoral vein after EVLA. Overall occlusion rate was 95%. No post-procedural deep venous thrombosis or pulmonary embolism occurred. Laser energy, less than 80 J/cm, was significantly associated with increased recanalization of saphenous vein, among the other energy levels. EVLA seems a good alternative to surgery by the application of energy of not less than 80 J/cm. It is both safe and effective. It is a well-tolerated procedure with rare and relatively minor complications.

Retrograde passage of radiofrequency catheter for the endovenous ablation of the great saphenous vein: a modified technique and report of two cases

“…Endovenous access for thermal ablation of GSV is routinely performed from below the knee level commonly. [3] Occasionally, the puncture for GSV at this level may not be feasible due to various reasons such as obesity, thin GSV diameter, bleeding to subcutaneous tissue, and venoconstriction. All these factors may complicate the operation and force the physician for an alternative access point to GSV.…”

Review of the progress toward achieving heat confinement—the holy grail of photothermal therapy

“…of PT applications in the tangential field of cosmetics. PT targeting of melanin, in the form of laser hair removal, 64,65 and PT targeting of hemoglobin, in the treatment of port-wine stains 66 and varicose veins, 67,68 and have been widely and successfully applied in the clinic for decades. These applications take advantage of the fact that in biological structures such as hair follicles and blood vessels, there is a locally higher concentration of melanin and hemoglobin, respectively, than is present within surrounding tissues.…”

A novel technique in varicose vein surgery: Grasp-all-first

“…Treatment also prevents complications such as the development of thrombosis and venous ulcers, and disability. [3] Removal of VVs, via very small incisions of just a few millimeters, is called phlebectomy. [1] A small hook or mosquito clamp is used to pull the vein out and the vein is exteriorized from the wound (Figure 1).…”