Histological and Immunofluorescent Analysis of a Large Tributary of the Great Saphenous Vein Treated with a 1920 nm Endovenous Laser: Preliminary Findings

Abstract

ObjectivesTo analyse the biological effects of a 1920 nm endovenous laser (EVL) on extra-fascial great saphenous vein (GSV) in vitro.MethodsA 10 cm length of a large tributary bypassing a hypoplastic segment of the GSV (sometimes called an “extra-fascial GSV”) was obtained during routine varicose vein surgery. The length was treated in five sections with different LEEDs (0 (control), 20, 40, 60, and 80 J/cm) with a 1920 nm EVL at 4W power, in a novel in vitro treatment model. The biological effects were assessed by histological staining of the samples for haematoxylin and eosin (HE) and Martius Scarlet Blue (MSB), and by immunofluorescent detection of p-p53 and VCAM-1.ResultsHistological analysis showed significant structural damage at LEEDs above 60 J/cm, especially in the intima and media, with the treatment at 80 J/cm causing perforation of the vein wall. In addition, there was a significant increase in p-p53 expression in treated tissue at 60 and 80 J/cm.ConclusionsUsing this ex vivo model, the results indicate that in vitro treatment with a 1920 nm EVL, at or above an LEED of 60 J/cm and 4 W power, causes significant vein wall cell death reaching deep into the media by a combination of direct thermal damage and apoptosis. A wavelength of 1920 nm appears to be effective for the endovenous ablation of truncal veins.

Pattern of thermal damage and tissue carbonisation from endovenous radiofrequency ablation catheter – Using an in vitro porcine liver model

“…It was previously believed that protein contraction was responsible for the efficacy of ETA. 9 Research from our own unit, using immunofluorescent analysis on an in-vitro model of transplanted extra-facial Great Saphenous Vein (GSV) treated with a 1920 nm endovenous laser disputes this, 10 as does the conclusion of another paper in the series that used a 1470 nm endovenous laser. 11 We showed that when using a Linear Endovenous Energy Density (LEED) value of 60 J/cm or above, cell death by apoptosis and necrosis occurs deep into the media.…”

“…11 We showed that when using a Linear Endovenous Energy Density (LEED) value of 60 J/cm or above, cell death by apoptosis and necrosis occurs deep into the media. 10 , 11 However, when considering endovenous laser, the optimal LEED might be different with different wavelengths and different fibre tips that vary the emitted energy distribution.…”

Re: “Histological and Immunofluorescent Analysis of the Large Tributary of the Great Saphenous Vein Treated With a 1920 nm Endovenous Laser: Preliminary Findings”

“…The last issue of EJVES Short Reports (2018; 39: 7–11) included the report “Histological and immunofluorescent analysis of the large tributary of the great saphenous vein treated with a 1,920 nm endovenous laser: preliminary findings” by Ashpitel et al 1 . We have read it with great interest.…”

Re. “Comments to: Histological and Immunofluorescent Analysis of the Large Tributary of the Great Saphenous Vein Treated With a 1920 nm Endovenous Laser: Preliminary Findings”

“…I would like to thank Justyna Wilczko and her colleagues for their interest and comments on our work 1, 2…”

“…With regard to the comment about vein diameter, this is of only secondary importance to the thickness of the vein wall. Ever since I proposed the idea that successful ablation needed transmural vein wall cell death in 2004, 3 and suggested that leaving a “living vein wall skeleton” of media and adventitia would allow recanalisation, 4 we have been looking at how the processes of thermal ablation and chemical ablation affect the vein wall 2, 5…”