Local cooling effect on perforation rates comparing the 980–1470 nm laser wavelengths used with endovenous laser ablation: double blind <i>in vitro</i> experimental study

Tarhan, Ibrahım Arif; Dumantepe, Mert; Yurdakul, İlhan; Kehlіbar, Tamer; Özler, Azmi

doi:10.1258/phleb.2012.012021

Cited by 11 publications

(8 citation statements)

References 34 publications

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“…Early studies achieved 100 % GSV occlusion rates with a 1470-nm laser using a mean of 107 J/cm. Later studies obtained LEEDs of 79 and 57 J/cm with a radial fiber laser [11,12]. In our current study, we achieved a much lower and more sufficient LEED of 38 (range, 35-46) J/cm, especially for SSV.…”

Section: Discussionsupporting

confidence: 45%

“…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: Discussionsupporting

confidence: 45%

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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“…Tarhan et al experimented on the effects of two different laser wavelengths in EVLA procedures. 24 They observed that, perforation rates and complication rates were much better with higher wavelength of the laser.…”

Section: Discussionmentioning

confidence: 98%

“…This might reduce perivascular thermal injury and postoperative pain. 24,25 In the case of liposclerotic or ulcerated skin in the affected region where the perforator treatment needs to take place, a percutaneous approach by EVLA seems a safe treatment option. Another benefit is that retreatment is easily performed should recurrence of incompetent perforating veins arise.…”

Section: Discussionmentioning

confidence: 99%

Combined treatment with endovenous laser ablation and compression therapy of incompetent perforating veins for treatment of recalcitrant venous ulcers

Seren

Dumantepe²,

Fazlioğulları³

et al. 2015

Phlebology

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Objective Patients with healed venous ulcers often experience recurrence of ulceration, despite the use of long-term compression therapy. This study examines the effect of closing incompetent perforating veins (IPVs) on ulcer recurrence rates in patients with progressive lipodermatosclerosis and impending ulceration. Methods Patients with nonhealing venous ulcers of >2 months’ duration underwent duplex ultrasound to assess their lower extremity venous system for incompetence of superficial, perforating, and deep veins. Endovenous laser ablation (EVLA) of perforating veins was performed on patients with CEAP 6 disease with increasing hyperpigmentation, lipodermatosclerosis, and/or progressive malleolar pain. A minimum of 2 months of compressive therapy was attempted before endovenous ablation of IPVs. Demographic data, risk factors, CEAP classification, procedural details, and postoperative status were all recorded. Results Forty ulcers with 46 associated IPVs were treated with EVLA in 36 patients with CEAP 6 recalcitrant venous ulcers. Treated incompetent perforator veins were located in the medial ankle (85.7%), calf (10.7%), and lateral ankle (3.5%). Endovenous laser ablation was successful in 76% (35/46) with the first laser treatment of incompetent perforator veins and 15.2% (7/46) additional ablation procedures were performed. Of the 46 treated IPVs, 42 (91.3%) were occluded on the duplex examination at 12 months. The average energy administrated per perforating vein treated was 162 joule. Two patients reported localized paresthesia, which subsided spontaneously, but no deep venous thrombosis or skin burn was observed. Conclusion Especially in the case of liposclerotic or ulcerated skin in the affected region, PAP of IPVs is highly effective, safe, and appears to be feasible. Patients with active venous ulcers appear to benefit from EVLA of incompetent perforators in order to reduce the risk of ulcer recurrence.

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“…Once introduced and accepted in clinical treatment of insufficient varicose veins, the following request is an explicit precise deposition of the energy in the target layers of the vein wall, thus further reducing side effects especially harming the surrounding tissue. Although proper tumescence application (46,51,52) and ultra sound guided treatment serves for safety and controlled application, the physics of heat diffusion and conductivity could not be overcome.…”

Section: Discussionmentioning

confidence: 99%

Endovenous Laser Application

Sroka¹,

Pongratz²,

Siegrist³

et al. 2013

Phlebologie

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SummaryIntroduction: Endoluminal vein treatment is a promising minimal invasive treatment option for peoples suffering from varicose veins. The basic mechanism underlying this procedure is to selectively induce heat in the vessel wall with the result of denaturation of proteins and shrinkage of collagen fibers due to energy application. So far energy could be applied either as RF-current, laser light or water steam. The different approaches to deliver such forms of energies are described.Methods: Investigations on heat dependent vein tissue effects were performed. The degree of shrinkage and wall thickening due to heat induction was calculated. Tensile test on vein tissue were performed. Investigation using the radial emitting laser fibre in the ox-foot-model under reproducible condition were done and wavelengths dependent tissue reaction were explored.Results: The experiments clearly demonstrate the degree of the shrinkage of length and diameter, the thickening of the vein wall, as well as the decrease of the elasticity of the tissue. The optical irradiation pattern of the radial emitting laser fiber serves for safe and reproducible energy application directly to the vein wall. Using a laser wavelength with high absorption by the tissue water needs reduced irradiation and irradiance compared to wavelengths with less water absorption. Conclusion: An experimental approach to improve laser application for endovenous varicose treatment is described. Laser parameters and treatment parameters were found which are now under clinical testing. The demonstrated tissue effects may help to find further arguments for clinical findings and sensations described by the patients during follow-up.

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Local cooling effect on perforation rates comparing the 980–1470 nm laser wavelengths used with endovenous laser ablation: double blind in vitro experimental study

Abstract: It can be commented that reducing the ambient temperature is more beneficial than modifying the laser wavelength on perforation rates. Therefore we suppose tumescent anaesthesia temperature is effective on perforation independently from the wavelengths or type of the laser fibre.

Cited by 11 publications

References 34 publications

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

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

Combined treatment with endovenous laser ablation and compression therapy of incompetent perforating veins for treatment of recalcitrant venous ulcers

Endovenous Laser Application

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