Morphological changes of veins and perivenous tissues during endovenous laser coagulation using 2-μm laser radiation and various types of optical fibers

Artemov, S. A.; Belyaev, A. N.; Bushukina, O. S.; Khrushchalina, S.A.; Kostin, S. V.; Lyapin, A.A.; Ryabochkina, P. A.; Taratynova, A.D.

doi:10.1016/j.jvsv.2021.08.018

Cited by 8 publications

(4 citation statements)

References 23 publications

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“…Obviously applying high values of linear energy density (LEED) produces an effective damage to the target structure but increases the risk of spreading the damage also to the neighboring biological structures. 19,20 It is possible to deduce, therefore, that the lower the energy applied to obtain the same result, that is to denature the collagen proteins, the lower are the risks of perivasal tissue damage. Anyway, the exact threshold is not established.…”

Section: Discussionmentioning

confidence: 99%

Third generation of laser (>1900) for endovenous thermoablation (EVLA) of varicose veins: A systematic review and meta-analysis

Palombi,

Morelli,

Bruzzese

et al. 2024

Phlebology

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Objectives Third generation lasers with longer wavelengths (>1900 nm) have been introduced, in recent years, for the treatment of varicose veins. The possible advantage of the new generation lasers is that they allow complete damage to the vein wall using a lower Power in Watts (W: J/sec) and a lower linear energy density (LEED: J/cm). The aim of this work is to evaluate the results present in the literature regarding efficacy and safeness of the new generation lasers for the treatment of varicose veins. Methods Published articles were searched on PubMed database and on Cochrane Library, entering the keywords “1940 nm or 1920 nm laser AND varicose veins laser thermoablation (EVLA).” The primary endpoint of the study was to value rate of occlusion and adverse events at the short term follow-up. The search yielded a total of 14 studies. In the end, only six studies were judge eligibility. Results The studies were heterogenous in their documentation, EVLA, duplex ultrasound protocol and result reporting. A total of 540 limbs of 377 patients were treated with endovenous laser ablation (EVLA) with laser 1920–1940 nm. The treated veins had a mean diameter of 0.74 ± 0.17 cm and a mean length of 27.87 ± 20.63 cm. The pooled estimates of immediate occlusion rate was of 99.8% (95% CI: 97.9% to 100.0) with high heterogeneity (I2 = 60%; 95% PI: 89.7% to 100%), while at short-term follow-up was of 98.2% (95% CI: 94.0% to 100.0%) with higher heterogeneity (I2:79%; 95% PI: 77.1% to 100.0%). EHIT occurred in 7 cases (pooled estimate: 0.7%). The other adverse events rate reported were 1% of hyperpigmentation, 2.8% of neurological complications, 0.6% thrombophlebitis and 1.9% of bruising/hematoma. The pooled mean estimates of LEED was equal to 38.2 J/cm (95% CI: 26.3 to 50.1 J/cm) although with a very large heterogeneity (I2 = 100%). Conclusions The overall success rate of EVLA was high. The analysis of these studies suggests that using lower parameters (Power and linear administered energy) may have no effect on the treatment success rate. Short-term results demonstrate comparable occlusion rates respect the second-generation lasers. Instead, data suggest a low complication rates. Short-term results demonstrate comparable complications rates respect the second-generation lasers (1300-1470 nm). Randomized studies with longer follow-up are required to evaluate the EVLA 1900 nm procedure further.

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Section: Discussionmentioning

confidence: 99%

Third generation of laser (>1900) for endovenous thermoablation (EVLA) of varicose veins: A systematic review and meta-analysis

Palombi,

Morelli,

Bruzzese

et al. 2024

Phlebology

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“…Endovenous laser ablation (EVLA) in recent years has observed a trend towards using longer wavelength laser systems in combination with a radial-emitting fibre [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. Because of a higher coefficient of absorption in water for 1940 nm as compared to other wavelengths [ 15 , 16 , 17 , 18 ], and radial dissipation of the light energy with radial emitting fibres, the desired ablation of the vein wall can be achieved with lower power levels with thermal changes predominantly limited to the intima and media [ 19 , 20 ]. This translates in a clinical setting into high occlusion rates, low postoperative pain and low complication rates [ 14 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Prospects of Endovenous Laser Ablation (EVLA) Standardization—Mid-Term Results of a Four-Zone Dosimetry Guiding Tool for 1940 nm Laser

Setia

Dikic²,

Demhasaj³

et al. 2023

JCM

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Background: Heterogeneity regarding dosimetry and reporting of endovenous laser ablation (EVLA) mandates the development of a standardized protocol. This study presents the mid-term results of EVLA with 1940 nm-laser and radial-fibre, supported by a four-zone dosimetry tool. Materials and methods: Four anatomical dosimetry zones for great saphenous veins (GSV) and two for small saphenous veins (SSV) were defined with set power levels. Zone-1G (4 W) extended from the inguinal ligament to the apex of femoral triangle, Zone-2G (4 W) from the apex of femoral triangle to the upper border of patella. Zone-3G (3 W) from the patella to the tibial tuberosity. Zone-4G (2 W) extended from the tibial tuberosity to the ankle. Zone-1S from the sapheno-popliteal junction to the tibial tuberosity. Zone-2S from the tibial tuberosity to the ankle. Power was increased by 1 W for veins >10 mm and decreased by 1 W when fibre sticking was encountered. Pullback-velocity was max. 1 mm/s. Results: A total of 152 consecutive patients (185 procedures) were recruited. Mean follow-up time was 11.9 months. Mean linear endovenous energy density for GSV was Zone-1G:42 J/cm, Zone-2G:33 J/cm, Zone-3G:27 J/cm, Zone-4G:22 J/cm, Zone-1S:34 J/cm, Zone-2S:27 J/cm. Occlusion rates were 98.9% (1-month) and 93.7% (12-months). Complications at 1 M were low, namely laser-induced paraesthesia (LIP) 2.2% and endovenous heat-induced thrombosis (EHIT) 1.6%. Persistent LIP (12 M) was observed in 0.5%. Conclusion: The proposed four-zone guiding tool is a step towards standardizing dosimetry and documentation for EVLA with 1940 nm. This strategy shows good mid-term results with minimal complications. Long-term follow-up and application in further centres are necessary to prove its reproducibility. Such a guiding tool could improve the ability to analyse, compare and review different EVLA wavelengths and fibre types.

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“…Слід зазначити, що впровадження високоінформативних діагностичних технологій та інноваційних методів хірургічного лікування значно зменшило кількість післяопераційних рецидивів варикозної хвороби. Проте у переважній більшості наукових публікацій основний акцент причин післяопераційних рецидивів варикозної хвороби нижніх кінцівок робиться на тактичних і технічних помилках при виконанні сафенектомії [10].…”

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“…Актуальність сучасної проблеми лікування ХВН та покращення якості життя пацієнтів було висвітлено в роботах Youn [1], Siribumrungwong [2], Whing [3], Farah [4], Orhurhu [5], Branisteanu [6], Azar [7], Lurie [8], Lee [9], Artemov [10], Cong [11], El Kilic [12], Giannopoulos [13], Lin [14].…”

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Оцінка Якості Життя Пацієнта На Фоні Больового Синдрому За Умов Хірургічного Лікування Хронічної Венозної Недостатності

Боднар,

Беденюк,

Боднар

et al. 2024

Перспективи та інновації науки

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Relevance of the study. Pain syndrome in chronic venous insufficiency is a common complication that correlates with the clinical degree of the disease. Although lifestyle changes remain the mainstay of treatment for pain associated with chronic venous insufficiency, compression therapy, and various pharmacological agents have become safe and effective methods of preventing this pathology. Minimally invasive surgical methods have been developed for patients for whom these measures are not sufficient. The paper describes the development of pain and analyses its intensity in patients with chronic venous insufficiency, and also considers both traditional methods of surgical treatment of pain and new advances in medical and surgical therapy of this disease.The aim: to analyse the intensity of pain in patients after endovenous laser coagulation of the great saphenous vein in the setting of chronic venous insufficiency.Materials and methods. We examined 86 patients with varicose veins of the lower extremities who were treated at the Department of Surgery of Ternopil Regional Hospital No. 2 in the period from 2021 to 2023. All patients underwent surgical treatment for varicose veins of the lower extremities: Group I -46 patients who underwent thermal obliterating methods; Group II -40 patients who underwent planned surgical intervention in the amount of combined phlebectomy with removal of the trunk of the IVC to the lower reflux limit under general anesthesia or spinal anesthesia and perforation.

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Morphological changes of veins and perivenous tissues during endovenous laser coagulation using 2-μm laser radiation and various types of optical fibers

Cited by 8 publications

References 23 publications

Third generation of laser (>1900) for endovenous thermoablation (EVLA) of varicose veins: A systematic review and meta-analysis

Third generation of laser (>1900) for endovenous thermoablation (EVLA) of varicose veins: A systematic review and meta-analysis

Prospects of Endovenous Laser Ablation (EVLA) Standardization—Mid-Term Results of a Four-Zone Dosimetry Guiding Tool for 1940 nm Laser

Оцінка Якості Життя Пацієнта На Фоні Больового Синдрому За Умов Хірургічного Лікування Хронічної Венозної Недостатності

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