Factors affecting optimal linear endovenous energy density for endovenous laser ablation in incompetent lower limb truncal veins – A review of the clinical evidence
Restricted accessReview articleFirst published online June, 2017
Factors affecting optimal linear endovenous energy density for endovenous laser ablation in incompetent lower limb truncal veins – A review of the clinical evidence
The objective is to identify the factors that affect the optimal linear endovenous energy density (LEED) to ablate incompetent truncal veins.
Methods
We performed a literature review of clinical studies, which reported truncal vein ablation rates and LEED. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flow diagram documents the search strategy. We analysed 13 clinical papers which fulfilled the criteria to be able to compare results of great saphenous vein occlusion as defined by venous duplex ultrasound, with the LEED used in the treatment.
Results
Evidence suggests that the optimal LEED for endovenous laser ablation of the great saphenous vein is >80 J/cm and <100 J/cm in terms of optimal closure rates with minimal side-effects and complications. Longer wavelengths targeting water might have a lower optimal LEED. A LEED <60 J/cm has reduced efficacy regardless of wavelength. The optimal LEED may vary with vein diameter and may be reduced by using specially shaped fibre tips. Laser delivery technique and type as well as the duration time of energy delivery appear to play a role in determining LEED.
Conclusion
The optimal LEED to ablate an incompetent great saphenous vein appears to be >80 J/cm and <95 J/cm based on current evidence for shorter wavelength lasers. There is evidence that longer wavelength lasers may be effective at LEEDs of <85 J/cm.
CallamMJ. Epidemiology of varicose veins. Br J Surg1994; 81: 167–173.
2.
EvansCJFowkesFGHajivassiliouCA. Epidemiology of varicose veins. A review. Int Angiol1994; 13: 263–270.
3.
DwerryhouseSDaviesBHarradineK. Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: five-year results of a randomized trial. J Vasc Surg1999; 29: 589–592.
4.
National Institute for Health and Care Excellence. Varicose veins in the legs: the diagnosis and management of varicose veins. London: National Institute for Health and Care Excellence, http://publications.nice.org.uk/varicose-veins-in-the-legs-cg168 (2013, accessed 1 June 2015).
5.
van den BosRRProebstleTM. The state of the art of endothermal ablation. Lasers Med Sci2014; 29: 387–392.
6.
ProebstleTMKrummenauerFGulD. Nonocclusion and early reopening of the great saphenous vein after endovenous laser treatment is fluence dependent. Dermatol Surg2004; 30(2 Pt 1): 174–178.
7.
MalskatWSPoluektovaAAvan der GeldCW. Endovenous laser ablation (EVLA): a review of mechanisms, modeling outcomes, and issues for debate. Lasers Med Sci2014; 29: 393–403.
8.
van den BosRRKockaertMANeumannHA. Technical review of endovenous laser therapy for varicose veins. Eur J Vasc Endovasc Surg2008; 35: 88–95.
9.
ProebstleTMMoehlerTGulD. Endovenous treatment of the great saphenous vein using a 1,320 nm Nd:YAG laser causes fewer side effects than using a 940 nm diode laser. Dermatol Surg2005; 31: 1678–1683; discussion 83–84.
10.
TheivacumarNSDellagrammaticasDBealeRJ. Factors influencing the effectiveness of endovenous laser ablation (EVLA) in the treatment of great saphenous vein reflux. Eur J Vasc Endovasc Surg2008; 35: 119–123.
11.
TimpermanPESichlauMRyuRK. Greater energy delivery improves treatment success of endovenous laser treatment of incompetent saphenous veins. J Vasc Interv Radiol2004; 15: 1061–1063.
12.
ProebstleTMMoehlerTHerdemannS. Reduced recanalization rates of the great saphenous vein after endovenous laser treatment with increased energy dosing: definition of a threshold for the endovenous fluence equivalent. J Vasc Surg2006; 44: 834–839.
13.
PrinceEAAhnSHDubelGJ. An investigation of the relationship between energy density and endovenous laser ablation success: does energy density matter?J Vasc Interv Radiol2008; 19: 1449–1453.
14.
VuylstekeMLiekensKMoonsP. Endovenous laser treatment of saphenous vein reflux: how much energy do we need to prevent recanalizations?Vasc Endovascular Surg2008; 42: 141–149.
15.
GolbasiITurkayCErbasanO. Endovenous laser with miniphlebectomy for treatment of varicose veins and effect of different levels of laser energy on recanalization. A single center experience. Lasers Med Sci2015; 30: 103–108.
16.
TimpermanPE. Prospective evaluation of higher energy great saphenous vein endovenous laser treatment. J Vasc Interv Radiol2005; 16: 791–794.
17.
GoldmanMPMauricioMRaoJ. Intravascular 1320-nm laser closure of the great saphenous vein: a 6- to 12-month follow-up study. Dermatol Surg2004; 30: 1380–1385.
18.
SchwarzTvon HodenbergEFurtwanglerC. Endovenous laser ablation of varicose veins with the 1470-nm diode laser. J Vasc Surg2010; 51: 1474–1478.
19.
HirokawaMKuriharaN. Comparison of bare-tip and radial fiber in endovenous laser ablation with 1470 nm diode laser. Ann Vasc Dis2014; 7: 239–245.
20.
VuylstekeMEVandekerckhovePJDe BoT. Use of a new endovenous laser device: results of the 1,500 nm laser. Ann Vasc Surg2010; 24: 205–211.
21.
van den BosRRvan RuijvenPWvan der GeldCW. Endovenous simulated laser experiments at 940 nm and 1470 nm suggest wavelength-independent temperature profiles. Eur J Vasc Endovasc Surg2012; 44: 77–81.
22.
CavalliniAMarcerDFerrari RuffinoS. Endovenous ablation of incompetent saphenous veins with a new 1,540-nanometer diode laser and ball-tipped fiber. Ann Vasc Surg2014; 28: 686–694.
23.
VuylstekeMEThomisSMahieuP. Endovenous laser ablation of the great saphenous vein using a bare fibre versus a tulip fibre: a randomised clinical trial. Eur J Vasc Endovasc Surg2012; 44: 587–592.
24.
Pannier F, Rabe E, Rits J, et al. Endovenous laser ablation of great saphenous veins using a 1470 nm diode laser and the radial fibre-follow-up after six months. Phlebology 2011; 26: 35–39.
25.
DoganciSDemirkilicU. Comparison of 980 nm laser and bare-tip fibre with 1470 nm laser and radial fibre in the treatment of great saphenous vein varicosities: a prospective randomised clinical trial. Eur J Vasc Endovasc Surg2010; 40: 254–259.
26.
VuylstekeMVan DorpeJRoelensJ. Intraluminal fibre-tip centring can improve endovenous laser ablation: a histological study. Eur J Vasc Endovasc Surg2010; 40: 110–116.
27.
MordonSR. Endovenous laser treatment of the great saphenous vein: Measurement of the pullback speed of the fiber by magnetic tracking. IRBM2013; 34: 252–256.
28.
YangCHChouHSLoYF. Incompetent great saphenous veins treated with endovenous 1,320-nm laser: results for 71 legs and morphologic evolvement study. Dermatol Surg2006; 32: 1453–1457.
29.
MassakiABKiripolskyMGDetwilerSP. Endoluminal laser delivery mode and wavelength effects on varicose veins in an ex vivo model. Lasers Surg Med2013; 45: 123–129.
30.
KansakuRSakakibaraNAmanoA. Histological difference between pulsed wave laser and continuous wave laser in endovenous laser ablation. Phlebology2015; 30: 429–434.
31.
CorcosLDiniSDe AnnaD. The immediate effects of endovenous diode 808-nm laser in the greater saphenous vein: morphologic study and clinical implications. J Vasc Surg2005; 41: 1018–1024; discussion 25.
32.
KimHSNwankwoIJHongK. Lower energy endovenous laser ablation of the great saphenous vein with 980 nm diode laser in continuous mode. Cardiovasc Intervent Radiol2006; 29: 64–69.
33.
MordonSRWassmerBZemmouriJ. Mathematical modeling of 980-nm and 1320-nm endovenous laser treatment. Lasers Surg Med2007; 39: 256–265.
34.
DesmyttereJGrardCStalnikiewiczG. Endovenous laser ablation (980 nm) of the small saphenous vein in a series of 147 limbs with a 3-year follow-up. Eur J Vasc Endovasc Surg2010; 39: 99–103.
35.
RathodJTaoriKJoshiM. Outcomes using a 1470-nm laser for symptomatic varicose veins. J Vasc Interv Radiol2010; 21: 1835–1840.
36.
RaviRTraylerEABarrettDA. Endovenous thermal ablation of superficial venous insufficiency of the lower extremity: single-center experience with 3000 limbs treated in a 7-year period. J Endovasc Ther2009; 16: 500–505.
37.
DesmyttereJGrardCWassmerB. Endovenous 980-nm laser treatment of saphenous veins in a series of 500 patients. J Vasc Surg2007; 46: 1242–1247.
38.
MaurinsURabeEPannierF. Does laser power influence the results of endovenous laser ablation (EVLA) of incompetent saphenous veins with the 1 470-nm diode laser? A prospective randomized study comparing 15 and 25 W. Int Angiol2009; 28: 32–37.
39.
PannierFRabeEMaurinsU. First results with a new 1470-nm diode laser for endovenous ablation of incompetent saphenous veins. Phlebology2009; 24: 26–30.
