No significant differences in ultrasound morphology after endovenous laser ablation with 1940-nm versus 1470-nm radially emitting fibers: A one-year prospective randomized multicenter study

Abstract

Background

Endovenous laser ablation (EVLA) is a guideline-recommended treatment for great saphenous vein (GSV) incompetence. Higher-wavelength lasers (1470 nm, 1940 nm) with radial fibers aim to improve efficacy while reducing postoperative morbidity. Prospective comparisons remain limited.

Methods

In this multicenter, randomized trial, 66 patients (31 women, 35 men; mean age 54.8 ± 13.6 years) with symptomatic GSV reflux (CEAP C2–C5) were assigned to EVLA using a 1940-nm (Group 1; n = 32) or 1470-nm laser (Group 2; n = 34). Procedures employed standardized radial fibers and identical target LEED (160 J/cm for the first 5 cm, 80 J/cm thereafter). The primary endpoint was ultrasound-based vein morphology (diameter, resorption) at 3, 6, and 12 months. Secondary endpoints included occlusion rates, postoperative pain, sensory disturbances, complications, and quality of life. Outcome assessors were blinded during postoperative examinations.

Results

Baseline characteristics were comparable between groups. During follow-up, 4 patients in Group 1 and one in Group 2 discontinued participation. Complete occlusion was achieved in all patients. No significant differences in vein diameter reduction or resorption were observed between groups. Complete vein resorption at 12 months occurred in 67.9% (Group 1) and 48.5% (Group 2; p = .194). Postoperative pain scores were lower in the 1940-nm group at first follow-up in exploratory analyses, and fewer sensory disturbances occured (7.1% vs 24.1%; p = .092), without statistical significance. Interpretation is limited by differences in applied power (1940 nm: 8 W; 1470 nm: including cases treated at 10 W). No deep vein thrombosis or endothermal heat-induced thrombosis occurred.

Conclusion

In this randomized study, no significant differences in ultrasound-based morphological outcomes were observed between 1940-nm and 1470-nm EVLA for GSV incompetence. These findings support comparable efficacy between 1940-nm and 1470-nm EVLA; however, larger studies powered for clinical outcomes are required to confirm potential differences in postoperative morbidity.

Keywords

endovenous laser ablation great saphenous vein 1940-nm laser 1470-nm laser duplex ultrasound postoperative pain

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