We sought to investigate the mid-term and long-term efficacy of 1470 nm endovenous laser ablation (EVLA).
Material and Methods:
We conducted a systematic research on PubMed, Scopus, and Web of science for articles published by January 2024. The primary endpoints were truncal vein and great saphenous vein (GSV) occlusion.
Results:
Fifteen studies, 4 randomized controlled trials (RCTs), 5 prospective, and 6 retrospective case series, including 2064 patients and 2125 truncal veins (1862 GSV) were included. The pooled truncal vein occlusion estimates at 2, 3, and 5 years were 93.51% (95% confidence interval [CI]: 90.01, 95.84), 89.60% (95% CI: 82.75, 93.93), 88.94% (95% CI: 81.59, 93.58). The pooled GSV occlusion at 2, 3, and 5 years were 93.90% (95% CI: 90.30, 96.21), 93.01% (95% CI: 82.80, 97.36), and 89.06% (95% CI: 80.55, 94.12), respectively. The pooled deep vein thrombosis (DVT) and burn estimates were 1.42% (95% CI: 0.87, 2.31) and 2.64% (95% CI: 1.19, 5.75), respectively. The pooled overall and permanent neurologic complication estimates were 4.33% (95% CI: 1.62, 11.12) and 1.70% (95% CI: 0.69, 4.13), respectively. The pooled Venous Clinical Severity Score (VCSS) reduction by the end of follow-up was, mean difference (MD), 4.96 (95% CI: 3.87, 6.05). Meta-regression analysis including linear endovenous energy density (LEED) values ranging from 69 to 101.7 J/cm elucidated a statistically significant positive association between LEED and GSV occlusion at the 2-year (β=0.0977, p=0.02), 3-year (β=0.2021, p<0.01) and 5-year (β=0.0534, p=0.01) follow-up intervals.
Conclusion:
This review has displayed satisfactory medium and long-term truncal and GSV occlusion outcomes for the 1470 nm device. In addition, a positive association between GSV occlusion and LEED was identified, persisting through the 2-year, 3-year, and 5-year follow-up intervals. Despite these favorable findings further research is imperative, focusing not only on technical aspects, such as vein occlusion but also on critical clinical parameters, including varicose vein recurrence, to comprehensively evaluate the effectiveness and durability of EVLA.
Clinical Impact
This review demonstrated the efficacy and safety of the 1470 nm EVLA device in the treatment of lower limb venous insufficiency over the medium- and long-term periods, further substantiating its continued use. Moreover, the consistent positive association between linear endovenous energy density (LEED) and occlusion outcomes across the five-year follow-up interval highlighted the critical role of LEED in optimizing long-term clinical results, potentially offering valuable insights for practitioners.
Beebe-DimmerJLPfeiferJREngleJS, et alThe epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005;15(3):175–184. doi:10.1016/j.annepidem.2004.05.015.
2.
BontinisVBontinisAKoutsoumpelisA, et alA network meta-analysis on the efficacy and safety of thermal and nonthermal endovenous ablation treatments. J Vasc Surg Venous Lymphat Disord. 2023;11(4):854–865.e5. doi:10.1016/j.jvsv.2023.03.011.
3.
De MaeseneerMGKakkosSKAherneT, et alEditor’s choice–European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg. 2022;63(2):184–267. doi:10.1016/j.ejvs.2021.12.024.
4.
NasserMMGhoneimBEl DalyW, et alComparative study between endovenous laser ablation (EVLA) with 1940 nm versus EVLA with 1470 nm for treatment of incompetent great saphenous vein and short saphenous vein: a randomized controlled trial. J Vasc Surg Venous Lymphat Disord. 2024:101960. doi:10.1016/j.jvsv.2024.101960.
5.
PalombiLMorelliMBruzzeseD, et alEndovenous laser ablation (EVLA) for vein insufficiency: two-year results of a multicenter experience with 1940-nm laser diode and a novel optical fiber. Lasers Med Sci. 2024;39(1):61. doi:10.1007/s10103-024-04000-7.
6.
SetiaADikicSDemhasajS, et alProspects of Endovenous Laser Ablation (EVLA) standardization-mid-term results of a four-zone dosimetry guiding tool for 1940 nm laser. J Clin Med. 2023;12(13):4313. doi:10.3390/jcm12134313.
7.
KeoHHSommaCRegliC, et alSafety, feasibility, and early efficacy of the water-specific 1940-nm laser wavelength for ablation of saphenous incompetence. J Vasc Surg Cases Innov Tech. 2023;9(2):101125. doi:10.1016/j.jvscit.2023.101125.
8.
PalombiLMorelliMBruzzeseD, et alEndovascular laser treatment. Comparison of lasers and fibers of different generations: study of temperatures and tissue damage produced on a porcine liver model. Lasers Med Sci. 2023;38(1):105. doi:10.1007/s10103-023-03770-w.
9.
BontinisVBontinisAGiannopoulosA, et alEndovenous laser ablation (EVLA) 980 nm versus 1470 nm and the impact of fiber type: a systematic review and meta-analysis. Lasers Med Sci. 2024;39(1):165. doi:10.1007/s10103-024-04112-0.
10.
MalskatWSJEngelsLKHollesteinLM, et alCommonly Used Endovenous Laser Ablation (EVLA) parameters do not influence efficacy: results of a systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2019;58(2):230–242. doi:10.1016/j.ejvs.2018.10.036.
11.
AmzayybMvan den BosRRKodachVM, et alCarbonized blood deposited on fibres during 810, 940 and 1,470 nm endovenous laser ablation: thickness and absorption by optical coherence tomography. Lasers Med Sci. 2010;25(3):439–447. doi:10.1007/s10103-009-0749-1.
12.
NielsenAGCroucherAAMuschampSD, et alLinear endovenous energy density (LEED) should always be quoted with the power used in endovenous thermal ablation—results from an in-vitro porcine liver model study. Phlebology. 2023;38(3):172–180. doi:10.1177/02683555231156015.
13.
PageMJMcKenzieJEBossuytPM, et alThe PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71.
14.
GuyotPAdesAEOuwensMJ, et alEnhanced secondary analysis of survival data: reconstructing the data from published Kaplan-Meier survival curves. BMC Med Res Methodol. 2012;12:9. doi:10.1186/1471-2288-12-9.
15.
LuoDWanXLiuJ, et alOptimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res. 2018;27(6):1785–1805. doi:10.1177/0962280216669183.
16.
WanXWangWLiuJ, et alEstimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014;14:135. doi:10.1186/1471-2288-14-135.
17.
HigginsJPDeeksJJ.Selecting studies and collecting data. In: HigginsJPDeeksJJ, eds. Cochrane Handbook for Systematic Reviews of Interventions. Hoboken, NJ: John Wiley; 2008:151–185.
18.
SterneJAHernánMAReevesBC, et alROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. doi:10.1136/bmj.i4919.
19.
SlimKNiniEForestierD, et alMethodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712–716. doi:10.1046/j.1445-2197.2003.02748.x.
20.
GuvenH.Evaluating endovenous laser and glue ablation in the treatment of great saphenous vein insufficiency: a 5-year retrospective comparative study. Turk J Vasc Surg. 2023; 32(3):133–140.
21.
Hamel-DesnosCNyamekyeIChauzatB, et alFOVELASS: a randomised trial of endovenous laser ablation versus polidocanol foam for small saphenous vein incompetence. Eur J Vasc Endovasc Surg. 2023;65(3):415–423.
22.
AtikCOzcalişkanOAtikD.5-year clinical results of 1073 patients with varicose veins treated using radiofrequency ablation, endovenous laser ablation and cyanoacrylate embolisation. Sanamed. 2023;18(1):45–52.
23.
El KilicHBektasNBitargilM, et alLong-term outcomes of endovenous laser ablation, n-butyl cyanoacrylate, and radiofrequency ablation for treatment of chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord. 2022;10(4):865–871.
24.
SilvaAPPPintoDMMilagresVAMV, et alResults of venous reflux treatment with 1,470 nm endolaser and correlation with degree of venous insufficiency. J Vasc Bras. 2021;20:e20200172.
25.
WilczkoJSzaryCPlucinskaD, et alTwo-year follow-up after endovenous closure with short-chain cyanoacrylate versus laser ablation in venous insufficiency. J Clin Med. 2021;10(4):628.
26.
WestinGGCayneNSLeeV, et alRadiofrequency and laser vein ablation for patients receiving warfarin anticoagulation is safe, effective, and durable. J Vasc Surg Venous Lymphat Disord. 2020;8(4):610–616.
27.
VähäahoSHalmesmäkiKMahmoudO, et alThree-year results of a randomized controlled trial comparing mechanochemical and thermal ablation in the treatment of insufficient great saphenous veins. J Vasc Surg Venous Lymphat Disord. 2021;9(3):652–659.
28.
KarmotaAGDesokyHF.Endovenous laser ablation vs conventional surgery in the management of superficial venous insufficiency. Egypt J Surg. 2020;39(3):731–737.
29.
PaveiPSpreaficoGBernardiE, et alFavorable long-term results of endovenous laser ablation of great and small saphenous vein incompetence with a 1470-nm laser and radial fiber. J Vasc Surg Venous Lymphat Disord. 2021;9(2):352–360.
30.
ErogluEYasimA.A randomised clinical trial comparing N-butyl cyanoacrylate, radiofrequency ablation and endovenous laser ablation for the treatment of superficial venous incompetence: two year follow up results. Eur J Vasc Endovasc Surg. 2018;56(4):553–560.
31.
LawsonJAGauwSAvan VlijmenCJ, et alProspective comparative cohort study evaluating incompetent great saphenous vein closure using radiofrequency-powered segmental ablation or 1470-nm endovenous laser ablation with radial-tip fibers (Varico 2 study). J Vasc Surg Venous Lymphat Disord. 2018;6(1):31–40.
32.
SporbertFZollmannCZollmannP, et alEndoluminal thermal ablation of the great saphenous vein (GSV) insufficiency: laser and radiofrequency results after five years. Endoluminale Therapie der Vena saphena magna (VSM) bei Varikose/CVI. Phlebologie2016;45(6):357–362. doi:10.12687/phleb2336-6-2016.
33.
Arslan ÇalıkÜETortM, et alMore successful results with less energy in endovenous laser ablation treatment: long-term comparison of bare-tip fiber 980 nm laser and radial-tip fiber 1470 nm laser application. Ann Vasc Surg. 2017;45:166–172. doi:10.1016/j.avsg.2017.06.042.
34.
KalodikiEAzzamMSchnatterbeckP, et alThe Discord Outcome Analysis (DOA) as a reporting standard at three months and five years in randomised varicose vein treatment trials. Eur J Vasc Endovasc Surg. 2019;57(2):267–274. doi:10.1016/j.ejvs.2018.09.013.
35.
GauwSALawsonJAvan Vlijmen-van KeulenCJ, et alFive-year follow-up of a randomized, controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia. J Vasc Surg. 2016;63(2):420–428. doi:10.1016/j.jvs.2015.08.084.
36.
RassKFringsNGlowackiP, et alSame site recurrence is more frequent after endovenous laser ablation compared with high ligation and stripping of the great saphenous vein: 5 year results of a Randomized Clinical Trial (RELACS Study). Eur J Vasc Endovasc Surg. 2015;50(5):648–656. doi:10.1016/j.ejvs.2015.07.020.
37.
EggenCAMAlozaiTPronkP, et alTen-year follow-up of a randomized controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia. J Vasc Surg Venous Lymphat Disord. 2022;10(3):646–653.e1. doi:10.1016/j.jvsv.2021.08.008.
38.
RasmussenLLawaetzMBjoernL, et alRandomized clinical trial comparing endovenous laser ablation and stripping of the great saphenous vein with clinical and duplex outcome after 5 years. J Vasc Surg. 2013;58(2):421–426. doi:10.1016/j.jvs.2012.12.048.
39.
WallaceTEl-SheikhaJNandhraS, et alLong-term outcomes of endovenous laser ablation and conventional surgery for great saphenous varicose veins. Br J Surg. 2018;105(13): 1759–1767. doi:10.1002/bjs.10961.
40.
ProebstleTMMoehlerTGülD, et alEndovenous 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 Surg. 2005;31(12):1678; discussion 1683–1684. doi:10.2310/6350.2005.31308.
41.
TheivacumarNSDellagrammaticasDBealeRJ, et alFactors influencing the effectiveness of endovenous laser ablation (EVLA) in the treatment of great saphenous vein reflux. Eur J Vasc Endovasc Surg. 2008;35(1):119–123. doi:10.1016/j.ejvs.2007.08.010.
42.
GolbasiITurkayCErbasanO, et alEndovenous laser with miniphlebectomy for treatment of varicose veins and effect of different levels of laser energy on recanalization. A single center experience. Lasers Med Sci. 2015;30(1):103–108. doi:10.1007/s10103-014-1626-0.
43.
CowplandCACleeseALWhiteleyMS.Factors affecting optimal linear endovenous energy density for endovenous laser ablation in incompetent lower limb truncal veins: a review of the clinical evidence. Phlebology. 2017;32(5):299–306. doi:10.1177/0268355516648067.
44.
HeinebergLFBrandãoABFCaronFC, et alInfluence of linear intravenous energy density on the success of intravenous laser ablation for treatment of chronic venous insufficiency. J Vasc Bras. 2019;18:e20190009. doi:10.1590/1677-5449.190009.
45.
O’DonnellTFBalkEMDermodyM, et alRecurrence of varicose veins after endovenous ablation of the great saphenous vein in randomized trials. J Vasc Surg Venous Lymphat Disord. 2016;4(1):97–105. doi:10.1016/j.jvsv.2014.11.004.
46.
Van der VeldenSKLawaetzMDe MaeseneerMGR, et alPredictors of recanalization of the great saphenous vein in randomized controlled trials 1 year after endovenous thermal ablation. Eur J Vasc Endovasc Surg. 2016;52(2):234–241. doi:10.1016/j.ejvs.2016.01.021.
47.
IgnatievaNYZakharkinaOLMasayshviliCV, et alThe role of laser power and pullback velocity in the endovenous laser ablation efficacy: an experimental study. Lasers Med Sci. 2017;32(5):1105–1110. doi:10.1007/s10103-017-2214-x.
48.
SrivatsaSSChungSSidhuV.The relative roles of power, linear endovenous energy density, and pullback velocity in determining short-term success after endovenous laser ablation of the truncal saphenous veins. J Vasc Surg Venous Lymphat Disord. 2019;7(1):90–97. doi:10.1016/j.jvsv.2018.07.018.
49.
BontinisVBontinisAKoutsoumpelisA, et alEndovenous thermal ablation in the treatment of large great saphenous veins of diameters > 12 mm: a systematic review meta-analysis and meta-regression. Vasc Med. 2023;28(5):449–457. doi:10.1177/1358863X231183997.
50.
AthavaleAMonahanDFukayaE.A systematic review on ablation techniques for larger saphenous veins in patients with symptomatic superficial venous disease. J Vasc Surg Venous Lymphat Disord. 2024;12(1):101681. doi:10.1016/j.jvsv.2023.08.020.
51.
HagerESOzvathKJDillavouEDEvidence summary of combined saphenous ablation and treatment of varicosities versus staged phlebectomy. J Vasc Surg Venous Lymphat Disord. 2017;5(1):134–137. doi:10.1016/j.jvsv.2016.07.009.
52.
ConwayRGAlmeidaJIKabnickL, et alClinical response to combination therapy in the treatment of varicose veins. J Vasc Surg Venous Lymphat Disord. 2020;8(2):216–223. doi:10.1016/j.jvsv.2019.10.015.
53.
Bellmunt-MontoyaSEscribanoJMPantoja BustillosPE, et alCHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Syst Rev. 2021;9(9):Cd009648. doi:10.1002/14651858.CD009648.pub4.
54.
HirokawaMKuriharaN.Comparison of bare-tip and radial fiber in endovenous laser ablation with 1470 nm diode laser. Ann Vasc Dis. 2014;7(3):239–245. doi:10.3400/avd.oa.14-00081.
55.
GeissbühlerMHincapiéCAAghlmandiS, et alMost published meta-regression analyses based on aggregate data suffer from methodological pitfalls: a meta-epidemiological study. BMC Med Res Methodol. 2021;21(1):123. doi:10.1186/s12874-021-01310-0.
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