Fifteen Years Ago Laser was Supposed to Open Arteries,Now it is Supposed to Close Veins: What is the Reality Behind the Tool?

Abstract

Laser first emerged as a technology for use in the vascular arena nearly 20 years ago. The ability of laser to evaporate atherosclerotic plaque was extensively studied; however, the goal of creation of an adequate channel without arterial wall perforation proved to be elusive, and the technique fell into disfavor. More than a decade later, interest in lasers was sparked again with its application to endovenous thermal ablation of axial superficial venous reflux. The mechanism of action of endovenous laser therapy involves thermal damage of the vein wall, resulting in destruction of the intima and collagen denaturation of the media with eventual fibrotic occlusion of the vein. Apart from the obvious attraction of a minimally invasive procedure to ablate superficial venous reflux with its attendant benefits, another advantage of laser ablation includes a potentially decreased incidence of neovascularization in the groin secondary to preservation of superficial venous drainage of the abdominal wall. Early success in terms of ablation of the refluxing saphenous vein has been reported as 90% to 95%. Minor complications are reported in 3% to 10% of patients and include bruising around the puncture site, transient paresthesias, superficial phlebitis, and skin burns or pigmentation. The more serious complications of deep venous thrombosis or extension of thrombus into the femoral vein have been variously reported in 0% to 2.3% of limbs treated. Pulmonary embolism is extremely rare. There is a learning curve, with a decrease in the incidence of all complications with experience. The importance of detailed preoperative and intraoperative duplex ultrasound examination cannot be overemphasized. The identification of all refluxing venous segments and their ablation is the key to optimizing the rate of successful ablation to 97% at 1 year and minimizing recurrence of varicose veins. With encouraging early and mid-term results with endovenous laser therapy, future developments in this field must mandate standardization of technical aspects, follow-up imaging, and reporting.

Keywords

endovenous laser therapy superficial venous reflux atherosclerotic plaque

Get full access to this article

View all access options for this article.

References

1. Wollenek GL , Fasol R , Zilia P , Wolner, E . Laser-induced vascular lesions by cw-NdYAG or pulsed UV lasers during angioplastic procedures. Thorac Cardiovasc Surg 34:63-65, 1986.

2. Geschwind HJ , Teisseire B , Boussignac G , Vieilledent C . Laser angioplasty of arterial stenoses. Cardiovasc Intervent Radiol 9:313-317, 1986.

3. Abela GS , Seeger JM , Barbieri E , et al. Laser angioplasty with angioscopic guidance in humans. J Am Coll Cardiol 8:184-192, 1986.

4. Kaplan MD , Case RB , Choy DS . Vascular recanalization with the argon laser: the role of blood in the transmission of laser energy. Lasers Surg Med 5:275-279, 1985.

5. Navarro L , Min RJ , Bone C . Endovenous laser: a new minimally invasive method of treatment for varicose veins-preliminary observations using an 810 nm diode laser. Dermatol Surg 27:117-122, 2001.

6. Proebstle TM , Lehr HA , Kargl A , et al. Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles. J Vasc Surg 35:729-736, 2002.

7. Proebstle TM , Sandhofer M , Kargl A , et al. Thermal damage of the inner vein wall during endovenous laser treatment: key role of energy absorption by intravascular blood. Dermatol Surg 28:596-600, 2002.

8. Navarro L . Endovenous laser treatment with 810 nm to 980 nm wavelengths: method of action. In: ACP 19th Annual Conference, 2005; San Francisco, Calif; 2005.

9. Weiss RA . Comparison of endovenous radiofrequency versus 810 diode laser occlusion of large veins in an animal model. Deramatol Surg 28:56-61, 2002.

10.

10. Min RJ , Khilnani N , Zimmet SE . Endovenous laser treatment of saphenous vein reflux: long-term results. J Vasc Interv Radiol 14:991-996, 2003.

11.

11. Kabnick LS . Endovenous laser system (980 nm) for the treatment of saphenous vein insufficiency:7611 limbs. In: ACP 19th Annual Conference, 2005; San Francisco, Calif, 2005.

12.

12. Mozes G , Kalra M , Carmo M , Swenson L , Gloviczki P . Extension of saphenous thrombus into the femoral vein: a potential complication of new endovenous ablation techniques. J Vasc Surg 41:130-135, 2005.

13.

13. Gradman WS . Proximal great saphenous vein ligation with laser obliteration of saphenous vein reflux: Is there a risk/benefit ratio? In: ACP 19th Annual Conference, 2005; San Francisco, Calif, 2005.

14.

14. Gibson KDF, B.L. ; Ebert, A. ; Pepper, D. Endovenous laser ablation of the lesser saphenous vein: Results and complications. In: ACP 19th Annual Conference, 2005; San Francisco, Calif, 2005.

15.

15. Weiss RA , Weiss MA . Controlled radiofrequency endovenous occlusion using a unique radiofrequency catheter under duplex guidance to eliminate saphenous varicose vein reflux: a 2-year follow-up. Dermatol Surg 28:38-42, 2002.

16.

16. Perkowski P , Ravi R , Gowda RC , et al. Endovenous laser ablation of the saphenous vein for treatment of venous insufficiency and varicose veins: early results from a large single-center experience. J Endovasc Ther 11:132-138, 2004.

17.

17. Bush RG , Shamma HN , Hammond KA . 940-nm laser for treatment of saphenous insufficiency: histological analysis and long-term follow-up. Photomed Laser Surg 23:15-19, 2005.

18.

18. Timperman PE . Prospective evaluation of higher energy great saphenous vein endovenous laser treatment. J Vasc Interv Radiol 16:791-794, 2005.

19.

19. Proebstle TM , Krummenauer F , Gul D , Knop J . Nonocclusion and early reopening of the great saphenous vein after endovenous laser treatment is fluence dependent. Dermatol Surg 30(2 Pt 1):174-178, 2004.

20.

20. Timperman PE , Sichlau M , Ryu RK . Greater energy delivery improves treatment success of endovenous laser treatment of incompetent saphenous veins. J Vasc Interv Radiol 15:1061-1063, 2004.

21.

21. Proebstle TM . Recanalization of the great saphenous vein (GSV) can be observed at 2 and 3 years after endovenous laser treatment. In: ACP 19th Annual Conference, 2005; San Francisco, Calif, 2005.

22.

22. Proebstle TM , Gul D , Lehr HA , Kargl A , Knop J . Infrequent early recanalization of greater saphenous vein after endovenous laser treatment. J Vasc Surg 38:511-516, 2003.