Endovenous Laser Treatment of Saphenous Vein Reflux: How Much Energy Do We Need to Prevent Recanalizations?

Abstract

The aim of this study was to report the results of high-energy endovenous laser treatment to measure the relationship between the fluence and the outcome in terms of recanalization. In 97 patients, 129 great saphenous veins were treated with endovenous laser treatment, using a 980-nm diode laser. Follow-up visits were done at 3 days, 1 month, and 6 months. The best results were noted 1 month postoperative, but at 6 months, control late recanalizations occured decreasing occlusion rate to 90.6%. Patients were divided into 2 groups according to the outcome (occlusion or recanalization) at 6 months, and statistical analysis was done. The authors found 52 J/cm² mean fluence in the occlusion group and 43.7 J/cm² in the nonocclusion group. This was a statistical significant difference (P < .01). The occlusion rate on long term is fluence dependent. But recanalizations might occur even in these higher fluence treatment groups. A fluence of 52J/cm² is advised.

Keywords

varicose disease endovenous laser treament

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References

Callam MJ Epidemiology of varicose veins. Br J Surg. 1994;81:167-173.

Goldman MP , Weiss RA , Bergan JJ Diagnosis and treatment of varicose veins: a review. J Am Acad Dermatol. 1994;31:393-416.

Parente EJ , Rosenblatt M. Endovenous laser treatment to promote venous occlusion. Lasers Surg Med. 2003; 33:115-118.

Oh CK , Jung DS , Jang HS , Kwon KS Endovenous laser surgery of the incompetent greater saphenous vein with a 980-nm diode laser. Dermatol Surg. 2003;29:1135-1140.

Bergan JJ , Kumins NH , Owens EL , Sparks SR Surgical and endovascular treatment of lower extremity venous insufficiency . J Vasc Interv Radiol. 2002;13:563-568.

Rautio T. , Ohinmaa A. , Perälä J. , et al. Endovenous obliteration versus conventional stripping operation in the treatment of primary varicose veins: a randomised controlled trial with comparison of the costs. J Vasc Surg. 2002;35:958-965.

Vuylsteke M. , Vanden Bussche D. , Audenaert EA , et al. Endovenous laser obliteration for the treatment of primary varicose veins. Phlebology. 2006;21:80-87.

Cambell WB , Vijay Kumar A. , Allington KL , Michaels JA The outcome of varicose vein surgery at 10 years: clinical findings, symptoms and patient satisfaction. Ann R Coll Surg Engl. 2003;85:52-57.

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

10.

Weiss RA Endovenous techniques for elimination of saphenous reflux: a valuable treatment modality. Dermatol Surg. 2001;27:902-905.

11.

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. 2002;35:729-736.

12.

Chang CJ , Chua JJ Endovenous laser photocoagulation (EVLP) for varicose veins. Lasers Surg Med. 2002;31: 257-262.

13.

Goldman MP , Mauricio M. , Rao J. Intravascular 1320-nm laser closure of the great saphenous vein: a 6 to 12 month follow-up study. Dermatol Surg. 2004 ;30:1380-1385.

14.

Min RJ , Zimmet SE , Isaac MN , Forrestal MD Endovenous blaser treatment of the incompetent greater saphenous vein. J Vasc Interv Radiol. 2001;12: 1167-1171.

15.

Proebstle TM , Krummenauer F. , Knop GJD , et al. Nonocclusion and early reopening of the great saphenous vein after endovenous laser treatment is fluence dependent . Dermatol Surg. 2004;30:174-178.

16.

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

17.

Desmyttere J. , Grard C. , Mordon S. A 2 years follow-up study of endovenous 980nm laser treatment of the great saphenous vein: role of the blood content in the GSV. Med Laser Appl. 2005;20:283-289.

18.

Van den Bussche D. , Moreels N. , De Letter J. , Lanckneus M. Endovenous laser treatment for primary varicose veins. Acta Chir Belg. 2006;106:32-35.

19.

Kalra M. , Gloviczki P. Fifteen years ago laser was supposed to open arteries, now it is supposed to close veins: what is the reality behind the tool. Perspect Vasc Surg Endovasc Ther. 2006;18:3-8;discussion 9-10.

20.

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. 2002;28:596-600.

21.

Timperman PE Prospective evaluation of higher energy great sap henous vein endovenous laser treatment. J Vasc Interv Radiol. 2005;16:791-794.

22.

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. 2004;11: 132-138.

23.

Mordon SR , Wassmer B. , Zemmouri J. Mathematical modeling of endovenous laser treatment (ELT). Biomed Eng Online. 2006;25:5-26

24.

Proebstle TM , Moehler T. , Gûl D. , Herdemann S. Endovenous treatment of the great saphenous vein using a 1320 nm Nd:YAG laser causes fewer side effects than using a 940 nm Diode laser. Dermatol Surg. 2005;31:1678-1684.

25.

Schmedt CG , Sroka R. , Steckmeier S. , et al. Investigation on radiofrequency and laser (980 nm) effects after endoluminal treatment of saphneous vein insufficiency in an ex-vivo model . Eur J Endovasc Surg. 2006;32: 318-325.