Advertisement

Lasers in Medical Science

, Volume 29, Issue 2, pp 423–429 | Cite as

Temperature profiles of 980- and 1,470-nm endovenous laser ablation, endovenous radiofrequency ablation and endovenous steam ablation

  • W. S. J. MalskatEmail author
  • M. A. L. Stokbroekx
  • C. W. M. van der Geld
  • T. E. C. Nijsten
  • R. R. van den BosEmail author
Original Article

Abstract

Endovenous thermal ablation (EVTA) techniques are very effective for the treatment of varicose veins, but their exact working mechanism is still not well documented. The lack of knowledge of mechanistic properties has led to a variety of EVTA protocols and a commercially driven dissemination of new or modified techniques without robust scientific evidence. The aim of this study is to compare temperature profiles of 980-and 1,470-nm endovenous laser ablation (EVLA), segmental radiofrequency ablation (RFA), and endovenous steam ablation (EVSA). In an experimental setting, temperature measurements were performed using thermocouples; raw potato was used to mimic a vein wall. Two laser wavelengths (980 and 1,470 nm) were used with tulip-tip fibers and 1,470 nm also with a radial-emitting fiber. Different powers and pullback speeds were used to achieve fluences of 30, 60, and 90 J/cm. For segmental RFA, 1 cycle of 20 s was analyzed. EVSA was performed with two and three pulses of steam per centimeter. Maximum temperature increase, time span of relevant temperature increase, and area under the curve of the time of relevant temperature increase were measured. In all EVLA settings, temperatures increased and decreased rapidly. High fluence is associated with significantly higher temperatures and increased time span of temperature rise. Temperature profiles of 980- and 1,470-nm EVLA with tulip-tip fibers did not differ significantly. Radial EVLA showed significantly higher maximum temperatures than tulip-tip EVLA. EVSA resulted in mild peak temperatures for longer durations than EVLA. Maximum temperatures with three pulses per centimeter were significantly higher than with two pulses. RFA temperature rises were relatively mild, resulting in a plateau-shaped temperature profile, similar to EVSA. Temperature increase during EVLA is fast with a high-peak temperature for a short time, where EVSA and RFA have longer plateau phases and lower maximum temperatures.

Keywords

Endovenous thermal ablation Varicose veins Temperature profiles 

References

  1. 1.
    van den Bos R, Arends L, Kockaert M, Neumann M, Nijsten T (2009) Endovenous therapies of lower extremity varicosities: a meta-analysis. J Vasc Surg 49:230–9PubMedCrossRefGoogle Scholar
  2. 2.
    van den Bos RR, Milleret R, Neumann M, Nijsten T (2010) Proof-of-principle study of steam ablation as novel thermal therapy for saphenous varicose veins. J Vasc Surg 53:181–6Google Scholar
  3. 3.
    Mordon SR, Wassmer B, Reynaud JP, Zemmouri J (2008) Mathematical modeling of laser lipolysis. Biomed Eng Online 7:10PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Proebstle TM, Sandhofer M, Kargl A et al (2002) Thermal damage of the inner vein wall during endovenous laser treatment: key role of energy absorption by intravascular blood. Dermatol Surg 28:596–600PubMedCrossRefGoogle Scholar
  5. 5.
    Fan CM, Rox-Anderson R (2008) Endovenous laser ablation: mechanism of action. Phlebology 23:206–13PubMedCrossRefGoogle Scholar
  6. 6.
    Mordon SR, Wassmer B, Zemmouri J (2006) Mathematical modeling of endovenous laser treatment (ELT). Biomed Eng Online 5:26PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    van den Bos RR, van Ruijven PW, van der Geld CW, van Gemert MJ, Neumann HA, Nijsten T (2012) Endovenous simulated laser experiments at 940 nm and 1470 nm suggest wavelength-independent temperature profiles. Eur J Vasc Endovasc Surg 44:77–81PubMedCrossRefGoogle Scholar
  8. 8.
    van Ruijven PW, van den Bos RR, Alazard LM, van der Geld CW, Nijsten T (2011) Temperature measurements for dose-finding in steam ablation. J Vasc Surg 53:1454–6PubMedCrossRefGoogle Scholar
  9. 9.
    Nijsten T, van den Bos RR, Goldman MP et al (2009) Minimally invasive techniques in the treatment of saphenous varicose veins. J Am Acad Dermatol 60:110–9PubMedCrossRefGoogle Scholar
  10. 10.
    Vuylsteke M, Van Dorpe J, Roelens J, De Bo T, Mordon S, Fourneau I (2010) Intraluminal fibre-tip centring can improve endovenous laser ablation: a histological study. Eur J Vasc Endovasc Surg 40:110–6PubMedCrossRefGoogle Scholar
  11. 11.
    Pannier F, Rabe E, Rits J, Kadiss A, Maurins U (2011) Endovenous laser ablation of great saphenous veins using a 1470 nm diode laser and the radial fibre–follow-up after six months. Phlebology 26:35–9PubMedCrossRefGoogle Scholar
  12. 12.
    Biesman BS, Khan J (2000) Laser incisional surgery. Clin Plast Surg 27(2):213–220PubMedGoogle Scholar
  13. 13.
    Moritz AR, Henriques FC (1947) Studies of thermal injury: II. The relative importance of time and surface temperature in the causation of cutaneous burns. Am J Pathol 23:695–720PubMedCentralPubMedGoogle Scholar
  14. 14.
    Vangsness CT Jr, Mitchell W III, Nimni M, Erlich M, Saadat V, Schmotzer H (1997) Collagen shortening. An experimental approach with heat. Clin Orthop Relat Res 337:267–271PubMedCrossRefGoogle Scholar
  15. 15.
    Rasmussen LH, Lawaetz M, Bjoern L, Vennits B, Blemings A, Eklof B (2011) Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg 98:1079–87PubMedCrossRefGoogle Scholar
  16. 16.
    Almeida J, Mackay E, Javier J, Mauriello J, Raines J (2009) Saphenous laser ablation at 1470 nm targets the vein wall, not blood. Vasc Endovascular Surg 43:467–72PubMedCrossRefGoogle Scholar
  17. 17.
    Proebstle TM, Moehler T, Gul D, Herdemann S (2005) 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 Surg 31:1678–83, discussion 83–4PubMedCrossRefGoogle Scholar
  18. 18.
    Doganci S, Demirkilic U (2010) 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 Surg 40:254–9PubMedCrossRefGoogle Scholar
  19. 19.
    Proebstle TM, Vago B, Alm J, Gockeritz O, Lebard C, Pichot O (2008) Treatment of the incompetent great saphenous vein by endovenous radiofrequency powered segmental thermal ablation: first clinical experience. J Vasc Surg 47:151–6PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • W. S. J. Malskat
    • 1
    Email author
  • M. A. L. Stokbroekx
    • 1
  • C. W. M. van der Geld
    • 2
  • T. E. C. Nijsten
    • 1
  • R. R. van den Bos
    • 1
    Email author
  1. 1.Department of DermatologyErasmus Medical CenterRotterdamThe Netherlands
  2. 2.Department of Mechanical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands

Personalised recommendations