Lasers in Medical Science

, Volume 29, Issue 2, pp 405–422 | Cite as

Endovascular laser–tissue interactions and biological responses in relation to endovenous laser therapy

  • Michal Heger
  • Rowan F. van Golen
  • Mans Broekgaarden
  • Renate R. van den Bos
  • H. A. Martino Neumann
  • Thomas M. van Gulik
  • Martin J. C. van Gemert
Original Article


Endovenous laser treatment (ELT) has evolved into a frequently employed modality for the treatment of leg varicose veins. Due to the very high complete response rates, minimal complications and side effects, and the possibility to monitor therapeutic outcome noninvasively by duplex ultrasound, a considerable amount of reports have been published on clinical and translational studies, whereas disproportionally few studies have been performed to elucidate the molecular and cellular basis for post-ELT vessel obliteration. Consequently, this review addresses the putative molecular and cellular mechanisms responsible for varicose vein obliteration following laser irradiation in the context of endovenous laser–tissue interactions. First, the histological profile of laser-treated varicose veins is summarized, and an account is given of the temporal and spatial dynamics of cells involved in inflammation and remodeling in the heat-affected vein segment. Inasmuch as thrombotic occlusion of the venous lumen blocks circulatory access to the affected vessel segment and thermal damage in the vascular wall causes most cells to die, the majority of cells involved in inflammation and remodeling have to be recruited. Second, the (possible) biochemical triggers for the chemotactic attraction of immune cells and fibroblasts are identified, comprising (1) thermal coagula, (2) thrombi, (3) dead and dying cells in the vein wall, and (4) thermally denatured extracellular matrix proteins in the vein wall. The molecular biology underlying the chemotactic signaling and subsequent obliterative remodeling is elucidated. Finally, the relative contribution of every biochemical trigger to obliterative remodeling is addressed.


Endovenous laser ablation Varicose veins Great saphenous vein Tissue remodeling Venous thrombus organization Fibrosis Inflammation Cytokines and chemokines Damage-associated molecular patterns Innate immune response Phagocytosis 



Adenosine triphosphate


CC chemokine ligand


Chemokine (C–X–C motif) ligand


Damage-associated molecular pattern


Deoxyribonucleic acid


Endothelial cell


Extracellular matrix


Endovenous laser ablation


Extracellular-signal-regulated kinase


Fibroblast growth factor


High-mobility group box 1


Heat shock protein


Intercellular adhesion molecule




c-Jun N-terminal kinase


Monocyte chemotactic protein


Macrophage inflammatory protein


Matrix metalloproteinase


Macrophage scavenging receptor


Platelet-derived growth factor


P-selectin glycoprotein ligand


Receptor for advanced glycation end products


Ribonucleic acid


Smooth muscle cell


The human orthologue of the Src (gene), encoding v-src sarcoma (Schmidt-Ruppin A-2) viral oncogene homolog


Transforming growth factor


Tissue inhibitor of metalloproteinases


Toll-like receptor


Tumor necrosis factor


Urokinase-type plasminogen activator



MH is sponsored by grants from the Dutch Anti-Cancer Foundation in Amsterdam (Stichting Nationaal Fonds Tegen Kanker), the Phospholipid Research Center in Heidelberg, the Nijbakker-Morra Foundation in Leiden, and the Stichting Technologische Wetenschap. RFvG is sponsored by an AMC Scholarship grant.


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Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Michal Heger
    • 1
  • Rowan F. van Golen
    • 1
  • Mans Broekgaarden
    • 1
  • Renate R. van den Bos
    • 2
  • H. A. Martino Neumann
    • 2
  • Thomas M. van Gulik
    • 1
  • Martin J. C. van Gemert
    • 3
  1. 1.Department of Experimental Surgery, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.Department of DermatologyErasmus MCRotterdamThe Netherlands
  3. 3.Biomedical Engineering and Physics, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands

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