Abstract
Varicose veins, associated with great saphenous vein (GSV) incompetence, are traditionally treated with conventional surgery. In recent years, minimally invasive alternatives to surgical treatment such as the endovenous laser ablation (EVLA) and radiofrequency (RF) ablation have been developed with promising results. Residual varicose veins following EVLA, regress untouched, or phlebectomy or foam sclerotherapy can be concomitantly performed. The aim of the present study was to investigate the safety and efficacy of EVLA with different levels of laser energy in patients with varicose veins secondary to saphenous vein reflux. From February 2006 to August 2011, 740 EVLA, usually with concomitant miniphlebectomies, were performed in 552 patients. A total of 665 GSV, 53 small saphenous veins (SSV), and 22 both GSV and SSV were treated with EVLA under duplex USG. At 84 patients, bilateral intervention is made. In addition, miniphlebectomy was performed in 540 patients. A duplex ultrasound (US) is performed to patients preoccupying chronic venous insufficiency (with visible varicose veins, ankle edema, skin changes, or ulcer). Saphenous vein incompetence was diagnosed with saphenofemoral, saphenopopliteal, or truncal vein reflux in response to manual compression and release with patient standing. The procedures were performed under local anesthesia with light sedation or spinal anesthesia. Endovenous 980-nm diode laser source was used at a continuous mode. The mean energy applied per length of GSV during the treatment was 77.5 ± 17.0 J (range 60–100 J/cm). An US evaluation was performed at first week of the procedure. Follow-up evaluation and duplex US scanning were performed at 1 and 6 months, and at 1 and 2 years to assess treatment efficacy and adverse reactions. Average follow-up period was 32 ± 4 months (3–55 months). There were one patient with infection and two patients with thrombus extension into the femoral vein after EVLA. Overall occlusion rate was 95 %. No post-procedural deep venous thrombosis or pulmonary embolism occurred. Laser energy, less than 80 J/cm, was significantly associated with increased recanalization of saphenous vein, among the other energy levels. EVLA seems a good alternative to surgery by the application of energy of not less than 80 J/cm. It is both safe and effective. It is a well-tolerated procedure with rare and relatively minor complications.
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References
Caggiati A, Allegra C (2007) Historical introduction. In: Bergan JJ (ed) The vein book. Elsevier Academic Pres, Oxford, pp 1–14
Bergan JJ, Kumins NH, Owens EL, Sparks SR (2002) Surgical and endovascular treatment of lower extremity venous insufficiency. J Vasc Interv Radiol 13:563–568
Evans C, Fowkes FG, Ruckley CV, Lee AJ (1999) Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health 53:149–153
Navarro L, Min RJ, Boné C (2001) 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
Rasmussen LH, Bjoern L, Lawaetz M et al (2007) Randomized trial comparing endovenous laser ablation of the great saphenous vein with high ligation and stripping in patients with varicose veins: short-term results. J Vasc Surg 46:308–315
Stirling M, Shortell CK (2006) Endovascular treatment of varicose veins. Semin Vasc Surg 19:109–115
Desmyttere J, Grard C, Mordon S (2005) A 2 years follow-up study of endovenous 980 nm laser treatment of the great saphenous vein: role of the blood content in the GSV. Med Laser Appl 20:283–289
Schmedt CG, Sroka R, Steckmeier S et al (2006) Investigation on radiofrequency and laser (980 nm) effects after endoluminal treatment of saphenous vein insufficiency in an ex vivo model. Eur J Vasc Surg 32:318–325
Satokawa H, Yokoyama H, Wakamatsu H et al (2010) Comparison of endovenous laser treatment for varicose veins with high ligation using pulse mode and without high ligation using continuous mode and lower energy. Ann Vasc Dis 3(1):46–51
Zimmet SE (2007) Endovenous laser ablation. Phlebolymphology 14:51–58
Weiss RA (2001) Endovenous techniques for elimination of saphenous reflux: a valuable treatment modality. Dermatol Surg 27:902–905
Bone C (1999) Tratamiento endoluminal de las varices conlaser de Diodo. Estudio preliminary. Rev Patol Vasc 5:35–46
Proebstle TM, Krummenauer F, Gul D, Knop J (2004) Nonocclusion and early reopening of the great saphenous vein after endovenous laser treatment is fluence dependent. Dermatol Surg 30:174–178
Timperman PE, Sichlau M, Ryu RK (2004) Greater energy delivery improves treatment success of endovenous laser treatment of incompetent saphenous veins. J Vasc Interv Radiol 15:1061–1063
Agus GB, Mancini S, Magi G (2006) The first 1000 cases of Italian Endovenous-laser Working Group (IEWG). Rationale, and long-term outcomes for the 1999–2003 period. Int Angiol 25:209–215
Vuylsteke ME, Vandekerckhove PJ, De Bo TH, Moons P, Mordon S (2010) Use of a new endovenous laser device: results of the 1500-nm laser. Ann Vasc Surg 24:205–211
Schwarz T et al (2010) Endovenous laser ablation of varicose veins with the 1470-nm diode laser. J Vasc Surg 51:1474–1478
Fan CM, Rox-Anderson R (2008) Endovenous laser ablation: mechanism of action. Phlebology 23:206–213
Kalra M, Gloviczki P (2008) Endovenous ablation of the saphenous vein. Perspect Vasc Surg Endovasc Ther 20:371–380
Kontothanassis D, Di Mitri R, Ferrari Ruffino S, Zambrini E, Camporese G, Gerard JL, Labropoulos N (2009) Endovenous laser treatment of the small saphenous vein. J Vasc Surg 49:973–979
Marston WA, Brabham VW, Mendes R, Berndt D, Weiner M, Keagy B (2008) The importance of deep venous reflux velocity as a determinant of outcome in patients with combined superficial and deep venous reflux treated with endovenous saphenous ablation. J Vasc Surg 48:400–406
Fernández CF, Roizental M, Carvallo J (2008) Combined endovenous laser therapy and microphlebectomy in the treatment of varicose veins: efficacy and complications of a large single-center experience. J Vasc Surg 48:947–952
Perkowski P, Ravi R, Gowda RC, Olsen D, Ramaiah V, Rodriguez-Lopez JA, Diethrich EB (2004) 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
Mozes G, Kalra M, Carmo M, Swenson L, Gloviczki P (2005) Extension of saphenous thrombus into the femoral vein: a potential complication of new endovenous ablation techniques. J Vasc Surg 41:130–135
Theivacumar NS, Dellagarammaticas D, Beale R, Mavor A, Gough M (2006) The clinical significance of persistent below-knee great saphenous vein (BK-GSV) reflux following endovenous GSV laser ablation (EVLA): do we need to modify treatment? Phlebology 93:141–156
Schanzer H (2010) Endovenous ablation plus microphlebectomy/sclerotherapy for the treatment of varicose veins: single or two-stage procedure? Vasc Endovasc Surg 44:545–549
Monahan DL (2005) Can phlebectomy be deferred in the treatment of varicose veins? J Vasc Surg 42:1145–1149
Carradice D, Mekako AI, Hatfield J, Chetter IC (2009) Randomized clinical trial of concomitant or sequential phlebectomy after endovenous laser therapy for varicose veins. Br J Surg 96(4):369–375
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Golbasi, I., Turkay, C., Erbasan, O. et al. Endovenous 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 30, 103–108 (2015). https://doi.org/10.1007/s10103-014-1626-0
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DOI: https://doi.org/10.1007/s10103-014-1626-0