Endovenous laser with miniphlebectomy for treatment of varicose veins and effect of different levels of laser energy on recanalization. A single center experience

详细信息    查看全文

• 作者：Ilhan Golbasi ; Cengiz Turkay ; Ozan Erbasan ; Cemal Kemalo?lu…
• 关键词：Endovenous laser ablation ; Venous insufficiency ; Miniphlebectomy
• 刊名：Lasers in Medical Science
• 出版年：2015
• 出版时间：January 2015
• 年：2015
• 卷：30
• 期：1
• 页码：103-108
• 全文大小：147 KB
• 参考文献：1. Caggiati A, Allegra C (2007) Historical introduction. In: Bergan JJ (ed) The vein book. Elsevier Academic Pres, Oxford, pp 1-4 CrossRef
  2. Bergan JJ, Kumins NH, Owens EL, Sparks SR (2002) Surgical and endovascular treatment of lower extremity venous insufficiency. J Vasc Interv Radiol 13:563-68 CrossRef
  3. 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 53:149-53 CrossRef
  4. 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 27:117-22
  5. 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 46:308-15 CrossRef
  6. Stirling M, Shortell CK (2006) Endovascular treatment of varicose veins. Semin Vasc Surg 19:109-15 CrossRef
  7. 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 20:283-89 CrossRef
  8. 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 32:318-25 CrossRef
  9. 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):46-1 CrossRef
  10. Zimmet SE (2007) Endovenous laser ablation. Phlebolymphology 14:51-8
  11. Weiss RA (2001) Endovenous techniques for elimination of saphenous reflux: a valuable treatment modality. Dermatol Surg 27:902-05
  12. Bone C (1999) Tratamiento endoluminal de las varices conlaser de Diodo. Estudio preliminary. Rev Patol Vasc 5:35-6
  13. 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 30:174-78
  14. 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 15:1061-063 CrossRef
  15. 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 1999-003 period. Int Angiol 25:209-15
  16. 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 24:205-11 CrossRef
  17. Schwarz T et al (2010) Endovenous laser ablation of varicose veins with the 1470-nm diode laser. J Vasc Surg 51:1474-478 CrossRef
  18. Fan CM, Rox-Anderson R (2008) Endovenous laser ablation: mechanism of action. Phlebology 23:206-13 CrossRef
  19. Kalra M, Gloviczki P (2008) Endovenous ablation of the saphenous vein. Perspect Vasc Surg Endovasc Ther 20:371-80 CrossRef
  20. Kontothanassis D, Di Mitri R, Ferrari Ruffino S, Zambrini
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Medicine/Public Health, general
  Dentistry
  Laser Technology and Physics and Photonics
  Quantum Optics, Quantum Electronics and Nonlinear Optics
  Applied Optics, Optoelectronics and Optical Devices
  
• 出版者：Springer London
• ISSN：1435-604X

文摘

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?±-7.0?J (range 60-00?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?±-?months (3-5?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.