LASER ENDO-VEINEUXVasa. 1998 Feb;27(1):43-5Arteriovenous fistula after endoscopic dissection of the perforant vein of thel...
14 Th World Congress of International Union of Phlebology,Rome 9-14 Sept 2001, Abstract P 9Endovenous laser: light at the ...
termes de qualité et de taux de récidives, avec les résultats de la chirurgie dexérèse bien exécutée. Par suite,opposer le...
treatment, the highest average temperature was 729 degrees C (peak temperature1334 degrees C) observed flush with the lase...
(97%) showed a thrombotically occluded GSV. In one patient, the vessel showedincomplete occlusion. The distance of the pro...
lasers, while no bubbles could be produced in normal saline or plasma.CONCLUSION: Intravascular blood plays a key role for...
thereby eliminating the need for general anesthesia. Objectives of venousinsufficiency have been established and the endol...
histopathology. Additionally, an experimental in vitro set-up was constructed asa means of investigating the mechanism of ...
months (range, 3 to 12 months), no recanalization event could be observed. Apartfrom one thrombosis of the popliteal vein ...
Endovenous laser treatment of saphenous vein reflux: long-term resultsMin RJ, Khilnani N, Zimmet SEPURPOSE: To report long...
Endovenous laser treatment of saphenous vein refluxMin RJ, Khilnani NMReadily available noninvasive diagnostic tests now a...
Le LEV doit être curatif et non simplement palliatif, les crossectomies et les phlébectomies resteront toujoursnécessaires...
varicosisBogachev VIu, Kirienko AI, Zolotukhin IA, Briushkov AIu, Zhuravleva OVS. I. Spasokukotsky Faculty of Surgery with...
be related to the administration of low laser fluencesJ Endovasc Ther. 2004 Apr; 11(2): 132-8Endovenous laser ablation of ...
treated with an endovascular diode laser (810 nm, 14 W, continuous mode),followed by ambulatory phlebectomy of residual tr...
Cutaneous thermal injury after endovenous laser ablation of the great saphenousveinSichlau MJ, Ryu RKHerein a case of cuta...
saphenous vein treatment. Greater doses of energy delivered are associated withsuccessful EVLT, particularly when doses of...
saphenous vein. In most cases, the treated great saphenous vein was notidentifiable 6 months postoperatively. There was no...
Laser obliteration in the treatment of varicose disease of the lower limbsShevchenko IuL, Liadov KV, Stoiko IuM, Sokolov A...
thermal injury in 29 specimens was 194.40 microm (range, 10 to 900 microm;14.61% of the mean wall thickness); complete int...
instances of nerve damage or skin necrosis. One patient had a self-limitedmucosal tongue base ulcer. In this small series ...
closure rates and complications of both procedures. METHODS: Between June 1,2001, and June 25, 2004, endovenous GSV ablati...
first femoral venous valve and high ligation of the GSV for 112 patients withprimary deep venous insufficiency in 112 lowe...
Is there recanalization of the great saphenous vein 2 years after endovenouslaser treatment ?Disselhoff BC, der Kinderen D...
Endovenous treatment of the great saphenous vein using a 1,320 nm Nd:YAG lasercauses fewer side effects than using a 940 n...
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Rome 9-14 Sept 2001, Abstract P 9

  1. 1. LASER ENDO-VEINEUXVasa. 1998 Feb;27(1):43-5Arteriovenous fistula after endoscopic dissection of the perforant vein of thelower leg with the neodymium:YAG laser in chronic venous stasis syndromeFolsch C, Rauber K, Langer CThe endoscopic dissection of the perforating veins has been invented by Hauer inthe last decade. He introduced the videoendoscopy to this surgical procedure.The avoidance of operative access through areas of trophic changes is verybeneficial for reducing postoperative complications. Although postoperativethermic lesion have been reported on. Following an endoscopic laser coagulationof a Cockett perforating vein an arterio-venous fistula between the posteriortibial artery and vein developed by the mechanism mentioned. Persisting pain andthe persistence of the ulcer led to several diagnostic measures includingphlebography, digital subtraction angiography and CT-scan. After the fistula hadbeen closed successfully by percutaneous embolization with four platin wires theulcer disappeared.Dermatol Surg 2001 Feb;27(2):117-22Endovenous laser: a new minimally invasive method of treatment for varicoseveins--preliminary observations using an 810 nm diode laser.Navarro L, Min RJ, Bone C.BACKGROUND: Long-term success in the treatment of truncal and significant branchleg varicosities, when the saphenofemoral junction (SFJ) and the greatersaphenous vein (GSV) are involved, depends on the elimination of the highestpoint of reflux and the incompetent venous segment, and is best achieved bysurgical ligation and stripping. Minimally invasive alternatives in thetreatment of varicose veins with SFJ and GSV incompetence have been tried overthe years to increase patient comfort, reduce cost and risk, and allowimplementation by a wide variety of practitioners resulting in varying degreesof success depending on the fulfillment of the above two premises and theeffectiveness of the method used. OBJECTIVE: To demonstrate a novel way to uselaser energy through an endoluminal laser fiber for the minimally invasivetreatment of truncal varicosities that eliminates the highest point of refluxand the incompetent segment. METHODS: Patients were treated with 810 nm diodelaser energy administered endovenously through a bare-tipped laser fiber(400-750 microm). Vein access for endoluminal placement of the fiber through acatheter was achieved by means of percutaneous or stab wound incision underultrasound guidance and local anesthesia. Exact placement of the fiber wasdetermined by direct observation of the aiming beam through the skin and byultrasound confirmation. RESULTS: Preliminary short-term postprocedure results(up to 1 year, 2 months after treatment) in the endovenous laser treatment of 40greater saphenous veins in 33 patients indicate a 100% rate of closure with nosignificant complications. In addition, a 2-year experience of 80 cases ofisolated branch varicosities (Giacomini, anterolateral branch, etc.) also showsa 100% rate of closure. CONCLUSION: Early results of our endoluminal lasermethodology indicate a very effective and safe way to eliminate SFJ incompetenceand close the GSV. With proper patient selection, the ease of methodology andthe reduced risk and cost associated with endovenous laser treatment may make ita successful minimally invasive alternative for a wide group of patients thatpreviously would have required ligation and stripping.
  2. 2. 14 Th World Congress of International Union of Phlebology,Rome 9-14 Sept 2001, Abstract P 9Endovenous laser: light at the end of the tunnel ?R. MinThe newest minimally invasive technique for treatment of varicose veins is endovenous laser. Endovenous lasertreatment (EVLTTm) allows delivery of laser energy directly into the blood vessel lumen in order to producevein wall damage with subsequent fibrosis. Results of the first 100 GSVs treated by the above investigator withan 810 nm wavelength diode laser (Diomed, Inc., Andover, MA) are summarized in Table 1. Other thanself-limiting ecchymoses and mild discomfort along the treated GSV, there have been no minor or majorcomplications. The early results from more than 400 GSVS treated worldwide with EVLT have been impressivewith very effective occlusion of incompetent GSV segments. We eagerly await longer-term follow-up resultsfrom patients already treated with EVLT and additional evaluation of this promising new technique, which mayoffer a good alternative to ligation and stripping for those patients wishing to avoid surgery.Table 1. Post-Post-EVLTTM FolIow-U of GSVsFollow-U Ratio (%) Closed % Area Reduction1 month 100/100 (100%) 41 %3 months 72/72 (100%) 76 %6 months 54/55 (98%) 90¨%9 months, 40/41 (98%) >95 %12 months 25/27 (93%) >95 %* Evaluated with Duplex UltrasoundPhlébologie 2001,54(3) : 293-300L’énergie laser intraveineuse dans le traitement des troncs veineux variqueux : rapport sur 97 casNavarro L, Boné CObjectif: Éradiquer les varices des troncs et le reflux de la grande veine saphène (GVS) en obstruant la GVS delaine au genou par lénergie laser délivrée par voie intraveineuse au moyen dune fibre laser à embout nu.Méthodes : Après un test diagnostique approfondi utilisant lultrasonographie couleur, un cathéter est placé dansla GVS sous la jonction saphéno-fémorale. Lintroduction du cathéter dans la veine est effectuée sous anesthésielocale et guidée par ultrasonographie soit par une ponction sous-cutanée, soit par lapproche « stab wound-Muller Hook ». Une fibre laser à embout nu est introduite dans le cathéter et placée à 1-2 cm sous la jonctionsaphéno-fémorale. La position exacte de la fibre est appréciée par ultrasonographie et par observation directe dela lumière trans-cutanée. Une anesthésie locale péri-veineuse est réalisée sur toute la longueur de la GVS etlénergie de la diode laser est appliquée par pulsions dune seconde toute (s) la (les) 1-3 mm depuis la jonctionsaphéno-fémorale jusquau point dintroduction de la sonde.Résultats : Les résultats des 97 grandes veines saphènes traitées chez 79 patients indiquent une absence de refluxet loblitération de la GVS dans chaque cas, avec un suivi moyen de 7,0 mois. Le taux de recanalisation a été de0 % et aucune complication grave na été observée.Conclusion : Les résultats à court terme de cette méthode démontrent quil sagit dun procédé sûr et efficacepour oblitérer la GVS et pour éliminer les reflux des jonctions saphéno-fémorales et dune alternative autraitement chirurgical habituel de patients présentant des varices des troncs.Phlébologie 2001, 54(4) : 367-370Petit fait clinique, grand retentissement potentiel : l’arrivée du laser endoveineuxGorny P, Chahine D, Tran-Duy SNous rapportons ici la première expérience en France de traitement de la maladie variqueuse avec le laserendoveineux (LE). Le LE est une nouvelle méthode docclusion de la grande veine saphène à létage crural. Ellerecourt à la chaleur dégagée par une source laser diode 810 nm. La procédure est simple, sûre, bien tolérée,rapide (30 mn) et réalisable en cabinet médical. Elle est menée sous anesthésie locale. Les résultats à courtterme (1 à 9mois) sont excellents (99 à 100 % docclusion). Les résultats à long terme restent inconnus. Ceuxfournis par les diverses techniques docclusion ayant précédé celle-là ne soutiennent pas la comparaison, en
  3. 3. termes de qualité et de taux de récidives, avec les résultats de la chirurgie dexérèse bien exécutée. Par suite,opposer le LE directement à la chirurgie semble pour linstant prématuré. Néanmoins cette techniquemini-invasive apparaît comme une option thérapeutique intéressante, qui permettrait de retarder le recours à unechirurgie doptique plus radicale. A cet égard le LE pourrait concerner un grand nombre de patients et se révélerune bonne indication chez ceux désireux déviter la chirurgie dexérèse en première approche ou chez ceuxdésireux de choisir une solution thérapeutique offrant un rapport confort/ bénéfice élevé.J Vasc Interv Radiol 2001 Oct;12(10):1167-71Endovenous laser treatment of the incompetent greater saphenous vein.Min RJ, Zimmet SE, Isaacs MN, Forrestal MD.PURPOSE: To assess the safety and preliminary efficacy of endovenous lasertreatment (EVLT), a novel percutaneous technique for occlusion of theincompetent greater saphenous vein (GSV). MATERIALS AND METHODS: Ninety GSVs in 84 patients withreflux at the saphenofemoral junction (SFJ) into the GSV weretreated endovenously with pulses of laser energy and evaluated in a prospective,nonrandomized, consecutive enrollment multicenter study. Patients were evaluatedat 1 week and at 1, 3, 6, and 9 months to determine efficacy and complications.RESULTS: Eighty-seven of 90 GSVs (97%) were closed 1 week after initialtreatment with endovenous laser. The remaining three GSVs were closed afterrepeat treatment. Eighty-nine of 90 GSVs (99%) remained closed for as long as 9months according to serial duplex ultrasonography. Sonographic evaluationdemonstrated 73% reduction in GSV diameter at 6 months (61 patients) and 81%reduction in GSV diameter at 9 months (26 patients) after EVLT. One patientdeveloped a transient localized skin paresthesia. There have been no other minoror major complications. CONCLUSIONS: EVLT of the incompetent GSV appears to bean extremely safe technique that yields impressive short-term results. Long-termfollow-up is awaited.Dermatol Surg 2002 Jan;28(1):56-61Comparison of endovenous radiofrequency versus 810 nm diode laser occlusion oflarge veins in an animal modelWeiss RABACKGROUND: Endovenous occlusion using radiofrequency (RF) energy has been shownto be effective for the elimination of sapheno-femoral reflux and subsequentelimination of varicose veins. Recently, endovenous laser occlusion has beenintroduced with initial clinical reports indicating effective treatment forvaricose veins. However, in our practice we note increased peri-operativehematoma and tenderness with the laser. Little is known regarding the mechanismof action of this new laser vein therapy. OBJECTIVE: To better understand themechanism of action of endovenous laser vs. the endovenous RF procedure in thejugular vein of the goat model. METHODS: A bilateral comparison was performedusing 810 nm diode laser transmitted by a bare-tipped optical fiber vs. the RFdelivery by engineered electrodes with a temperature feedback loop using athermocouple (Closure procedure) in three goat jugular veins. Immediate andone-week results were studied radiographically and histologically. Temperaturemeasurements during laser treatment were performed by using an array of up tofive thermocouples, spaced 2 mm apart, placed adjacent to a laser fiber tipduring goat jugular vein treatment. RESULTS: Immediate findings showed that 100%of the laser-treated veins showed perforations by histologic examination andimmediate contrast fluoroscopy. The RF-treated side showed immediateconstriction with maintenance of contrast material within the vein lumen and noperforations. The difference in acute vein shrinkage was also dramatic as lasertreatments resulted in vein shrinkage of 26%, while RF-treated veins showed a77% acute reduction in diameter. At one week, extravasated blood that leakedinto the surrounding tissue of laser treated veins acutely, continued to occupyspace and impinge on surrounding structures including nerves. For the laser
  4. 4. treatment, the highest average temperature was 729 degrees C (peak temperature1334 degrees C) observed flush with the laser fiber tip, while the temperaturefeedback mechanism of the RF method maintains temperatures at the electrodes of85 degrees C. CONCLUSION: Vein perforations, extremely high intravasculartemperatures, failure to cause significant collagen shrinkage, and intactendothelium in an animal model justify a closer look at the human clinicalapplication of the 810 nm endovenous laser technique. Extravasated bloodimpinging on adjacent structures may theoretically lead to increasedperi-operative hematoma and tenderness. Further study and clinical investigationis warranted.Journal des maladies vasculaires Mars 2002 (27); Suppl 1 : IS 18Laser endo-veineux: résultatsAnastasie BDe mai à décembre 2001 63 patients ont étés traités; 43 femmes et 20 hommes de 24 à 89 ans. 82 axes veineuxont subi le traitement, soit 71 en territoire des grandes saphènes dont 4 récidives récurrentes et 11 petitessaphènes. 58 ont eu un abord par ponction percutanée à la malléole ou à la jarretière, 11 ont nécessité unecrossectomie saphène interne, ce qui a permis un cathétérisme rétrograde ; 13 autres ont eu un mini abordchirurgical par crochet de phlébectomie. Cette technique a été adaptée à partir de celle du Dr RJ Min en utilisantun laser 810 Diomed (12-14 W, 1 s) et 980 nm Biolitec (8 –12 W, 1,5 – 2,5 s). Les tirs laser sont effectués tousles 3 mm. La reprise d’une activité complète était obtenue en 6 jours en moyenne. Deux patients (2,4 %) audébut de la phase d’apprentissage ont eu une endo-sclérose incomplète au hunter, sclérosée ensuite souséchographie. Il est à noter que les territoires occlus sont restés stables chez ces deux patients. Un abcès du scarpafut à déplorer, 2 patients présentèrent un érythème douloureux et inflammatoire résolutif en 15 jours avec untraitement AINS local et général. Nous n’avons pas noté d’hématomes, ni d’infection cellulitique, thrombose ouembolie pulmonaire, perforation vasculaire. 97,6 % sont occlus jusqu’à 6 mois de suivi. La réduction dediamètre vasculaire mesurée échographiquement était de 40 % à J8 et 60 % à J90 en moyenne. Del giglio (980nm) obtient, après avoir traité des branches puis des grandes et petites saphènes, 94 % d’occlusion à 24 mois sur34 membres inférieurs. Boné (810 et 940 nm Dornier) sur 97 grandes saphènes aboutit à 100 % d’occlusion à 7mois de suivi moyen. Min (810 nm) publie ses résultats sur 90 grandes saphènes ; 99 % des vaisseaux sontocclus sur un suivi moyen de 9 mois. A 24 mois, 97 % des saphènes traitées restent occluses. Aucun effetindésirable important (hématome, infection, thrombose, embolie pulmonaire, perforations) n’était noté dans cestravaux.J Vasc Surg 2002 Apr;35(4):729-36Endovenous treatment of the greater saphenous vein with a 940-nm diode laser:thrombotic occlusion after endoluminal thermal damage by laser-generated steambubblesProebstle TM, Lehr HA, Kargl A, Espinola-Klein C, Rother W, Bethge S, Knop JPURPOSE: Despite a rapid spread of the technique, very little is known about thelaser-tissue interaction in endovenous laser treatment (EVLT). We evaluated EVLTof the incompetent greater saphenous vein (GSV) for efficacy, treatment-relatedadverse effects, and putative mechanisms of action. METHODS: Twenty-six patientswith 31 limbs of clinical stages C(2-6), E(P), A(S,P), P(R) with incompetent GSVproven by means of duplex scanning were selected for EVLT in an outpatientsetting. A 600-microm fiber was entered into the GSV via an 18-gauge needlebelow the knee and proceeded to the saphenofemoral junction (SFJ). Afterinfiltration of tumescent local anesthesia, multiple laser pulses of 15 J energyand a wavelength of 940 nm were administered along the vein in a standardizedfashion. D-dimers were determined in peripheral blood samples 30 minutes aftercompletion of EVLT in 16 patients and on postoperative day 1 in 20 patients. OneGSV that was surgically removed after EVLT was examined by means ofhistopathology. Additionally, an experimental in vitro set-up was constructed asa means of investigating the mechanism of laser action within a blood-filledtube. RESULTS: A median of 80 laser pulses (range, 22-116 laser pulses) wereapplied along the treated veins. On days 1, 7, and 28, all limbs except one
  5. 5. (97%) showed a thrombotically occluded GSV. In one patient, the vessel showedincomplete occlusion. The distance of the proximal end of the thrombus to theSFJ was a median 1.1 cm (range, 0.2-5.9 cm) in the remaining patients. Adverseeffects in all 26 patients were ecchymoses and palpable induration along thethrombotically occluded GSV that lasted for 2 to 3 weeks. In two limbs (6%),thrombophlebitis of a varicose tributary required oral treatment withdiclofenac. D-dimers in peripheral blood were tested with normal results in 14of 16 patients 30 minutes after completion of the procedure and elevated resultsin 7 of 20 patients at day 1 after EVLT. However, an increase of D-dimers fromday 0 to day 1 was observed in 15 of the 16 patients undergoing tests 30 minutesafter EVLT and on day 1. The 940-nm laser was demonstrated by means of in vitroexperiments and the histopathological examination of one explanted GSV to act bymeans of indirect heat damage of the inner vein wall. CONCLUSION: EVLT of theGSV with a 940-nm diode laser is effective in inducing thrombotic vesselocclusion and is associated with only minor adverse effects. Laser-inducedindirect local heat injury of the inner vein wall by steam bubbles originatingfrom boiling blood is proposed as the pathophysiological mechanism of action ofEVLT.Phlébologie 2002 ; 55 (3) : 239-43Traitement de l’insuffisance veineuse de la grande saphène par photocoagulation laser endoveineuse :technique et indicationsGuex JJ ; Min RJ ; Pittaluga P Les procédures de traitement endovasculaires sont devenues extrêmement communes en pathologie vasculaire, le mouvement sétend également au traitement de certaines varices. Les méthodes endovasculaires déjà connues sont : la sclérothérapie échoguidée, avec ou sans cathéter (et son dernier avatar la mousse), le clip endoveineux (V Clip°) et la radiofréquence (VNUS").La méthode la plus récente (EVLT Diomed°) emploie un générateur Laser Diode de 15 W et dune longueurdonde de 810 nm dont lénergie est délivrée in situ par une fibre optique de 600 µm.La procédure est strictement ambulatoire, sous anesthésie locale semi-tumescente, et sous contrôleéchographique. Il ny a ni hospitalisation ni arrêt de travail.La fibre optique est montée dans la grande veine saphène à travers un cathéter introduit au genou selon laméthode de Seldinger, puis positionnée grâce à léchographie. La photocoagulation de la veine variqueuse estobtenue en retirant progressivement la fibre optique, sous compression manuelle, en appliquant des impulsionslaser dune puissance de 12 W et dune durée de 1 sec suivies dune pause de 1 sec. Les soins postopératoires selimitent au port dune compression pendant une semaine.La technique est simple, rapide et efficace.Dermatol Surg 2002 Jul;28(7):596-600Thermal damage of the inner vein wall during endovenous laser treatment: keyrole of energy absorption by intravascular bloodProebstle TM, Sandhofer M, Kargl A, Gul D, Rother W, Knop J, Lehr HABACKGROUND: Despite the clinical efficacy of endovenous laser treatment (EVLT),its mode of action is incompletely understood. OBJECTIVE: To evaluate the roleof intravascular blood for the effective transfer of thermal damage to the veinwall through absorption of laser energy. METHODS: Laser energy (15 J/pulse, 940nm) was endovenously administered to explanted greater saphenous vein (GSV)segments filled with blood (n = 5) or normal saline (n = 5) in addition to GSVsunder in vivo conditions immediately prior to stripping. Histopathology wasperformed on serial sections to examine specific patterns of damage.Furthermore, in vitro generation of steam bubbles by different diode lasers(810, 940, and 980 nm) was examined in saline, plasma, and hemolytic blood.RESULTS: In saline-filled veins, EVLT-induced vessel wall injury was confined tothe site of direct laser impact. In contrast, blood-filled veins exhibitedthermal damage in more remote areas including the vein wall opposite to thelaser impact. Steam bubbles were generated in hemolytic blood by all three
  6. 6. lasers, while no bubbles could be produced in normal saline or plasma.CONCLUSION: Intravascular blood plays a key role for homogeneously distributedthermal damage of the inner vein wall during EVLT.Lasers Surg Med 2002;31(4):257-62Endovenous laser photocoagulation (EVLP) for varicose veinsChang CJ, Chua JJBACKGROUND AND OBJECTIVES: Untreated varicose veins have significant morbidityand potential mortality. Treatment aims to relieve symptoms, improve appearance,and to prevent deterioration. Current therapeutic options include graduatedcompression stockings, sclerotherapy, ambulatory phlebectomy, surgical ligation,and stripping. Results of laser photocoagulation of vascular anomalies have beenencouraging. Applying these concepts of laser-tissue interactions, we developeda new method of treatment for varicose veins of the lower extremities.STUDY DESIGN/MATERIALS AND METHODS: One hundred and forty-nine patients with 252 varicosegreater saphenous veins underwent endovenous laser photocoagulation(EVLP) from January 1996 to January 2000. Subjects age ranged between 23 years9 months and 80 years 7 months with a mean age of 50 years 8 months. There were122 females and 27 males. Only patients with primary varicose veins andsaphenofemoral reflux documented by Duplex ultrasound were treated. All patientsreceived surgical ligation of the saphenofemoral junction (SFJ). EVLP wasperformed using the neodymium:yttrium-aluminium-garnet (Nd:YAG) (1,064 nm)laser, delivered with a 600 microm optical fiber. Laser power was set at 10 or15 W, delivered with a pulse duration of 10 seconds. The outcome was comparedbefore and after EVLP, based on the score of severity of the varicose veins byHachs classification. RESULTS: The range of total delivered energy is from9,200 to 20,100 J. The entire procedure was completed in 95-175 minutes (mean122.33 minutes) for bilateral procedures, and 65-100 minutes (mean 81.07minutes) for unilateral procedures. The follow-up period ranged from 12 to 28months with a mean of 19 months. One hundred and forty-one patients with 244legs involved (96.8%) demonstrated remarkable improvement (P < 0.05). Commonearly complications of EVLP are: local paraesthesia of the treated area in 92legs (36.5%), ecchymosis and dyschromia in 58 legs (23.0%), superficial burninjury in 12 legs (4.8%), superficial phlebitis in four legs (1.6%), andlocalized hematoma in two legs (0.8%) at 3 weeks post-operatively. The finaloutcome showed no significant morbidity or mortality. All patients recoveredcompletely. CONCLUSIONS: EVLP is a simple effective treatment modality forvaricose veins. This less invasive method can minimize the complications ofconventional surgery.J Vasc Interv Radiol 2002 Jun;13(6):563-8Surgical and endovascular treatment of lower extremity venous insufficiency.Bergan JJ, Kumins NH, Owens EL, Sparks SRLower extremity venous insufficiency is a highly prevalent condition. Now it isunderstood that telangiectasias, reticular varicosities, and true varicose veinsare physiologically similar and etiologically identical. The four maininfluences causing these abnormalities are heredity, female sex, gravitationalhydrostatic forces, and hemodynamic muscular compartment pressure. There areclear indications and goals for intervention. A cornerstone in the treatment ofvenous insufficiency is elimination of sources of venous hypertension. One ofthese is the refluxing greater saphenous vein. Minimally invasive saphenousablation can be achieved by radiofrequency energy and laser light energy. Thesenew techniques eliminate the psychologic barrier to treatment caused by the term"stripping" and allow the objectives of surgery to be achieved with minimalinvasion and quick recovery. Endovenous techniques show great promise. Theyprovide minimal invasion, often under local anesthesia and intravenous sedation,
  7. 7. thereby eliminating the need for general anesthesia. Objectives of venousinsufficiency have been established and the endoluminal minimally invasivetechniques developed in recent years appear to accomplish their goals.J Mal Vasc 2002 Oct;27(4):222-5Feasibility of ambulatory endovenous laser for the treatment of greatersaphenous varicose veins: one-month outcome in a series of 20 outpatientsGerard JL, Desgranges P, Becquemin JP, Desse H, Melliere DThe purpose of this feasibility study was to demonstrate that endovenous lasercan be a useful alternative to conventional surgery for ambulatory treatment ofadvanced varicose veins. We assessed an open, non-randomized series of patientstreated in one center by the same operator. The study protocol was approved bythe local ethics committee. Twenty patients with stage II or III varicose veinsin the Porter classification gave their informed consent to participate in thestudy. The patients were treated with endovenous laser by the first author inthe outpatient clinic of the Henri Mondor University Hospital vascular surgerydepartment. All procedures were conducted under local anesthesia. A 980 nm laserdiode optic fiber was introduced into the vein percutaneously. Laser beams werefired from the sapheno-femoral junction to just under the genu, withdrawing thefiber 3 mm every 1.5 sec. Clinical evaluation with a quality-of-lifequestionnaire and duplex-scan was performed at days 3, 8 and 30 post-op.Complete occlusion and retraction of the treated vein was observed at day 3 and30, from the point of introduction to the sapheno-femoral junction in 18 of the20 patients. The branches of the greater saphenous vein remained patent withphysiological flow in the stump which remained patent 1 to 2 cm upstream fromthe sapheno-femoral junction. The length of the patent stump dependend on thelevel of the anterior or posterior branch. There were no adverse effects relatedto the local anesthesia. Pain was low to mild during treatment and the daysfollowing the procedure, requiring 8 tablets of acetominophen at most. Hematomaswere minimal and had completely resolved by the end of the first month. No workstoppage was required for the 14 patients with occupational activities. Therewere no cases of deep or superficial vein thrombosis. Complete occlusion andretraction of the varicose vein at one month suggests this treatment has along-lasting effect. Long-term evaluation is required. Treatment of advancedvaricose veins with endovenous laser can be an alternative to surgical treatmentproviding the advantage of outpatient ambulatory treatment.J Vasc Surg. 2002 Apr;35(4):729-36Comment in: J Vasc Surg. 2003 Jan;37(1):242; author reply 242.Endovenous treatment of the greater saphenous vein with a 940-nm diode laser:thrombotic occlusion after endoluminal thermal damage by laser-generated steambubblesProebstle TM, Lehr HA, Kargl A, Espinola-Klein C, Rother W, Bethge S, Knop JPURPOSE: Despite a rapid spread of the technique, very little is known about thelaser-tissue interaction in endovenous laser treatment (EVLT). We evaluated EVLTof the incompetent greater saphenous vein (GSV) for efficacy, treatment-relatedadverse effects, and putative mechanisms of action. METHODS: Twenty-six patientswith 31 limbs of clinical stages C(2-6), E(P), A(S,P), P(R) with incompetent GSVproven by means of duplex scanning were selected for EVLT in an outpatientsetting. A 600-microm fiber was entered into the GSV via an 18-gauge needlebelow the knee and proceeded to the saphenofemoral junction (SFJ). Afterinfiltration of tumescent local anesthesia, multiple laser pulses of 15 J energyand a wavelength of 940 nm were administered along the vein in a standardizedfashion. D-dimers were determined in peripheral blood samples 30 minutes aftercompletion of EVLT in 16 patients and on postoperative day 1 in 20 patients. OneGSV that was surgically removed after EVLT was examined by means of
  8. 8. histopathology. Additionally, an experimental in vitro set-up was constructed asa means of investigating the mechanism of laser action within a blood-filledtube. RESULTS: A median of 80 laser pulses (range, 22-116 laser pulses) wereapplied along the treated veins. On days 1, 7, and 28, all limbs except one(97%) showed a thrombotically occluded GSV. In one patient, the vessel showedincomplete occlusion. The distance of the proximal end of the thrombus to theSFJ was a median 1.1 cm (range, 0.2-5.9 cm) in the remaining patients. Adverseeffects in all 26 patients were ecchymoses and palpable induration along thethrombotically occluded GSV that lasted for 2 to 3 weeks. In two limbs (6%),thrombophlebitis of a varicose tributary required oral treatment withdiclofenac. D-dimers in peripheral blood were tested with normal results in 14of 16 patients 30 minutes after completion of the procedure and elevated resultsin 7 of 20 patients at day 1 after EVLT. However, an increase of D-dimers fromday 0 to day 1 was observed in 15 of the 16 patients undergoing tests 30 minutesafter EVLT and on day 1. The 940-nm laser was demonstrated by means of in vitroexperiments and the histopathological examination of one explanted GSV to act bymeans of indirect heat damage of the inner vein wall. CONCLUSION: EVLT of theGSV with a 940-nm diode laser is effective in inducing thrombotic vesselocclusion and is associated with only minor adverse effects. Laser-inducedindirect local heat injury of the inner vein wall by steam bubbles originatingfrom boiling blood is proposed as the pathophysiological mechanism of action ofEVLT.MMW Fortschr Med. 2002 Dec 5;144(49):47-50Crossectomy--exhairesis--stripping--laser therapy. How even refractory varicoseveins respond to treatmentWelter HF, Mosa T, Kettmann RChronic venous insufficiency affects more than 50% of the German population.Major factors involved in its development are age, family disposition, femalesex and an occupation involving much standing. Together with the clinicalpresentation, Doppler and duplex ultrasonography in particular enable a reliablepre-operative diagnosis, and deep venous thrombosis can also be definitivelyexcluded. Indications for surgical treatment are in particular varicosis of thegreater and lesser saphenous vein and perforating vein insufficiency. Commonlyused procedures are crossectomy, restrictive stripping of pathological veinsegments, resection of varicose side branches, and the endoscopic discission ofperforating veins. Recent developments are deep-freezing and extraction of thevein and endovenous laser treatment (EVLT), requiring only tiny incisions. Inmost cases, these interventions can be performed on an outpatient basis.Dermatol Surg 2003 Apr;29(4):357-61Endovenous Laser Treatment of the Lesser Saphenous Vein With a 940-nm DiodeLaser: Early ResultsProebstle TM, Gul D, Kargl A, Knop JBACKGROUND. : Until now, endovenous laser treatment (ELT) of the lessersaphenous vein (LSV) has not been reported. OBJECTIVE. : To evaluate efficacyand side effects for ELT of the LSV. METHODS. : Otherwise unselected patientswith an incompetent LSV were included. After perivenous infiltration oftumescent local anesthesia, laser energy (940 nm) was administered endovenously,either in a pulsed fashion or continuously during constant backpull of the laserfiber. Patients were scheduled for duplex follow-up at Day 1 and also at 1, 3, 6and 12 months, postoperatively. RESULTS. : Forty-one LSVs were targeted in 33patients with a median age of 66 years (range, 35 to 93). Seventy-three percentof patients had skin changes (C4). Thirty-six percent had an open or healedvenous ulcer (C5,6) and 15% a postthrombotic syndrome (ES AS,D PR). Thirty-nineLSVs (95%) completed ELT successfully. During a median follow-up interval of 6
  9. 9. months (range, 3 to 12 months), no recanalization event could be observed. Apartfrom one thrombosis of the popliteal vein in a patient with polycythemia vera,only minor side effects, particularly no permanent paresthesia, could beobserved. CONCLUSION. : ELT of the LSV under tumescent local anesthesia isfeasible and effective. Caution is warranted with ELT of thrombophilic patients.Lasers Surg Med. 2003;33(2):115-8Endovenous laser treatment to promote venous occlusionParente EJ, Rosenblatt MBACKGROUND AND OBJECTIVES: Current treatment methods of superficial venousinsufficiency (SVI) can be painful or result in incomplete occlusion. Theobjective of this study was to evaluate a technique for laser endovenousablation with a newly developed diffuser fiber. STUDY DESIGN/MATERIALS ANDMETHODS: Six lateral saphenous veins in three goats were used. A specificallydesigned diffuser laser fiber tip was employed in all trials to deliver awavelength of 1,064 nm. Each segment was treated with a different energy fluenceby changing the power setting of the laser or the withdrawal rate of the fiber.Energy fluence was calculated by dividing the Joules employed for each segmentover the internal surface area of the vessel. Segments were evaluated withultrasound and histologically. RESULTS: Seventy-five percent of the segmentswere occluded when an energy fluence of greater than 85 J/cm(2) was employed. Noperforations were observed, but perivascular changes were more common at higherenergy fluence. CONCLUSIONS: Endovenous laser occlusion of veins with minimalperivascular effects can be achieved with laser wavelengths of 1,064 nm if anenergy fluence of 84.9-224 J/cm(2) is employed and circumferential effect isachieved. Lasers Surg. Med. 33:115-118, 2003. Copyright 2003 Wiley-Liss, Inc.J Vasc Interv Radiol. 2003 Jul;14(7):911-5Temperature changes in perivenous tissue during endovenous laser treatment in aswine modelZimmet SE, Min RJPURPOSE: To conduct a pilot study to measure temperature at the outer vein wallduring endovenous laser treatment (EVLT). METHOD: Temperature at the outer veinwall was monitored during EVLT in a live pig ear vein (8 W: 1.0 and 2.0 secondspulse duration; 10 W: 1.0 and 1.5 second pulse duration; 12 W: 0.5, 1.0 and 1.5second pulse duration) and exposed hind limb vein (8 W: 0.5, 1.0, 1.5 secondpulse duration; 12 W: 0.5,1.0, 1.5 second pulse duration with perivenoustumescent fluid (TF); and 15 W: 0.5 second pulse duration without and with TF,1.0 second pulse duration with TF). RESULTS: Peak temperatures, near the outervein wall in an ear vein of a live pig, with laser fluence at 8 W were 40.8degrees C and 48.9 degrees C (pulse durations of 1.0 and 2.0 seconds,respectively). At 10 W, peak temperature was 47.1 degrees C and 49.1 degrees C(pulse durations of 1.0 and 1.5 seconds, respectively). At 12 W, peaktemperature ranged from 37.9 degrees C (0.5 second pulse duration) to 49.1degrees C (1.5 second pulse durations). In an exposed hind limb vessel, at 8 W,peak temperature ranged between 34.6 degrees C to 38.5 degrees C (0.5, 1.0 and1.5 second pulse durations). At 12 W and 0.5 to 1.5 second pulse durations, withTF, peak temperature ranged from 35.6 degrees C to 39.4 degrees C. At 15 W and0.5 second pulse duration, peak temperature was 44.0 degrees C without TF and34.5 degrees C with TF. At 15 W and 1.0 second pulse duration, with TF, pulseduration peak temperature was 37.0 degrees C. CONCLUSIONS: In the model studied,peak temperatures of perivenous tissues generated during endovenous laser seemunlikely to cause permanent damage to these perivenous tissues. The peaktemperature generated is reduced with the use of perivenous tumescent fluid.J Vasc Interv Radiol. 2003 Aug;14(8):991-6
  10. 10. Endovenous laser treatment of saphenous vein reflux: long-term resultsMin RJ, Khilnani N, Zimmet SEPURPOSE: To report long-term follow-up results of endovenous laser treatment forgreat saphenous vein (GSV) reflux caused by saphenofemoral junction (SFJ)incompetence. MATERIALS AND METHODS: Four hundred ninety-nine GSVs in 423subjects with varicose veins were treated over a 3-year period with 810-nm diodelaser energy delivered percutaneously into the GSV via a 600- micro m fiber.Tumescent anesthesia (100-200 mL of 0.2% lidocaine) was delivered perivenouslyunder ultrasound (US) guidance. Patients were evaluated clinically and withduplex US at 1 week, 1 month, 3 months, 6 months, 1 year, and yearly thereafterto assess treatment efficacy and adverse reactions. Compression sclerotherapywas performed in nearly all patients at follow-up for treatment of associatedtributary varicose veins and secondary telangiectasia. RESULTS: Successfulocclusion of the GSV, defined as absence of flow on color Doppler imaging, wasnoted in 490 of 499 GSVs (98.2%) after initial treatment. One hundred thirteenof 121 limbs (93.4%) followed for 2 years have remained closed, with the treatedportions of the GSVs not visible on duplex imaging. Of note, all recurrenceshave occurred before 9 months, with the majority noted before 3 months. Bruisingwas noted in 24% of patients and tightness along the course of the treated veinwas present in 90% of limbs. There have been no skin burns, paresthesias, orcases of deep vein thrombosis. CONCLUSIONS: Long-term results available in 499limbs treated with endovenous laser demonstrate a recurrence rate of less than7% at 2-year follow-up. These results are comparable or superior to thosereported for the other options available for treatment of GSV reflux, includingsurgery, US-guided sclerotherapy, and radiofrequency ablation. Endovenous laserappears to offer these benefits with lower rates of complication and avoidanceof general anesthesia.J Vasc Surg. 2003 Sep;38(3):511-6Infrequent early recanalization of greater saphenous vein after endovenous lasertreatmentProebstle TM, Gul D, Lehr HA, Kargl A, Knop JOBJECTIVE: The frequency of recanalization of the greater saphenous vein (GSV)after endovenous laser treatment (ELT) is unclear. This study was undertaken toestablish the incidence of early recanalization after ELT and to study thehistopathologic features of reperfused and excised GSV. METHODS: One hundrednine GSV in 85 consecutive patients with clinical stage C(2-6) E(P,S) A(S,P,D)P(R) disease were treated with ELT. Twelve months of follow-up with duplexscanning at regular intervals was possible in 104 treated veins (95.4%) in 82patients (96.5%). Recanalized vessels were removed surgically and examined athistopathology. RESULTS: ELT-induced occlusion proved permanent at duplexscanning over 12 months of follow-up in 94 of 104 GSV (90.4%) in 73 patients. In4 patients, 5 GSV (4.8%) were recanalized completely after 1 week, after 3months (n = 3), or after 12 months. Another 5 GSV (4.8%) in 5 patients exhibitedincomplete proximal recanalization over the 12 months of follow-up. Finally, 9recanalized vessels (8.6%) required further treatment with high ligation andstripping. Histopathologic analysis of recanalized GSV revealed a multiluminalpattern, as commonly noted in reperfusion after spontaneous thrombopleboticocclusion of the GSV. During follow-up, secondary incompetency of untreatedlateral accessory saphenous veins was observed in two legs (1.9%). CONCLUSION:Early recanalization requiring retreatment is observed in less than 10% of GSVafter ELT. The histopathologic pattern mimics recanalization afterthrombophlebotic occlusion.Tech Vasc Interv Radiol. 2003 Sep;6(3):125-31
  11. 11. Endovenous laser treatment of saphenous vein refluxMin RJ, Khilnani NMReadily available noninvasive diagnostic tests now allow physicians toaccurately map out abnormal venous pathways and identify sources of reflux. Inrecent years, minimally invasive alternatives to surgical treatment of saphenousvein reflux, the main contributor to most cases of symptomatic varicose veins,have been developed with promising results.(1-8) The latest percutaneoustechnique developed to treat incompetent saphenous veins is endovenous laser,which allows delivery of laser energy directly into the vein lumen to causecollagen contraction and denudation of endothelium. This stimulates vein-wallthickening with eventual fibrosis of the vein. These modern percutaneoustechniques now provide patients with alternatives to ligation and stripping fortreatment of significant sources of venous reflux without many of the potentialcomplications associated with surgery.Phlébologie 2003, 56 (3): 233-239Traitement laser endoveineux des axes saphéniens en ambulatoire. Définition des critères cliniques dedestruction per-opératoire (CDD). Etude sur 80 cas.Out patient endovenous laser treatment of saphenous axes. Definition of peroperative clinical criteria ofdestruction (CDD) in 80 patientsAnido REtude du résultat chez 80 patients à un an de la très récente technique endovasculaire permettant la destructiondes troncs saphène jusqu’à la jonction saphéno-fémorale ou poplitée.Technique innovante, efficace tant sur le plan fonctionnel qu’esthétique, confortable, strictement ambulatoire,elle est réalisée par l’introduction d’une fibre optique de 600 µm d’un laser diode par voie endoveineuse souscontrôle échographique et de la transillumination jusqu’à la jonction.L’ intervention est faite sous anesthésie locale tumescente et neuroleptanalgésie.Les résultats du traitement par endolaser veineux sont éloquents : ils montrent 98% d’excellents résultats stablesà 1 an. Ils reposent sur un apprentissage rigoureux de la méthode appuyé par un écho marquage spécifique autraitement laser, et la perception des critères cliniques de destruction (CCD) per opératoire obtenue par un bonparamétrage des constantes (durée et puissance).Study of the results in 80 patients with follow up of one year following endovascular destruction of thesaphenous trunk up to the saphenofemoral or saphenopopliteal junctions. This new technique which isfunctionnaly and esthetically effective and strictly ambulatory is realised by the introduction of a laser fiber(diode laser) of 600 µm endovenously up to the junction under echographic and transillumation control underlocal tumescent anesthesia and neuroleptanalgesia.The results of endolaser treatment are excellent with 98% of success at follow up of one year.The technique requires methodical training centred on specific echo-doppler evaluation, and the preoperativeappreciation of the clinical criteria of destruction obtained with the correct parameters (pulse duration andpower).Phlébologie 2003, 56 (4) : 369-382Laser endo-veineux (LEV)Anastasie B, Celerier A, Cohen-solal G, Anido R, Bone C, Mordon S, Vuong PLe laser endoveineux (LEV), technique récente, a été développé en premier par l’équipe du Dr Carlos Boné en1997. Il permet de scléroser un vaisseau par une méthode de photocoagulation, en utilisant un laser de longueurspécifique ayant pour cible soit l’oxyhémoglobine seule (810 nm) soit l’oxyhémoglobine et l’eau (940 et 980nm). La lumière est véhiculée par une fibre optique introduite par un cathéter de guidage. Les résultats montrentsur les études publiées un taux moyen d’occlusion de 97 % à 24 mois.Ce traitement prometteur nécessite pour son utilisation une formation spécifique, sans laquelle des échecspeuvent survenir et par conséquent jeter un discrédit sur la méthode. Les reperméations éventuelles peuvent êtrereprises par la même méthode, complétée par la sclérose conventionnelle et l’échosclérose. Les excellents tauxd’occlusion à deux ans, le fait que l’on puisse traiter au moins jusqu’à 28 mm de calibre saphène, la spécificitévasculaire de l’effet thermique laissent présager sa supériorité aux autres techniques endovasculaires.
  12. 12. Le LEV doit être curatif et non simplement palliatif, les crossectomies et les phlébectomies resteront toujoursnécessaires en sachant que nous les pratiquons de moins en moins car en cas de nécessité, un traitement en deuxtemps peut aussi être proposé. En effet, la suppression du reflux sous-jacent peut aboutir à une inversioncirculatoire de la crosse, en quelques mois, qui redevient fonctionnelle en assumant le retour veineux collatéral.La crossectomie sera peut-être remplacée par l’endosclérose de la crosse écho-guidée en cas de crosseincontinente sécurisée par des fibres à diffusion latérale ou à grande ouverture numérique.Les patients réfutés jusque-là et ceux refusant la chirurgie peuvent constituer une indication et subir au moins unLEV du tronc saphène malgré l’indication de la crossectomie, permettant ainsi de supprimer l’essentiel du reflux.Ce traitement concerne aussi bien le chirurgien vasculaire que l’angiologue interventionnel. Le LEV permetd’optimiser la coopération angio-chirurgicale, de traiter uniquement les segments veineux qui sont pathologiquesen minimisant, voire en supprimant le traumatisme chirurgical, limitant ainsi l’angiogénèse ultérieure.L’introduction de longueurs d’onde absorbées à la fois par l’eau et l’hémoglobine (980 nm – Double pulse)potentialise le résultat.The endovenous laser (EVL), a recent technique, was first developed in 1997 by Dr Carlos Boné and his team.EVL permits a vessel sclerosis with photocoagulation using defined wavelength laser targeting oxyhæmoglobinalone (810 nm) or oxyhæmoglobin and water (940 and 980 nm). Light is transported by an optic fiber introducedby a guiding catheter. The results in published studies show an average occlusion rate of 97% after 24 months.This attractive treatment requires special training on the part of the practitioner in order to prevent failure of theproceedings and thus discredit the method. Possible repermeations can be treated with the same processcompleted by conventional or echo-guided sclerotherapy. Excellent results after 24 months, the possibility oftreating up to 28 mm of saphena diameter, and the vascular specificity of thermal effect presage its superioritycompared to other endovascular techniques.The EVL must be curative and not simply palliative, crossectomy and phlebectomy will always be necessary,even though they will be used less and less. If necessary the treatment can be proposed in two steps. Thesuppression of underlying reflux promotes circulatory inversion of the saphenal cross in a few months allowingfunctional flow taking over collateral branchs. Crossectomy could be replaced by echo-guided crossendosclerosis in case of cross reflux, secured by lateral diffusion fiber or wide aperture angle..Unaccepted patients and those refusing surgery can initially benefit EVL of saphenal trunk to relieve the majorpart of reflux in spite of the indication of coupled crossectomyThis treatment concerns vascular surgeons as well as interventional angiologists. EVL allows us to optimize co-operation between the angiologist and the vascular surgeon, treating only pathological venous segments,minimizing surgical traumatism and therefore limiting later angiogenesis. Introduction of wavelengths absorbedby both water and hæmoglobin (980 nm - Double pulse) potentializes results.Dermatol Surg. 2003 Nov; 29(11): 1135-40Endovenous laser surgery of the incompetent greater saphenous vein with a 980-nmdiode laserOh CK, Jung DS, Jang HS, Kwon KSBACKGROUND: In recent years, the minimal endoluminal invasive alternativesagainst surgical ligation and stripping for the treatment of incompetent greatersaphenous vein (GSV) have been explored. Endovenous laser surgery is one ofthese endoluminal alternatives, and its clinical results are being reported atup to 3 years. OBJECTIVE: To evaluate the safety and efficacy of a 980-nm diodelaser for the elimination of the incompetent GSV. METHOD: Fifteen limbs in 12patients with incompetent GSV were treated via an endovenous route with a 980-nmlaser under local anesthesia in an outpatient setting. The effects wereevaluated clinically along with duplex ultrasound at 1, 4, and 12 weeks afterthe treatment to determine efficacy and possible complications. RESULTS:Complete occlusion and retraction of treated GSV in all patients were observedduring the 12 weeks of the postoperative period. There have been no significantcomplications to be concerned. CONCLUSION: The endovenous 980-nm diode lasersurgery is a relatively simple, safe, office-based procedure that is expected topromise favorable results while a long-term follow-up is awaited.Angiol Sosud Khir. 2004;10(1):93-100Endovasal laser obliteration of the greater saphenous vein in patients with
  13. 13. varicosisBogachev VIu, Kirienko AI, Zolotukhin IA, Briushkov AIu, Zhuravleva OVS. I. Spasokukotsky Faculty of Surgery with a Course of Cardiovascular Surgeryand Surgical Phlebology, Faculty for Advanced Medical Training, Russian StateMedical University, Moscow, Russia. phlebo-union@mtu-net.ruThis paper describes the first results of endovasal laser obliteration of thegreater sephenous vein in two patient groups (n=40) math varicosis. In 15 cases(control group), laser obliteration was employed during routine operation as analternative to phlebectomy according to Babcock following crossectomy. In 25patients (the main group), operation was performed without ligation of thesaphenofemoral anastomosis. After puncture and catheterization according toSeldinger the greater saphenous vein was exposed to thermal action over thelength from the osteal valve to the upper third of the leg. The follow up of thepatients amounted to 12 months. The results obtained in the main patient groupseem most interesting. Stable elimination of truncal varicosis could be attainedin more than 90% of cases, which was associated with quick medicosocialrehabilitation, the minimal number of complications and an excellent cosmeticeffect.Rozhl Chir. 2004 Feb;83(2):96-101Endovascular therapy of truncal varicose veins of the lower extremities with adiode laserKaspar S, Havlicek KThe authors present their experiences with new miniinvasive treatment ofvaricose veins--endovenous diode laser system. The results of 60 procedurestreating truncal varices are reported with special concern to percutaneousaccess technique under ultrasound guidance. This new concept based onhaemodynamic ultrasound findings is compared to the traditional surgicaltechnique of cross-sectomy and stripping.Dermatol Surg. 2004 Feb; 30(2 Pt 1): 174-8Nonocclusion and early reopening of the great saphenous vein after endovenouslaser treatment is fluence dependentProebstle TM, Krummenauer F, Gul D, Knop JBACKGROUND: Parameters influencing failure and recanalization rates ofendovenous laser treatment (ELT) of the great saphenous vein (GSV) are still tobe determined. OBJECTIVE: To evaluate treatment-related parameters of ELT withrespect to early failure of occlusion or recanalization of GSVs. METHODS: Aseries of 77 consecutive patients received ELT of 106 GSVs with continuouspullback of the laser fiber. Duplex examination was performed at 1 day, 4 weeks,and 3 months after the procedure. Clinical patient and vessel characteristics aswell as technical parameters of the ELT procedure were evaluated via multiplelogistic regression analysis. RESULTS: A median vein length of 60 cm (range of18 to 90) was treated with a median pullback velocity of 0.6 cm/sec (range of0.4 to 1.3), resulting in a median energy delivery of 23.4 J/cm (range of 11.8to 35.5) and a median laser fluence of 11.8 J/cm2 (range of 2.8 to 37.3). At day1 after ELT, 6 GSVs (6%) were not occluded. At 1 and 3 months after ELT, 9 GSVs(9%) and 11 GSVs (10%), respectively, were found open by color duplexexamination. Risk factors for nonocclusion 3 months after ELT, by univariateanalysis, were laser fluence, laser energy per centimeter of vein length,diameter of the vein before treatment, and distance of the thrombus to thesapheno-femoral junction at day 1 after treatment. Finally, multiple regressionanalysis selected laser fluence (p=0.004, odds ratio=0.40 J/cm2) as the relevantrisk factor for ELT failure or recanalization. CONCLUSION: ELT failure seems to
  14. 14. be related to the administration of low laser fluencesJ Endovasc Ther. 2004 Apr; 11(2): 132-8Endovenous laser ablation of the saphenous vein for treatment of venousinsufficiency and varicose veins: early results from a large single-centerexperiencePerkowski P, Ravi R, Gowda RC, Olsen D, Ramaiah V, Rodriguez-Lopez JA, DiethrichEBPURPOSE: To report early results of a single-center experience with endovenouslaser ablation of the saphenous vein (ELAS). METHODS: From February 2002 toJanuary 2003, 165 eligible patients (116 women; mean age 59.1 years, range27-90) were treated with ELAS for venous insufficiency in 203 lower limbs. Allpatients were symptomatic, and the majority (62%) had class 4 or higher clinicaldisease (CEAP classification). Eighteen (8.9%) patients had ulcers. A 940-nmdiode laser was used in an office setting under local tumescent anesthesia todeliver 100 to 140 laser applications along the course of the vein. Two weeks ofcompression bandages and a 1-week course of ibuprofen were prescribedpostoperatively. All patients underwent a duplex scan of the target vein at 2weeks. RESULTS: The great (154, 76%), short 37 (18%), and accessory 12 (6%)saphenous veins were ablated, achieving a 97% clinical success rate.Postoperative complications were few (mild induration and ecchymosis) and welltolerated (no DVT or nerve injury). Of the 6 (3.0%) recanalized target veins, 4were only partially open and successfully treated with sclerosis. Of the 18patients with active ulceration, 15 (83%) demonstrated healing after ELAS. In asatisfaction survey of patients more than 1 year after ELAS treatment, 84% ofthe 31 responders claimed their symptoms had diminished to none or minimal; 97%were mostly or very satisfied with their treatment results. CONCLUSIONS: ELASfor symptomatic saphenous vein incompetence and varicose veins has excellentshort-term subjective and objective outcomes. This technique appears to be verysuccessful in reducing symptoms, resolving varicose veins, and healing ulcers.Ann Chir. 2004 May;129(4):248-57Endovenous therapy for varicose veins of the lower extremitiesPerrin MEndovenous treatment for varicose veins of the lower extremities is an oldtechnique. New technologies such as radiofrequency and laser have revived itsindications. Thermal energy which is delivered to the vein wall results in afibrous retraction and eventually complete obstruction of the vessel.J Cosmet Laser Ther. 2004 May;6(1):44-9Combined endovascular laser with ambulatory phlebectomy for the treatment ofsuperficial venous incompetence: a 2-year perspectiveSadick NS, Wasser SOBJECTIVE: Non-invasive radiofrequency and endovascular technologies arebecoming increasingly popular in the treatment of superficial venousincompetence. In conjunction with stab avulsion of truncal varicosities, thesetechnologies have been able to address functional as well as cosmeticsuperficial venous incompetence in a non-invasive fashion. The present studypresents a 2-year follow-up of 30 patients with combined axial incompetence ofthe greater saphenous vein (GSV) in conjunction with truncal varicositiestreated with combination diode laser technology and ambulatory phlebectomy.METHODS: Thirty patients (mean age 49 years) with Sapheno-Femoral Junctionreflux associated with GSV incompetence (mean 9.2 x 8.5 mm) and enlarged branchvaricosities, as documented by Duplex ultrasound, were enrolled. Patients were
  15. 15. treated with an endovascular diode laser (810 nm, 14 W, continuous mode),followed by ambulatory phlebectomy of residual truncal varicosities. Patientswere examined 3, 6, 12 and 24 months following this procedure to determine thelong-term efficacy of this procedure. RESULTS: A 2-year closure rate of 96.8%was documented by Duplex evaluation. All 273 ambulatory phlebectomy veinsegments were eradicated. Two cases of transient hyperpigmentation and one caseof telangiectatic matting were documented. CONCLUSION: The combination ofendovascular laser and ambulatory phlebectomy appear to be an effective and safetreatment approach for the management of combined saphenous and truncal varicosevein incompetence.J Vasc Interv Radiol. 2004 Jun;15(6):625-7Arteriovenous fistula after endovenous laser treatment of the short saphenousveinTimperman PEReports of major complications from endovenous laser treatment of saphenousveins with use of perivenous tumescent anesthesia are very rare. The authorreports a major complication of endovenous laser treatment, the creation of anarteriovenous (AV) fistula. The fistula was created between the short saphenousvein (SSV) and the superficial sural artery in the popliteal fossa duringendovenous laser treatment of the SSV. The proximity of the superficial suralartery and the SSV in the popliteal fossa increases the risk of fistulaformation. Color-flow Doppler ultrasonography can demonstrate potentiallydangerous anatomic relationships between the vein segment intended for treatmentand adjacent arteries. Recognition of these relationships should increase theoperators ability to minimize the risk of AV fistula formation.J Cosmet Dermatol. 2004 Jul;3(3):162-6Intravascular lasers in the treatment of varicose veinsGoldman MPHistorically, surgical treatments, such as high ligation or complete removal ofan incompetent greater saphenous vein, were used to treat varicose veinsresulting from saphenofemoral junction reflux. The relative lack of efficacy ofthese invasive methods, along with potential morbidity and significant patientdowntime, has inspired the search for other treatments. Endovenousradiofrequency closure of the greater saphenous vein is effective and safe butits high cost, in terms of non-reusable catheters, and its slow withdrawal rateimpair its practicality. A new technique for endovenous occlusion usingendoluminal laser technology offers a less invasive alternative to ligation andstripping as well as a faster and less expensive method to treat varicosesaphenous trunks and junctions. Initial clinical experience in several hundredpatients shows a high degree of success with minimal side effects, most of whichcan be prevented or minimized by minor modifications of the technique. Thispaper reviews the use of an intravascular laser to destroy varicose veins.Various wavelengths including 810, 940, 980, 1064 and 1320 nm have been used toproduce intravascular destruction of varicose veins. The 1320-nm intravascularlaser with a motorized pull-back system appears to be the most efficient andreproducible system to effectively close and/or destroy an incompetent greatersaphenous vein.J Vasc Interv Radiol. 2004 Aug;15(8):865-7
  16. 16. Cutaneous thermal injury after endovenous laser ablation of the great saphenousveinSichlau MJ, Ryu RKHerein a case of cutaneous thermal injury in the leg of a patient who underwentendovenous laser (EVL) ablation of an incompetent great saphenous vein (GSV) isreported. Follow-up ultrasonography (US) of the site of skin burn showed thatthe burn was directly over thrombosed superficial tributaries originating fromthe GSV, but medial to the treated GSV. At the level of skin burn, thethrombosed GSV was 22 mm deep, but the tributaries were 1 mm deep. In addition,US showed echogenic fat surrounding and conforming to the superficial thrombosedtributaries. Based on the clinical scenario and follow-up US findings, it wasconcluded that the cutaneous thermal injury resulted from heated blood travelingfrom the 22-mm-deep GSV to the superficial tributaries directly beneath the siteof skin burn.Zhonghua Wai Ke Za Zhi. 2004 Sep 22;42(18):1125-7Endovenous laser treatment of 62 patients with primary varicose veins of lowerextremitiesCheng YK, Zhu SQ, Luo WJ, Shen QM, Sun JMOBJECTIVE: To retrospectively analyze the experiences and results of thetreatment on 62 patients with primary varicose of lower extremities withendovenous laser. METHODS: All patients were treated with endovenous laser. Thelaser treatment could begin when the fiber withdraw with 1 cm/2 s. The laserpower was 10 - 12 w with the laser pulse duration and the interval 1 secondrespectively. RESULTS: The duration of follow-up varied from 2 months to 8months. After endovenous treatment, the varicose veins and edema disappeared inall cases. The itching and uncomfortable feeling was dissipated. Nomorphine-like analgesic has been used and no serious complications occurred.CONCLUSION: Endovenous laser treatment of primary varicose of lower extremitiesis a safe and effective technique.J Vasc Interv Radiol. 2004 Oct;15(10):1061-3Greater energy delivery improves treatment success of endovenous laser treatmentof incompetent saphenous veinsTimperman PE, Sichlau M, Ryu RKPURPOSE: Early and midterm results of endovenous laser treatment (EVLT) of thesaphenous veins for the treatment of symptomatic insufficiency are promising.However, technical factors contributing to success or failure of saphenous veinEVLT have not been fully investigated. This study was performed to test thehypothesis that treatment success is related to achieving a critical thresholdof energy delivery relative to the length of vein treated.MATERIALS AND METHODS:Data regarding length of treated vein and total energy delivered were collectedfrom prospectively acquired databases at two institutions. Ultrasound (US)examinations were obtained for all treated veins. Successful EVLT was defined asUS-documented absence of flow in the treated vein. EVLT failure was defined byUS evidence of flow at any point in the treated vein segment at any time morethan 1 week after the treatment date. A two-tailed Student t test was performedfor statistical analysis and the null hypothesis was rejected at a P value lessthan .05. RESULTS: One hundred eleven treated veins were followed up with USover 3-78 weeks (mean, 29.5 weeks). During this time, 85 treated veins (77.5%)remained closed. In this group of successfully treated veins, average energydelivered was 63.4 J/cm (range, 20.5-137.8 J/cm). The average energy deliveredto the 26 veins (22.5%) in the failure group was 46.6 J/cm (range, 25.7-78J/cm). This difference in delivered energy was statistically significant (P <.0001). No treatment failures were identified in patients who received doses of80 J/cm or more. CONCLUSION: EVLT is an effective method of incompetent
  17. 17. saphenous vein treatment. Greater doses of energy delivered are associated withsuccessful EVLT, particularly when doses of more than 80 J/cm are delivered.Zhonghua Wai Ke Za Zhi. 2004 Oct 22;42(20):1244-6Endovenous holmium laser treatment for varicose veinsZhang Q, Huang SM, Meng LY, Wang XD, Ding JQOBJECTIVE: To discuss the technical pionts, advantages, follow-up results andmechanism of endovenous holmium laser treatment for varicose veins. METHODS:Endovenous holmium laser procedures were performed for 96 patients (99 legs)with primary varicosity of lower extremities. Perioperative Duplex was used forpreoperative diagnosis, intraoperative guide and postoperative follow-up. Thetime of procedure and clinical results were observed. The mean follow-up timewas 7 months. RESULTS: Sixty-seven in 99 legs with saphenous vein occludedimmediately during operation. All saphenous veins were confirmed to be occluded7 days after the procedure. There was no recanalization with Duplex findingduring the follow-up period. No wound complications. Two cases were with minorskin burn. One case was with saphenous nerve injury. Three cases were with thighecchymosis. CONCLUSION: Preliminary results show endovenous holmium lasertreatment for varicose veins is safe and effective in treating varicose veinswith cosmetic appearance and quicker recovery.Lasers Surg Med. 2004;34(5):446-5060-minute application of S-Caine Peel prior to 1,064 nm long-pulsed Nd:YAG lasertreatment of leg veinsJih MH, Friedman PM, Sadick N, Marquez DK, Kimyai-Asadi A, Goldberg LHBACKGROUND AND OBJECTIVES: Advancements in laser treatment of leg veinsnecessitate concurrent investigations in topical anesthesia to minimizetreatment-related pain. To evaluate the efficacy of the S-Caine Peel forproviding topical anesthesia after a 60-minute application. STUDYDESIGN/PATIENTS AND METHODS: A randomized, double-blinded, placebo-controlledtrial was performed in two centers. Sixty patients received S-Caine Peel andplacebo vehicle on different treatment sites for 60 minutes prior to lasertreatment of leg veins using a 1,064 nm long-pulsed Nd:YAG laser. Patients ratedtheir level of pain using a visual analog scale. Adequacy of anesthesia andexpressed pain at each site were rated by the investigator. RESULTS: The meanvisual analog scale (VAS) was 27 mm for active sites compared to 43 mm forplacebo (P < 0.001). Improved pain relief was noted for 67% of active versus 30%of placebo sites (P < 0.001). Anesthesia was judged adequate by the investigatorfor 55% of active compared with 12% of placebo sites (P < 0.001). CONCLUSIONS:The S-Caine Peel is safe and effective when applied for 60 minutes prior tolaser therapy of leg veins.Dermatol Surg. 2004 Nov;30(11):1380-5Intravascular 1320-nm laser closure of the great saphenous vein: a 6- to12-month follow-up studyGoldman MP, Mauricio M, Rao JOBJECTIVE: The objective was to determine the safety and efficacy of anintravascular laser with a novel wavelength to close the great saphenous vein.METHODS: Twenty-four cases of an incompetent great saphenous vein (0.5-1.2 cm indiameter) associated with distal varicose veins were treated with a 1320-nmintravascular laser at 5 W with an automatic pullback mechanism at 1 mm/s.Patients were evaluated with duplex ultrasound to determine efficacy oftreatment at various time periods to at least 6 months after the procedure.RESULTS: All patients demonstrated complete closure of the incompetent great
  18. 18. saphenous vein. In most cases, the treated great saphenous vein was notidentifiable 6 months postoperatively. There was no recurrence of any varicoseveins. All preoperative symptoms resolved after treatment, and no complicationswere noted. All patients were very pleased with the outcome of the procedure.CONCLUSIONS: At 6 months or greater follow-up, a 5-W, 1320-nm intravascularlaser with 1 mm/s automatic pullback, delivered through a diffusion-tip fiber,is safe and effective in treating an incompetent great saphenous vein up to 1.2cm in diameter.Rofo. 2005 Feb;177(2):179-87Endovenous treatment of primary varicose veins: an effective and safetherapeutic alternative to stripping ?Kluner C, Fischer T, Filimonow S, Hamm B, Kroncke TEndovenous laser therapy (EVLT) is a new, minimally invasive therapeutic optionfor treating primary varicose veins and provides an effective and safealternative to conventional surgical management (stripping). Short-term andintermediate-term outcome is comparable to surgical stripping in terms ofelimination of venous reflux (90 % - 98 %), resolution of visible varices (85%), and improvement of subjective complaints such as sensations of heaviness andtension (96 %). Complications occur in 1 % - 3 % of cases, which is markedlybelow the rate of conventional surgical management (up to 30 %). Theintermediate-term incidence of recurrent varicosis in a vein treated by EVLTdepends on the laser fluence applied and is reported to range from 7 % - 9 %compared to 10 % - 20 % after surgical intervention. Based on a review of thecurrent literature and our own experience, this survey article presents anoverview of the indications and contraindications, the technique andpathophysiology of laser-induced venous occlusion, and the results and possiblecomplications of EVLT.J Vasc Surg. 2005 Jan;41(1):130-5Comment in: J Vasc Surg. 2005 Jul;42(1):182; author reply 182-3.Extension of saphenous thrombus into the femoral vein: a potential complicationof new endovenous ablation techniquesMozes G, Kalra M, Carmo M, Swenson L, Gloviczki PEndovenous techniques such as radiofrequency ablation (RFA) and endovenous lasertherapy (ELT) have emerged as percutaneous minimally invasive procedures forablation of incompetent great saphenous veins in patients with varicosity andvenous insufficiency. Early reports showed safety and efficacy of bothtechniques, with excellent technical success rates and few major complications,such as deep vein thrombosis or pulmonary embolism. During our initialexperience with ELT in 56 limbs of 41 patients, 39 underwent postoperativeduplex scanning. We encountered three cases (7.7%) with thrombus extension intothe common femoral vein. All three patients were anticoagulated, and a temporaryinferior vena cava filter was placed in one. All remained asymptomatic. Thethrombus resolved by 1 month in all three patients. Review of the literaturerevealed that the incidence of thrombus extension into the common femoral veinor deep vein thrombosis in published clinical series is 0.3% after ELT and 2.1%after RFA. This possibility warrants routine postoperative duplex scanning, morealertness during these procedures, and patient education on this possiblecomplication.Khirurgiia (Mosk). 2005;(1):9-12
  19. 19. Laser obliteration in the treatment of varicose disease of the lower limbsShevchenko IuL, Liadov KV, Stoiko IuM, Sokolov AL, Barannik MI, Belianina EO,Lavrenko SVExperience of endovenous laser coagulation in the treatment of the varicosedisease of the lower extremities is presented. This method was used in 107patients. Surgical technique of isolated endovenous laser coagulation andcombined phlebectomy was described in detail. Morphologic data on laser injuryof a venous wall are presented. Short- and long-term results were evaluated withclinical and ultrasonic methods. It is demonstrated that endovenous lasercoagulation may be regarded as alternative to traditional saphenectomy. Thismethod decreases surgical trauma, number of complications and hospital stay.Semin Vasc Surg. 2005 Mar;18(1):15-8Saphenous ablation: what are the choices, laser or RF energyMorrison NEndovenous ablation has been reported to be safe and effective in eliminatingthe proximal portion of the great saphenous vein from the venous circulation,with faster recovery and better cosmetic results than surgical stripping.However, the definition of a successful outcome in the literature has not beenuniform. As in a successful stripping procedure, complete elimination of atleast the proximal portion of the great saphenous vein should also be thestandard for these endovenous ablation procedures. Our experience with over1,400 endovenous ablation procedures, of which 1,150 were radiofrequency andover 250 were laser procedures, has allowed evaluation and comparison of thesetwo techniques. And while we have not seen as high success rates as in publishedreports (especially with laser ablation), we have still concluded that bothradiofrequency and laser techniques to destroy the saphenous vein are safe andeffective. Patient acceptance is overwhelmingly better than stripping.Physicians performing these techniques should embrace a commitment to addressingall sites of venous insufficiency in a patient, not just the proximal greatsaphenous vein. Without this level of commitment, one will be left with poorresults and a dissatisfied patient.J Vasc Surg. 2005 Jun;41(6):1018-24; discussion 1025The immediate effects of endovenous diode 808-nm laser in the greater saphenousvein: morphologic study and clinical implicationsCorcos L, Dini S, De Anna D, Marangoni O, Ferlaino E, Procacci T, Spina T, Dini MBACKGROUND: We conducted this study to evaluate the immediate venous morphologicalterations produced in the great saphenous veins by the endovenous diode 808-nmlaser used for the treatment of superficial venous insufficiency and varicoseveins of the lower limbs and to clarify the clinical implications of thehistologic findings. METHODS: Chosen for the study were 24 limbs of 16 patientswith CEAP classification 3 to 6, ultrasound-documented greater saphenousinsufficiency, and venous diameters between 3.9 mm and 17 mm (mean, 8.04 mm)without phlebitis, saphenous aneurysms, congenital malformations, or deep venousinsufficiency. All limbs underwent surgical saphenofemoral disconnection, andthe greater saphenous vein was treated with an endovenous diode 808-nm laser bycontinuous emission at 8 to 12 W and variable retraction speed (</>1 mm/s).Spinal or local, but not tumescent, anesthesia was used. Twenty-nine specimens(3 to 5 cm long) of 24 proximal greater saphenous and five anterior accessorysaphenous veins were excised and studied by light microscopy for diameter andthickness of the venous wall, extent of injury into the intima, media, andadventitia, as well as penetration of thermal damage. RESULTS: The histologicevaluation showed thermal injury to the intima in all specimens andfull-thickness intimal injury in 22 specimens (75%); the average penetration of
  20. 20. thermal injury in 29 specimens was 194.40 microm (range, 10 to 900 microm;14.61% of the mean wall thickness); complete intimal circumference injuryoccurred in 8 specimen veins <10 mm in diameter (27.5%), full thickness damagein 6 (20.7%), and perforation in 2 (6.9%). CONCLUSIONS: Saphenous ablation using808-nm laser by variable retraction speed, combined with saphenofemoralinterruption, leads to sufficient vein wall injury to assure venous occlusion.Full thickness thermal injury or perforation is infrequent. Optimal results canbe obtained in veins <10 mm in diameter.J Vasc Interv Radiol. 2005 Jun;16(6):791-4Prospective evaluation of higher energy great saphenous vein endovenous lasertreatmentTimperman PEPURPOSE: In this study, the hypothesis that higher energy dose improvesprocedural success without increasing complications was prospectively evaluatedby performing endovenous laser therapy (ELT) at energies greater than 80 J/cm.MATERIALS AND METHODS: One hundred consecutive great saphenous (GSV), anterioraccessory great saphenous (AAGSV), or posterior accessory great saphenous(PAGSV) veins were treated with the intent to deliver an energy dose of greaterthan 80 J/cm. Eighty-one patients (64 women, 17 men) were treated. Mean age was49 years (range, 25-77 years; SD, 12 years). Ultrasound (US) and clinicalfollow-up was performed at 1 week, 3, 6, 9, and 12 months until all veins had atleast 3 months of follow-up. Success was defined as absence of reflux throughoutthe entire treated segment on follow-up US and clinical resolution of symptoms.Incomplete vein ablation was defined as US evidence of flow in a segment of atreated vein at any point during the follow-up period. RESULTS: One hundredveins were treated with an average energy of 95 J/cm (range, 57-145 J/cm; SD, 16J/cm). Follow-up and success at 1 week was 100%. Four veins could not befollowed up beyond 1 week. Of the 96 remaining veins all had 3 months follow-upwith an average follow-up of 9 months (range, 3-13 months; SD, 4 months). Therewere five failures and 91 successes for a success rate of 95%. Four of thetreatment successes demonstrated segmental patency but no reflux on US for acomplete vein ablation rate of 91%. No major complications occurred. Thetreatment failures occurred at an average energy dose of 98 J/cm. Two of thethree failures were AAGSVs, one was a GSV ipsilateral to one of the failedAAGSVs, and two were bilateral GSVs treated during the same procedure. Averagebody mass index (BMI) was 30 for the successes and 46 for the failures. Thisdifference was statistically significant (P = .0009). The mean length of thefailed treatments from the saphenofemoral junction to their termination into avaricose tributary was 10.9 (range, 8-15 cm; SD, 3.7 cm). This was significantlyless than the length of the successful treatments (P = .000003). CONCLUSION:Higher energy GSV ELT is safe and highly successful.J Vasc Interv Radiol. 2005 Jun;16(6):879-84Ultrasound-guided endovenous diode laser in the treatment of congenital venousmalformations: preliminary experienceSidhu MK, Perkins JA, Shaw DW, Bittles MA, Andrews RTDepartment of Radiology, Childrens Hospital and Regional Medical Center, 4800Sand Point Way NE, R5438-1, Seattle, WA 98105, USA.The authors present their experience in treating congenital venous malformationswith ultrasound (US)-guided endovenous diode laser. Six patients underwenttreatment of eight venous malformations for complaints including pain, activitylimitation, or cosmetic defect. At a mean follow-up interval of 14.5 months, allhad either resolution of (five patients) or marked decrease in (one patient)pain, allowing them to resume previously limited activities. There were no
  21. 21. instances of nerve damage or skin necrosis. One patient had a self-limitedmucosal tongue base ulcer. In this small series of patients, endovenous lasertreatment of venous malformations was effective during short-term follow-up.Di Yi Jun Yi Da Xue Xue Bao. 2005 Jul;25(7):889-91.Comparison of immediate therapeutic effects of endovenous laser treatment andconventional therapy for lower extremity varicose veinsWu LP, Huang ZH, Wang J, Zhou HF, Zhang YXOBJECTIVE: To compare the immediate therapeutic effects of endovenous lasertreatment (ELT) and conventional surgery for lower extremity varicosity (LEV).METHODS: Twenty-two limbs of 20 patients with ELT and 36 limbs of 30 patientswith traditional surgery were analyzed in terms of operation time, number of theincision, postoperative pain, complications, postoperative hospital stay andone-year recurrence rate. RESULTS: ELT group had shorter operation time, fewerincisions, less postoperative pain and shorter hospital stay than conventionalsurgery group, but the two groups showed no significant difference incomplications and one-year recurrence rate. CONCLUSIONS: As a safe and effectivenew treatment of LEV with minimal invasiveness and leaving no scars ELT has thepotential to replace conventional surgery and extends the surgical indicationsfor LEV treatment.J Cardiovasc Surg (Torino). 2005 Aug;46(4):395-405Endovenous laser ablation of varicose veinsMin RJ, Khilnani NMReadily available non-invasive diagnostic tests now allow physicians toaccurately map out abnormal venous pathways and identify all sources of reflux.Minimally invasive alternatives to surgical removal of incompetent truncal veinshave been developed with impressive RESULTS: Endovenous laser treatment can beperformed in the office under local anesthesia and is associated with virtuallyno recovery period. Better understanding of the primary mechanism of energytransfer by direct contact between the laser fiber tip and vein wall hasunderscored the importance of vein emptying. Improved utilization of tumescentanesthesia has helped facilitate circumferential laser fiber to vein wallcontact and virtually eliminated the incidence of heat-related complications.Further refinements in the technique and optimization of laser energy parametershave improved success rates of vein closure from 90% to nearly 100%. Compared tosurgery, endovenous laser has also demonstrated lower rates of recurrencelargely due to the absence of neovascularity. This review of endovenous lasertreatment should validate this exciting technique as a scientifically acceptableoption for eliminating truncal vein reflux. If measured by patient acceptanceand satisfaction, endovenous laser and other minimally invasive methods havealready supplanted traditional surgery as the treatment of choice forsuperficial venous insufficiency.J Vasc Surg. 2005 Sep;42(3):488-93Endovenous laser therapy and radiofrequency ablation of the great saphenousvein: analysis of early efficacy and complicationsPuggioni A, Kalra M, Carmo M, Mozes G, Gloviczki PBACKGROUND: Endovenous laser therapy (EVLT) and radiofrequency ablation (RFA)are new, minimally invasive percutaneous endovenous techniques for ablation ofthe incompetent great saphenous vein (GSV). We have performed both procedures atthe Mayo Clinic during two different consecutive periods. At the time of thisreport, no single-institution report has compared RFA with EVLT in themanagement of saphenous reflux. To evaluate early results, we reviewed saphenous
  22. 22. closure rates and complications of both procedures. METHODS: Between June 1,2001, and June 25, 2004, endovenous GSV ablation was performed on 130 limbs in92 patients. RFA was the procedure of choice in 53 limbs over the first 24-monthperiod of the study. This technique was subsequently replaced by EVLT, which wasperformed on the successive 77 limbs. The institutional review board approvedthe retrospective chart review of patients who underwent saphenous ablation.According to the CEAP classification, 124 limbs were C2-C4, and six were C5-C6.Concomitant procedures included avulsion phlebectomy in 126 limbs, subfascialendoscopic perforator surgery in 10, and small saphenous vein ablation in 4(EVLT in 1, ligation in 1, stripping in 2). Routine postoperative duplexscanning was initiated at our institution only after recent publicationsreported thrombotic complications following RFA. This was obtained in 65 limbs(50%) (54/77 [70%] of the EVLT group and 11/53 [20.8%] of the RFA group) between1 and 23 days (median, 7 days). RESULTS: Occlusion of the GSV was confirmed in93.9% of limbs studied (94.4% in the EVLT [51/54] and 90.9% in the RFA group[10/11]). The distance between the GSV thrombus and the common femoral vein(CFV) ranged from -20 mm (protrusion in the CFV) to +50 mm (median, 9.5 mm) andwas similar between the two groups (median, 9.5 mm vs 10 mm). Thrombus protrudedinto the lumen of the CFV in three limbs (2.3%) after EVLT. All three patientswere treated with anticoagulation. One received a temporary inferior vena cavafilter because of a floating thrombus in the CFV. Duplex follow-up scans ofthese three patients performed at 12, 14, and 95 days, respectively, showed thatthe thrombus previously identified at duplex scan was no longer protruding intothe CFV. No cases of pulmonary embolism occurred. The distance between GSVthrombus and the saphenofemoral junction after EVLT was shorter in olderpatients (P = .006, r(2) = 0.13). The overall complication rate was 15.4% (20.8%in the EVLT and 7.6% in the RFA group, P =.049) and included superficialthrombophlebitis in 4, excessive pain in 6 (3 in the RFA group), hematoma in 1,edema in 3 (1 in the RFA group), and cellulitis in 2. Except for two of thethree patients with thrombus extension into the CFV, none of these adverseeffects required hospitalization. CONCLUSION: GSV occlusion was achieved in >90%of cases after both EVLT and RFA at 1 month. We observed three cases of thrombusprotrusion into the CFV after EVLT and recommend early duplex scanning in allpatients after endovenous saphenous ablations. DVT prophylaxis may be consideredin patients >50 years old. Long-term follow-up and comparison with standard GSVstripping are required to confirm the durability of these endovenous procedures.J Vasc Surg. 2005 Sep;42(3):494-501; discussion 501Endovenous laser treatment combined with a surgical strategy for treatment ofvenous insufficiency in lower extremity: a report of 208 casesHuang Y, Jiang M, Li W, Lu X, Huang X, Lu MBACKGROUND: We assessed the safety and efficacy of endovenous laser treatment(EVLT) of the saphenous vein combined with a surgical strategy for treatment ofdeep venous insufficiency in the lower extremity. METHODS: Two hundred thirtyvenous insufficiencies of the lower limbs in 208 consecutive patients (93 menand 115 women; mean age, 54.15 years) were treated with EVLT combined withsurgical strategies. All patients were symptomatic. There were 84 limbs (36.5%)in C(2), 25 (10.9%) in C(3), 109 (47.7%) in C(4), 1 (0.4%) in C(5), and 9 (3.9%)in C(6) (CEAP), and Klippel-Trenaunay syndrome was present in 2 limbs. A totalof 119 (51.7%) had perforator vein incompetence. Four therapeutic methods wereincluded in this series according to symptoms, CEAP classification, and venousreflux. Simple EVLT was performed for 15 patients with only great saphenous vein(GSV) incompetence or Klippel-Trenaunay syndrome in 19 lower limbs. EVLTcombined with high ligation of the GSV and open ligation of perforators wasperformed for 5 patients with GSV and perforator incompetence in 5 lower limbs.EVLT was combined with high ligation of the GSV for 76 patients with GSVincompetence in 94 lower limbs. EVLT was combined with external banding of the
  23. 23. first femoral venous valve and high ligation of the GSV for 112 patients withprimary deep venous insufficiency in 112 lower limbs. All patients were followedup on an outpatient basis for physical examinations and postoperativecomplaints, and duplex ultrasonography was performed 2 weeks, 6 months, and 1year after operation. RESULTS: All patients tolerated the procedure well andreturned to normal daily activities immediately, achieving a 100% immediateclinical success rate. Spot skin burn injuries occurred in 2 patients (1.0%).Paresthesia in the gaiter area was noted in 15 patients (7.2%). Nopostprocedural symptomatic deep venous thrombosis or pulmonary embolismoccurred. Three patients had local recurrent varicose veins in the calf (1.4%)during a 2- to 27-month follow-up (mean, 6.12 months). Postoperative clinicalclasses were significantly improved between 2 weeks and 24 months (P = .0001 at2 weeks and 3 to 18 months; P = .0055 at 24 months compared with beforeoperation), especially in preoperative C(2) to C(3) stage patients, who achievedcomplete amelioration. CONCLUSIONS: EVLT is a novel minimally invasive treatmentwith advantages of safety, effectiveness, and simplicity, and it leaves noscars. Its indications can be expanded by combining EVLT with surgicalstrategies.Br J Surg. 2005 Oct;92(10):1189-94Systematic review of endovenous laser treatment for varicose veinsMundy L, Merlin TL, Fitridge RA, Hiller JEBACKGROUND: The safety and effectiveness of endovenous laser treatment (EVLT)for varicose veins are not yet fully evaluated. METHODS: Medical bibliographicdatabases, the internet and reference lists were searched from January 1966 toSeptember 2004. Only case series were available for inclusion in the review.RESULTS:: Thirteen studies met the inclusion criteria. Self-limiting features,such as pain, ecchymosis, induration and phlebitis, were commonly encounteredafter treatment. Deep vein thrombosis and incorrect placement of the laser invessels were uncommon adverse events. No study has yet assessed theeffectiveness of laser therapy in comparison to saphenofemoral junction ligationwith saphenous vein stripping. Occlusion of the saphenous vein and abolition ofvenous reflux occurred in 87.9-100 per cent of limbs, with low rates ofre-treatment and recanalization. CONCLUSION: From the low-level evidenceavailable it seems that EVLT benefits most patients in the short term, but ratesof recanalization, re-treatment, occlusion and reflux may alter with longerfollow-up. The lack of such data, in addition to the small numbers of patientsin the available studies, demonstrates the need for a randomized clinical trialof EVLT versus conventional surgery.Di Yi Jun Yi Da Xue Xue Bao. 2005 Oct;25(10):1334-5Minimally invasive surgical treatment for venous leg ulcerWu LP, Huang ZH, Wang J, Zhang YX, Xie ZYOBJECTIVE: To evaluate therapeutic effects of endovenous laser treatment (ELT)and subfascial endoscopic perforator surgery (SEPS) in the treatment of venousleg ulcer (VLU). METHODS: ELT and SEPS were performed in 10 patients with VLU(involving 10 legs). Among them, external valvuloplasty was performed in 4 legswith deep venous valve insufficiency. RESULTS: Ulcer of the 10 legs healedwithin 10-60 days after the operation, and follow-up study ranging from 2 to 8months with the average of 6 months revealed no recurrences. CONCLUSION: ELTcombined with SEPS provides an effective approach for VLU treatment with minimalinvasion, and when combined with external valvuloplasty, this approach mayeffectively reduce ulcer recurrence.J Endovasc Ther. 2005 Dec;12(6):731-8
  24. 24. Is there recanalization of the great saphenous vein 2 years after endovenouslaser treatment ?Disselhoff BC, der Kinderen DJ, Moll FLPURPOSE: To report the 2-year single-center results of endovenous lasertreatment (EVLT) for reflux in the great saphenous vein (GSV). METHODS: FromJanuary 2002 to January 2003, 85 symptomatic patients (56 women; mean age 49years, range 27-80) underwent EVLT in 100 limbs. All patients were symptomatic,and the majority (67, 79%) had CEAP clinical class C2 venous disease. Aftertreatment, they were monitored by clinical evaluation and duplex imaging.RESULTS: The initial treatment was completed in 93 limbs. Complicationsconsisted of bruising (31%), tightness (17%), pain (14%), induration (2%), andsuperficial thrombophlebitis (2%). No severe complications were observed. Over amean follow-up of 29 months (range 24-37), 3 patients died and 14 were lost tofollow-up, leaving 88 (95%) and 76 (82%) limbs available for imagingsurveillance at 1 and 2 years, respectively. At 3 months, treatment wasanatomically successful in 84% of cases (78 complete occlusion, 7 partialocclusion, and 8 nonocclusion) and functionally successful in 89% (83 no reflux,10 reflux). All technical failures and 73% (n=11) of the treatment failuresoccurred in the first half of the studied population, indicating a learningcurve effect (p=0.015). Mean energy delivered per unit length was 39+/-8 J/cm(range 25-65) for successful treatment (n=78) and 30+/-10 J/cm (range 21-50) forfailed treatment (n=15). No recanalization or recurrent GSV reflux afteranatomically and functionally successful treatment was observed in 73 and 61limbs at 1 and 2-year follow-up, respectively. CONCLUSIONS: EVLT is a feasible,safe, and fast procedure for eliminating GSV reflux and has excellent cosmeticresults. Despite the learning curve, we believe that the treatment results arepromising. When successful treatment is achieved by EVLT, a prospectivefollow-up of 2 years demonstrates durable results.Dermatol Surg. 2005 Dec;31(12):1685-94; discussion 1694Comparison of endovenous treatment with an 810 nm laser versus conventionalstripping of the great saphenous vein in patients with primary varicose veinsde Medeiros CA, Luccas GCBACKGROUND: Patients with varicose veins seek medical assistance for manyreasons, including esthetic ones. The development of suitable and more flexibleinstruments, along with less invasive techniques, enables the establishment ofnew therapeutic procedures. OBJECTIVE: To compare endovenous great saphenousvein photocoagulation with an 810 nm diode laser and the conventional strippingoperation in the same patient. METHODS: Twenty patients selected for operativetreatment of primary great saphenous vein insufficiency on duplex scanning wereassigned to a bilateral random comparison. In all cases, both techniques wereperformed, one on each lower limb. Clinically, evaluation was assessed on theseventh, thirtieth, and sixtieth postoperative days. Patients underwentexamination with duplex ultrasonography and air plethysmography during thefollow-up. RESULTS: Patients who received endovenous photocoagulation presentedwith the same pain but fewer swellings and less bruising than the strippingside. Most patients indicated that the limb operated on by laser received morebenefits than the other. There was only one recanalization and no adverseeffects. The venous filling time showed better hemodynamics in both techniques.CONCLUSION: The endovenous great saphenous vein photocoagulation is safe andwell tolerated and presents results comparable to those of conventionalstripping.Dermatol Surg. 2005 Dec;31(12):1678-83; discussion 1683-4
  25. 25. Endovenous treatment of the great saphenous vein using a 1,320 nm Nd:YAG lasercauses fewer side effects than using a 940 nm diode laserProebstle TM, Moehler T, Gul D, Herdemann SBACKGROUND: Limited data are available about treatment-related side effects withrespect to laser wavelength in endovenous laser treatment (ELT) of the greatsaphenous vein (GSV). OBJECTIVE: To compare the results and side effects of a940 nm diode and a 1,320 nm neodymium:yttium-aluminum-garnet (Nd:YAG) laser.METHODS: Three patient cohorts (A, B, and C) received ELT of the GSV using a 940nm diode laser at 15 W (group A) or 30 W (group B) or using a 1,320 nm laser at8 W (group C). In all cases, energy was administered continuously with constantpullback of the laser fiber under perivenous tumescent local anesthesia.RESULTS: The GSVs of group A (n = 113), group B (n = 136), and group C (n = 33)received ELT. An average linear endovenous energy density of 24, 63, and 62 J/cmand an average endovenous fluence equivalent of 12, 30, and 33 J/cm2 wereadministered to the vein. Occlusion rates were 95% (group A), 100% (group B),and 100% (group C) at day 1 after ELT and 90.3% (group A), 100% (group B), and97% (group C) at 3 months after ELT. With the 1,320 nm laser ELT (group C),treatment-related pain (50%) and the need for analgesics (36%) weresignificantly reduced (p < .005) in comparison with treatment-related pain (81%)and the need for analgesics (67%) after the 30 W 940 nm laser ELT (group B).Ecchymosis was also significantly reduced (p < .05) in group C (1,320 nm)compared with group B (30 W, 940 nm). CONCLUSION: ELT of the GSV using a 1,320nm Nd:YAG laser causes fewer side effects compared with 940 nm diode laser ELT.Cardiovasc Intervent Radiol. 2006 Jan-Feb;29(1):64-9Lower energy endovenous laser ablation of the great saphenous vein with 980 nmdiode laser in continuous modeKim HS, Nwankwo IJ, Hong K, McElgunn PSPURPOSE: To assess clinical outcomes, complication rates, and unit energyapplied using 980 nm diode endovenous laser treatment at 11 watts forsymptomatic great saphenous vein (GSV) incompetence and reflux disease. METHODS:Thirty-four consecutive ablation therapies with a 980 nm diode endovenous laserat 11 watts were studied. The diagnosis of GSV incompetence with reflux was madeby clinical evaluation and duplex Doppler examinations. The treated GSVs had amean diameter of 1.19 cm (range 0.5-2.2 cm). The patients were followed withclinical evaluation and color flow duplex studies up to 18.5 months (mean 12.19months +/- 4.18). RESULTS: Using 980 nm diode endovenous laser ablation incontinuous mode, 100% technical success was noted. The mean length of GSVstreated was 33.82 cm (range 15-45 cm). The mean energy applied during thetreatment was 1,155.81 joules (J) +/- 239.50 (range 545.40-1620 J) for a meantreatment duration of 90.77 sec +/- 21.77. The average laser fiber withdrawalspeed was 0.35 cm/sec +/- 0.054. The mean energy applied per length of GSV was35.16 J/cm +/- 8.43. Energy fluence, calculated separately for each patient,averaged 9.82 J/cm(2) +/- 4.97. At up to 18.5 months follow-up (mean 12.19months), 0% recanalization was noted; 92% clinical improvement was achieved.There was no major complication. Minor complications included 1 patient withhematoma at the percutaneous venotomy site, 1 patient with thrombophlebitis onsuperficial tributary varices of the treated GSV, 24% ecchymoses, and 32%self-limiting hypersensitivity/tenderness/"pulling" sensation along thetreatment area. One patient developed temporary paresthesia. Four endovenouslaser ablation treatments (12%) were followed by adjunctive sclerotherapies forimproved cosmetic results. CONCLUSION: Endovenous laser ablation treatment ofGSV using a 980 nm diode laser at 11 watts in continuous mode appears safe andeffective. Mean energy applied per treated GSV length of 35.16 J/cm or meanlaser fluence of 9.82 J/cm(2) appears adequate, resulting in 0% recanalizationand low minor complication rates.

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