ILV and EVLAR electronic presentation .

1. ILV (Internal LASER valvuloplasty) and EVLAR (Endovenous LASER Remodeling) with 1470 nm. Initial experiences.
Authors: Enrique Ferracani Ristenpart MD, Juan Bercowicz MD, Christian Schulte MD, Ramiro Pozzo Bio-Ing. Buenos Aires, Argentine.
Background : phebology today brings stripping , ablation or occluding approaches only , but sparing concept is growing up and I´m asked myself : Why do we ablate the vein in different
scenarios and don´t spare it? Can we do that? Let me show the basis of my inquiries : today we know where and how the disease starts (upstream; downstream) and leads to venous valvular reflux.
We know that venous disease is an inflammatory response caused by increased endothelial permeability MP and cytokine-activated leukocyte wall stress. Shear stress plays a very important role.
Volume increase (reservoirs) generates a pressure on the wall and activates the inflamatory cascade .
ELVES (international studies) have considered “LASER failure“ the recanalization of the saphenous vein but , at the same time showed :
"absence of saphenous reflux with permeable ducts " in ultra sound controls (11,9%). We can restore vein diameter with this tool
.
?
Material : investigation started in early 2011, in three phases.
Phase I : reproduce diameters reduction with LASER 1470nm Phase II : the same but intra-
operative ultra sound reflux control. Phase III : the same plus ultra sound control follow up.
Five patients, four females and one male, mean age 45 years. CEAP Functional Class 3 -5.Phase
I and II : first two patients demanded post ELVES procedure and no post-treatment ultra sound
monitoring is available.Phase III : three remaining were followed with duplex ultra sound color.
All of them signed an informed consent.and were particular patients.
Conclusions:Energy adjustment , follow up and larger number of patients, “will enable” the assessment of the reliability of ILV & EVLAR approach
; meanwhile : reduction of reflux by remodeling a “diseased vein” could be achieved without complications. Results stay stable at (6-12) follow up.
Initial Area 0.52cm2 Initial reflux 4”x40cm
Seldinger 8 Fr Angioscopy
Initial area 0.16cm2 Final area 0.09cm2
1470nm
Obtained reflux
< 0.5” / 10cm
Doppler control: absence
of thrombosis
EVLAR: vein reduction
Methods : ILV: sub-valvular LASER with 1mm radial fiber. Shots 6W/4 sec
EVLAR Remodeling the saphenous vein ; 2mm radial fiber . Shots 2-4W/ 6 sec
US Concept : Refluxed Volume = Cm/sec x Area (r2) (TRV:ml) Takashi Yamaki MD
Objective : What does the future have in store for phebology? : “valve repair “ . It should be
the goal of the future treatment of chronic venous disease .We present ILV and EVLAR as a
new approach using photons stitches for obtain reduction in diameters. The target of 1470 nm is
collagen water and we applied this concept “as a photon stitch” shrinking dilated collagen
Final area 0.32cm2
ILV : subvalvular shots
Inclution Criteria: we don't make CEAP selection criteria because our goal was get diameter reduction and reflux in the saphenous vein (circumferences was 1.25 to 4.40 cm and reflux 3 to 5 “).Exclution Criteria: high risk factors.
Results