Catheter laser ablation of superficial veins of the lower extremities in the symptomatic treatment of venous reflux − comparison of the immediate results of two types of laser

Czech version

Authors: T. Honěk; M. Horváth; V. Horváth; M. Šlais; T. Kneifl; J. Honěk; A. Havlínová; M. Vítovec; V. Fabián; P. Šebesta
Authors‘ workplace: Avicena-chirurgie, s. r. o., Nemocnice Malvazinky, Praha
Published in: Rozhl. Chir., 2019, roč. 98, č. 6, s. 248-251.
Category: Original articles

Overview

Introduction: Catheter-Based Endovenous Laser Ablation (EVLA) is a commonly used alternative to surgical treatment of varicose veins. Recently, catheterization methods have proved to be methods of choice due to the preference of patients who value minimal invasiveness. Research of EVLA currently focuses on optimization of the procedure, which includes study of the benefits of the individual types of laser generators and the wavelengths used. In this observational study we compared our early results in a non-selected population of consecutive patients treated with two different types of lasers.

Methods: In the period from February 2010 to June 2017, EVLA was performed in a total of 1747 consecutive patients (74% were female) with venous reflux. The average vein width was 8.5 mm (5−25 mm). Our study sought to compare a more economical 1470nm diode laser (DL) generator (Velas 2, China) – used to operate on 630 patients – with a Nd-Yag crystal generator (Fotona - Slovenia) used in 1117 patients. All operations were performed using the same methodology, in an outpatient setting, in one specialized center. All procedures were completed in local tumescent anesthesia under peroperative ultrasound control. Postoperative sonography was performed in all patients.

Results: The results did not show a statistically significant difference in early closure rates (98.8% for Nd-Yag versus 99.8 for DL p-ns). Early recurrence was observed in 9 patients (15 vein segments) and managed successfully with early re-intervention and closure in all cases. The causes of incomplete closure included mainly the known risk factors (anticoagulation therapy, history of varicophlebitis). There was no correlation with larger venous diameter. In 6 patients, thrombus prolapse was observed in the deep femoral vein lumen. All cases were successfully cured after a week of low-molecular-weight heparin therapy. Only one case of low-risk pulmonary embolism was reported in a patient who failed to follow the regime recommendations.

Conclusion: This evidence did not show a significant difference in closure reliability and the amount of complications of the endovenous laser ablation of large and small saphenous vein with a 1060nm Nd-Yag crystal compared to the more economical 1470nm diode laser generator.

Keywords:

chronic venous insufficiency – endovenous laser ablation – laser generator – wavelength

Sources

Piazza G. Varicose veins. Circulation 2014;130:582−7. doi: 10.1161/CIRCULATIONAHA.113.008331.
Evans CJ, Fowkes FG, Ruckley CV, et al. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh vein study. J Epidemiol Community Health 1999;53:149−53.
Tassie E, Scotland G, Brittenden J, et al. Cost-effectiveness of ultrasound-guided foam sclerotherapy, endovenous laser ablation or surgery as treatment for primary varicose veins from the randomized CLASS trial. Br J Surg. 2014;101:1532−40. doi: 10.1002/bjs.9595.
Critchley G, Handa A, Maw A, et al. Complications of varicose vein surgery. Ann R Coll Surg Engl. 1997;79:105−10.
Siribumrungwong B, Noorit P, Wilasrusmee C, et al. A systematic review and meta-analysis of randomised controlled trials comparing endovenous ablation and surgical intervention in patients with varicose vein. Eur J Vasc Endovasc Surg. 2012;44:214−23. doi: 10.1016/j.ejvs.2012.05.017.
Miller GV, Lewis WG, Sainsbury JR, et al. Morbidity of varicose vein surgery: auditing the benefit of changing clinical practice. Ann R Coll Surg Engl. 1996;78:345−9.
Bootun R, Lane TR, Davies AH. A comparison of thermal and non-thermal ablation. Reviews in Vascular Medicine 2016;4:1−8.
Elias S. Minimally invasive vein surgery: latest options for vein disease. Mt Sinai J Med. 2010;77:270−8. doi: 10.1002/msj.20186.
Brittenden J, Cotton SC, Elders A, et al. A randomized trial comparing treatments for varicose veins. N Engl J Med. 2014;371:1218−27. doi: 10.1056/NEJMoa1400781.
Morrison N, Gibson K, McEnroe S, et al. Randomized trial comparing cyanoacrylate embolization and radiofrequency ablativon for incompetent great saphenous veins (VeClose). J Vasc Surg. 2015;61:985−94. doi: 10.1016/j.jvs.2014.11.071.
Rasmussen LH, Bjoern L, Lawaetz M, et al. Randomised clinical trial comparing endovenous laser ablation with stripping of the great saphenous vein: clinical outcome and recurrence after 2 years. Eur J Vasc Endovasc Surg. 2010;39:630−5. doi:10.1016/j.ejvs.2009.11.040
Darwood RJ, Theivacumar N, Dellagrammaticas D, et al. Randomized clinical trial comparing endovenous laser ablation with surgery for the treatment of primary great saphenous varicose veins. Br J Surg. 2008;95:294−301. doi: 10.1002/bjs.6101.
Carradice D, Mekako AI, Mazari FAK, et al. Randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins. Br J Surg. 2011;98:501−10. doi: 10.1002/bjs.7394.
Christenson JT, Gueddi S, Gemayel G, et al. Prospective randomized trial comparing endovenous laser ablation and surgery for treatment of primary great saphenous varicose veins with a 2-year follow-up. J Vasc Surg. 2010;52:1234−41.
Rasmussen LH, Lawaetz M, Bjoern L, et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011;98:1079−87. doi: 10.1002/bjs.7555.
Biemans AA, Kockaert M, Akkersdijk GP, et al. Comparing endovenous laser ablation,foam sclerotherapy, and conventional surgery for great saphenous varicose veins. J Vasc Surg. 2013;58:727−34. doi: 10.1016/j.jvs.2012.12.074.
Carradice D, Mekako AI, Mazari FA, et al. Clinical and technical outcomes from a randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins. Br J Surg. 2011;98:1117−23. doi: 10.1002/bjs.7615.
Carroll C, Hummel S, Leaviss J, et al. Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation. Health Technol Assess 2013;17:1−141. doi: 10.3310/hta17480.
Gloviczki P, Gloviczki ML. Guidelines for the management of varicose veins. Phlebology 2012;27 Suppl 1:2−9. doi:10.1258/phleb.2012.012S28
Honěk T, Horváth M, Horváth V, et al. Catheter-based endovenous laser ablation of saphenous veins in the treatment of symptomatic venous reflux: Early results. Cor et Vasa 2017;59:525−9.
Shutze WP, Kane K, Fisher T, et al. The effect of wavelength on endothermal heat-induced thrombosis incidence after endovenous laser ablation. J Vasc Surg Venous Lymphat Disord. 2016;4:36−43. doi: 10.1016/j.jvsv.2015.08.003.
Pannier F, Rabe E, Rits J, et al. Endovenous laser ablation of great saphenous veins using a 1470 nm diode laser and the radial fibre--follow-up after six months. Phlebology 2011;26:35−9. doi: 10.1258/phleb.2010.009096.
Malskat WS, Giang J, De Maeseneer MG, et al. Randomized clinical trial of 940- versus 1470-nm endovenous laser ablation for great saphenous vein incompetence. Br J Surg. 2016;103:192−8. doi: 10.1002/bjs.10035.
Galanopoulos G, Lambidis C. Minimally invasive treatment of varicose veins: Endovenous laser ablation (EVLA). Int J Surg. 2012;12:134−9. doi: 10.1016/j.ijsu.2012.02.013.
van den Bos RR, Kockaert MA, Neumann HA, et al. Technical review of endovenous laser therapy for varicose veins. Eur J Vasc Endovasc Surg. 2008;35:88−95. doi:10.1016/j.ejvs.2007.08.005
Proebstle TM, Moehler T, Herdemann S. Reduced recanalization rates of the great saphenous vein after endovenous laser treatment with increased energy dosing: definition of a threshold for the endovenous fluence equivalent. J Vasc Surg. 2006;44:834−9. doi: 10.1016/j.jvs.2006.05.052.
Theivacumar NS, Dellagrammaticas D, Beale RJ, et al. Factors influencing the effectiveness of endovenous laser ablation (EVLA) in the treatment of great saphenous vein reflux. Eur J Vasc Endovasc Surg. 2008;35:119−23. doi: 10.1016/j.ejvs.2007.08.010.
Maurins U, Rabe E, Pannier F. Does laser power influence the results of endovenous laser ablation (EVLA) of incompetent saphenous veins with the 1 470-nm diode laser? A prospective randomized study comparing 15 and 25 W. Int Angiol. 2009;28:32−7.
Yu DY, Chen HC, Chang SY, et al. Comparing the effectiveness of 1064 vs. 810 nm wavelength endovascular laser for chronic venous insufficiency (Varicose Veins). Laser Therapy 2013;22:247–53. doi: 10.5978/islsm.13-OR-19.
Doganci S, Demirkilic U. Comparison of 980 nm laser and bare-tip fibre with 1470 nm laser and radial fibre in the treatment of great saphenous vein varicosities: a prospective randomised clinical trial. Eur J Vasc Endovasc Surg. 2010;40:254−9. doi: 10.1016/j.ejvs.2010.04.006.

Labels

Surgery Orthopaedics Trauma surgery

Development of vascular substitutes for low-flow peripheral bypass grafting – a review

Splanchnic vein closures

Bleeding from lumbar ventral epidural venous plexus managed with hemostatic agent from oxidized non-regenerated cellulose

Mladí, chcete operovat? Přidejte nám na důchody!

Iatrogenic thoracic aortic injury in esophagectomy – a case report and literature review

Combined endovascular and surgical treatment of symptomatic tandem occlusion of common carotid artery and middle cerebral artery – case repor

Madelung’s disease – a case report

Article was published in

Perspectives in Surgery

2019 Issue 6