#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

A Six-Year Experience with Endovenous Laser in the Treatment of Lower Extremity Varices


Authors: S. Kašpar 1,2;  M. Pirkl 2;  J. Příborská 2;  D. Kašpar 1
Authors‘ workplace: Flebocentrum Hradec Králové, přednosta: MUDr. S. Kašpar, Ph. D. 1;  Katedra klinických oborů Fakulty zdravotnických studií Univerzity Pardubice a Chirurgická klinika Krajské nemocnice Pardubice, přednosta: doc. MUDr. K. Havlíček, CSc. 2
Published in: Rozhl. Chir., 2009, roč. 88, č. 3, s. 106-114.
Category: Monothematic special - Original

Overview

Aims:
Endovascular techniques of saphenous ablation are the miniinvasive alternatives of the radical surgical treatment. This study summarizes our own clinical experience with endovenous laser.

Material and Methods:
During 6 year period we performed in total 723 endovenous laser procedures of trunk varicose veins of lower extremities in 630 patients. Every patient was preoperatively examined clinically and with color duplex machine. Primary varicose veins were operated on in 664 cases, in 59 cases the procedure was performed in recurrent varicose veins with reflux in the residual saphenous trunk. Post-operative follow-up (clinical and duplex ultrasound) was performed after 5 days and 1 month, 6 months and yearly thereafter.

The results were evaluated by comparison of CEAP clinical class and quality of life (QoL) pre- and post-operatively, by the percentage of recanalizations and also using Kaplan-Meier life-table method.

Results:
No thrombosis, nor pulmonary embolism were diagnosed in the post-operative period; from the whole cohort of 723 laser procedures, the postoperative data were available during different time periods in 718 cases (99.3%).

Saphenous occlusion was verified in 97.3% after 1 month, non-occlusion or early reopening was seen in 2.7 %. In total, 44 non-occluded trunk veins were found during the whole follow-up period (1–72 months, mean 15 months) which represents the final occlusion result of 93.9%. With stronger Kaplan-Meier analysis, we reached 88.9% occlusion rate during the follow-up period of 6 years.

Cox regression analysis of factors influencing non-occlusion and early or late recanalisation of saphenous vein found 2 factors with statistical importance: energy per centimeter of vein length (p = 0.04) and laser power (p = 0.04).

Cumulative rate of occlusions in 72 months horizon is significantly higher (94%) in patients treated with more than 50 J/cm compared to less than 50 J/cm (87%), log-rank test 0.039. When comparing the influence of laser power on the quality of saphenous occlusion, the treshold of 13W was set arbitrary based on median values in occluded and non-occluded cohorts and using the Kaplan-Meier survival method, the results of the treatment with power less than 13W and more than 13W were analysed. Using the power values less than 13W, the results were significantly better (p = 0.031) compared to power values of 13 W or more.

Mean clinical CEAP classification improved from 2.22 (before operation) to 0.24 (1 month after) and 0.48 ( last visit) and also QoL was significantly better in laser group compared to traditional surgery group (p<0.001). The sick leave was also significantly shorter in the laser group ( median 0 days) compared to traditional group ( median 40 days), p<0.01.

Conclusions:
The results of endovenous laser ablation of varicose veins depend mainly on meticulous pre-operative ultrasound examination and sufficient technical parameters of the therapy. The present study supports the concept of „slow heating“ during the endovenous laser treatment of varicose veins to achieve sufficient energy per centimetre of the vein and the optimal clinical outcome.

Key words:
endovenous laser – laser energy – laser power – saphenous occlusion


Sources

1. Callam, M. J. Epidemiology of varicose veins. Br. J. Surg., 1994; 81(2): 167–173.

2. Herman, J., et al. Chirurgie varixů dolních končetin. Praha: Grada Publishing, 2003, 186 s.

3. Mazuch, J. Varixy dolných končatín v klinickej praxi. Martin, vydavatelstvo Osveta 1988, 160 s.

4. Babcock, W. W. A new operation for the extirpation of varicose veins of the leg. NY Med. J., 1907; 86: 153.

5. Keller, W. A new method of extirpating the internal saphenous and similar veins in varicose conditions: a preliminary report. NY Med. J., 1905; 82: 385.

6. Mayo, C. H. Treatment of varicose veins. Surg. Gynecol. Obstet, 1906; 2: 385–388.

7. Muller, R. Traitement des varices par la phlébectomie ambula-toire. Bull. Soc. Fr. Phléb., 1966; 19: 277–279.

8. van der Stricht, J. La saphénectomie par invagination sur fil. Presse Med., 1963; 71: 1081–1082.

9. Oesch, A. PIN-stripping: a novel method of atraumatic stripping. Phlebology, 1993; 8: 171–173.

10. Kaspar, S., Siller, J., Cervinkova, Z., Danek ,T. Standardisation of Parameters During Endovenous Laser Therapy of Truncal Varicose Veins - Experimental Ex-vivo Study. Eur. J. Vasc. Endovasc. Surg., 2007; 34: 224–228.

11. Launois, R., Reboul-Marty, J., Henry, B. Construction and validation of a quality of life questionnaire in chronic lower limb venous insufficiency (CIVIQ). Qual. Life Res., 1996; 5(6): 539–554.

12. Kašpar, S., Havlíček, K. Endovaskulární léčba kmenových varixů dolních končetin. Rozhl. Chir., 2004; 83: 96–101.

13. Navarro, L., Min, R., Boné, C. Endovenous laser: a new minimally invasive method of treatment for varicose veins. Preliminary observation using a 810nm diode laser. Dermatol. Surg., 2001; 27: 117–122.

14. Hejhal, P., Firt, P., Livora, D. Endovaskulární koagulace povrchových žilních městků dolních končetin. Rozhl. Chir., 1959; 37: 418–425.

15. Politowski, M., Zelazny, T. Complications and difficulties in electrocoagulation of varices of the lower extremities. Surgery, 1966 ;59(6): 932–934.

16. Watts, G. T. Endovenous diathermy destruction of internal saphenous. Br. Med. J. 1972; 4(5831): 53.

17. Chandler, J. G., Pichot, O., Sessa, C., et al. Treatment of primary venous insufficiency by endovenous saphenous vein obliteration. Vasc. Surg., 2000; 34: 201–214.

18. Manfrini, S., Gasbarro, V., Danielsson, G., et al. Endovenous management of saphenous vein reflux. Endovenous Reflux Management Study Group. J. Vasc. Surg., 2000; 32(2): 330–342

19. Proebstle, T. M., Lehr, H. A., Kargl, A., Espinola-Klein, C., Rother, W., Bethge, S., Knop, J. Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles. J. Vasc. Surg., 2002; 35(4): 729–736.

20. Min, R. J., Khilnani, N. M. Endovenous laser ablation of varicose veins. J Cardiovasc. Surg. (Torino), 2005; 46(4): 395–405.

21. Gorisch, W., Boergen, K. P. Heat-induced contraction of blood vessels. Lasers Surg. Med. 1982; 2(1): 1–13.

22. Kašpar, S., Červinková, Z. Endovenózní laserová fotokoagulace insuficientní safény v experimentu. Rozhl. Chir., 2007; 86(2): 78–84.

23. Myers, K., Fris, R., Jolley, D. Treatment of varicose veins by endovenous laser therapy: assessment of results by ultrasound surveillance. Med. J. Aust., 2006 Aug, 21; 185(4): 199–202.

Labels
Surgery Orthopaedics Trauma surgery
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#