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


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


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Surgery Orthopaedics Trauma surgery
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