4.07] Acute tissue effects after clinical endovenous therapy of varicosis

Abstract

Objective Endoluminal laser and radiofrequency therapy of incompetent great saphenous veins seem to be an effective minimal-invasive treatment procedure for varicosis. Although both ex-vivo and clinical experiences are encouraging, there is a lack of knowledge regarding the acute tissue alterations of human vein tissue. The purpose of this study was to compare the acute tissue effects induced by endovenous therapies performed with RF and laser-assisted techniques. Material and methods Patients suffering from varicosis were divided into four therapy groups after informed consent. These four groups were: surgical stripping (25 specimen/18 patients), radiofrequency with Closure Fast™ catheter (8/5), radiofrequency with Closure Plus™ catheter (21/14), and laser bare fiber (28/10). The clinical treatment was performed following the clinical applications parameters of each procedure protocol. Immediately after treatment, specimens were harvested and prepared for histological investigation (H&E- and Elastica-Van Gieson (EVG) staining). The histological slides were examined by light microscopy. Results Stripped varicosis veins showed asymmetric changes in tissue layers with major differences in the intima when examined histologically. RF treatment (Closure Plus™) resulted in symmetric thermal alterations and a bulked media. The lumen was filled with thrombi of blood and vacuoles, and radial delamination in the media could be observed. There was a higher degree of thermal alteration after Closure Fast™ therapy with a larger effect of delamination in the media region. Laser therapy showed asymmetric changes in the vessel wall with perforation and flutes while the diametral wall appeared unchanged. Conclusion This descriptive histological study clearly demonstrated the different degrees of the circular effects induced during treatment. Its dependency on the clinical outcome must be further investigated at a future date.