Fiber type as compared to wavelength may contribute more to improving postoperative recovery following endovenous laser ablation.

Abstract

To define the relative importance of fiber type as compared to laser wavelength on tissue injury depth, postoperative pain, and bruising during endovenous laser ablation. This study included 213 limbs that were treated with an 810-, 980-, or 1470-nm laser, with bare-tip (BT) or jacket-tip (JT) fibers. Pain scores (10-point scale) and bruising scores (5-point scale) were recorded. Tissue thermal injury depth (mm) was evaluated invitro for the 810- and 1470-nm wavelengths with BT and JT fibers. The JT fibers had lower pain scores as compared to the BT fibers at 810nm (1.69± 1.77 vs 3.70± 1.34; P<.0005) and at 980nm (1.14± 1.06 vs 2.71± 1.80; P<.0005). The JTfibers had lower bruising scores as compared to the BT fibersat 980nm (0.89± 1.06 vs 2.00± 1.44; P<.0005). The invitro study showed lower thermal injury depths for the JT ascompared to the BT fibers at 810nm (0.36mm± 0.26mm vs 1.05mm± 0.34mm; P<.0005) and at 1470nm (0.20± 0.16mm vs 0.71± 0.31mm; P<.0005). With regard to wavelength, 980-nm laser had lower pain scores as compared to 810-nm laser withBT fibers (2.71± 1.80 vs 3.70± 1.34; P= .015), andwith JT fibers, a similar result trended toward significance (1.14± 1.06 vs 1.69± 1.77; P= .057). The 980-nm JT fibershowed less bruising as compared to the 810-nm JT fiber (0.89± 1.06 vs 1.42± 1.19; P= .019). Similarly, the 1470-nm JT fiber showed less bruising as compared to the 810-nm JT fiber (0.94± 1.02 vs 1.42± 1.19; P= .038). The invitro study showed thermal injury depths that were less for 1470 nm as compared to 810nm, with JT fibers (0.20± 0.16mm vs 0.36± 0.26mm; P= .013) or with BT fibers (0.71± 0.31mm vs 1.05± 0.34mm; P=.001). All mean differences between JTand BTfibers were greater than between differing wavelengths. The multivariate analysis for the invitro study showed a meandifference between 1470 nm and 810 nm of 0.26mm, P<.0005 favoring 1470 nm and a mean difference between JTand BT fibers of 0.61mm, P<.0005 favoring the JT fibers. The use of a JT fiber appeared to be more significant in reducing pain and bruising as compared to a longer wavelength. Moreover, the results appeared additive, and thecohort using 1470 nm with a JT fiber produced thebest treatment outcomes. Additional study is required toconfirm the efficacy and durability of the various iterations evaluated; however, these data should be taken into consideration when undertaking treatment with endovenous laser ablation.