Abstract
The endovenous laser ablation (EVLA) of the insufficient saphenous vein has similar results to open conventional surgery, but less morbidity. The echo-guided polidocanol foam sclerotherapy technique has been used for the same purpose. The combined techniques may play a role for more severe diseases, such as those with varicose ulcers. An EVLA device (called VELAS) has been developed in the Optics and Photonics Research Center of USP-São Carlos in agreement with FMB-UNESP. In this study, we present the preliminary results of the VELAS device (MMO 980nm diode) in patients with chronic venous ulcer, associated with echo-guided polidocanol foam sclerotherapy for the treatment of varicosities. Primary outcomes were healing time of the venous ulcer, occlusion of the treated veins and treatment-related adverse events. We included 12 patients with insufficient saphenous vein and chronic venous ulcer. Initially, we treated all of them with thermoablation of the insufficient saphenous vein (VELAS), on an outpatient basis, with local anesthesia. After one week of the procedure, we sclerosed the varicosities with polidocanol foam (Tessari technique). The national VELAS device was easily handled. Total venous occlusion occurred in 83.3% of the patients (in seven days) and the association of the techniques was responsible for a wound healing rate of 83.3%, with no adverse events.
Highlights
The conventional treatment of lower limbs varicose veins consists of surgical removal of insufficient veins
We treated varicose veins of the saphenous system with 10ml solution containing 2ml of 1% Polidocanol and 8ml of ambient air in the form of foam by the Tessari technique, a volume fractionated by the caliber and length of the varicosities, when necessary
The laser emission occurred safely, as previously calibrated and tested by the engineers. This laser device has a frequency of 980nm and is quite effective in venous ablation; equipment with a higher frequency (1470nm) report to have a higher affinity for water[8]. The use of this VELAS laser device with retrograde ablation technique was sufficiently capable of promoting the closure of most treated veins in the evaluation in seven days, similar to what is found in the literature[9,10]
Summary
The conventional treatment of lower limbs varicose veins consists of surgical removal of insufficient veins. Endovascular treatments for varicose veins have been available These techniques have achieved great popularity, especially in firstworld countries, because they are less invasive and involve fewer anesthesia-related risks. Results obtained in 13 surgeries performed in patients with great saphenous vein (GSV) or lesser saphenous vein (LSV) severe insufficiency with active chronic venous ulcer in the lower limb (CEAP 6). Ethics The equipment was approved for use in patients, as part of a clinical research protocol, after numerous electronic and physical tests, as well as extensive performance regulation initially in corpses’ parts (veins) and pre-clinical tests in experimental animals (rabbits), the equivalence with imported devices being demonstrated This project was submitted to, and approved by, the Ethics in Research Committee (CEP) of the Botucatu Medical School (FMB-UNESP), with protocol number 3240/2009.
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