Laser Ablation Of Saphenous Vein Research Articles

Endovenous laser ablation of saphenous veins - favorable clinical results confirm theoretical advantages of the 1940nm diode laser.

Endovenous laser ablation (EVLA) is a recognized alternative to surgical treatment of varicose veins, although an optimal laser generator and its settings still remain a matter of debate. The aim of our study was to correlate clinical results with the theoretical advantage of the 1940nm diode laser characterized by high absorption of heat in a thin layer of coagulated tissue. From 1/2010 to 12/2021 EVLA was performed in a total of 3529 consecutive patients with varicose veins and ultrasonographically documented superficial venous reflux of lower extremities. Three types of laser were used successively with the wavelengths of 1064 nm, 1470 nm and 1940 nm, respectively. All patients were prospectively enrolled in our registry. An early postoperative followup visit was scheduled including an assessment of venous closure; additional visits were performed only in case of complications. The success of venous closure did not differ (p=0.054) between the three laser types and was over 98%. The catheterbased method made it possible to perform multiple ablations in one procedure the trend was 1.08, 1.31 and 1.62. In 2021 the number of ablations per patient with the laser DL Tethys 1940 nm was 1.79. With this laser it was possible to reduce the total energy applied to one half (8 W, 5080 J/cm). The postoperative course of patients treated using the 1940nm laser was smoother - no other but the early followup visit was needed in 95.6% cases (p.

Endovenous laser ablation of saphenous vein - mid-term results confirm permanent closure and possibility to treat more lesions in one procedure.

Endovenous Laser Ablation (EVLA) is acommon alternative to surgical treatment of varicose veins. The aim of our study was to demonstrate that laser occlusion is durable, that we can treat all patients in aone day setting, even with veins >10mm in diameter, and that multiple EVLAs can be done at the same time. In the period from 1/2017 to 12/2019 EVLA was performed in atotal of 1551 consecutive patients with varicose veins and ultrasonographically documented venous reflux. The mid-term results were evaluatedin agroup of patients operated from 1/2017 to 6/2017 (316 pts.). We compared arisk group that consisted of patients with veins >10mm in diameter (40 pts.) with acontrol group (the remaining 276 pts.). Patients with veins >10mm are traditionally considered as candidates for conventional surgery. The catheter-based method enabled us to perform more ablations in one procedure. In 2019 we performed 1.44 EVLA procedures per patient. There was only one postoperative follow-up visit, indicating an uncomplicated postoperative course, in 87.5% of patients of the risk group. In the control group 100% of patients had only one follow-up visit including ultrasound examination, showing an uncomplicated postoperative course (p.

Iatrogenic Lower Extremity High-Output Arteriovenous Fistula After Endovenous Greater Saphenous Venous Ablation Resulting in Right Heart Failure

Endovenous laser ablation of saphenous vein for chronic venous insufficiency resulting in clinically significant arteriovenous fistulae are extremely rare. We present a case of a high-output lower extremity superficial femoral artery (SFA) -femoral vein (FV) arteriovenous fistula resulting in right heart failure and distal deep venous thrombosis managed with a covered arterial stent-graft.

Volume of 4% sodium bicarbonate required to remove pain in tumescent anaesthesia for endovenous laser ablation of saphenous veins: a randomized, double-blind, controlled trial

Background: Sodium bicarbonate in tumescent anaesthesia for endovenous laser ablation (EVLA) of saphenous varicose veins is underused. Objective: To find the volume of 4% sodium bicarbonate required to significantly reduce intraprocedural pain. Methods: Tumescent solution ingredients were determined by recalculating concentrations based on the Klein solution and was titrated to a slightly alkaline pH by buffering with 4% sodium bicarbonate. The outcome variable was the level of intraprocedural pain measured with a visual analogue scale. Results: In total, 74 patients undergoing EVLA were randomized to receive either buffered solution at pH 7.1 (group A) or buffered solution at pH 6.63 (group B). Median pain scores (interquartile range) were significantly lower in patient group A than in group B (0.65 (0.2-1.38) versus 1.65 (0.87-3.5), p<0.01). Conclusions: These results show that tumescent anesthesia for EVLA of saphenous veins is less painful if the local anesthetic is buffered prior to its infiltration. Nonetheless, the buffering may be inadequate. We advise adding 143 mL of 4% sodium bicarbonate to 1000 mL 0.08% lidocaine so that the pH of the solution is increased to 7.1 and the intraprocedural pain is reduced significantly.

Catheter-based endovenous laser ablation of saphenous veins in the treatment of symptomatic venous reflux: Early results

IntroductionCatheter-based endovenous laser ablation (EVLA) is a widely used alternative to surgery and is slowly becoming a state of the art method in the treatment of varicose veins. In this observational study we sought to determine whether the method is safe and feasible in an unselected population of patients and if it can be used on more vein segments during one procedure. Methods and resultsFrom February 2010 to March 2016 EVLA was performed in 1209 venous segments in 1117 consecutive patients (74% women) with venous reflux. Mean diameter of ablated segments was 9.3 mm (range 5–25mm). All procedures were performed on an out-patient basis using local tumescent anesthesia. Intraoperative sonographic guidance was mandatory. Early closure was successful in 98.8% of treated venous segments. Early non-closure occurred in 9 patients (15 treated segments) and all were successfully resolved by early re-EVLA. The causes of incomplete closure were mainly of technical character due to the learning period – low energy, non-closure of proximal tributaries, non-complete emptying of the vein during procedure. Non-closure was not related to diameter of the vein. In 6 patients the prolapse of the thrombus into the lumen of deep femoral vein was noted. The thrombus resolved after one week treatment with low molecular weight heparin. Low-risk pulmonary embolism was observed in one non-compliant patient. ConclusionEVLA of the greater saphenous vein, small saphenous vein and large tributaries in the treatment of symptomatic reflux is a flexible, safe, effective and reproducible method. The closure of venous segments was performed without limitation in venous diameter and amount of segments.

Clinical risk factors to predict deep venous thrombosis post-endovenous laser ablation of saphenous veins

Endovenous laser ablation of saphenous veins is an alternative in treating symptomatic varicose veins. Deep venous thrombosis (DVT) has been reported in up to 7.7% of patients undergoing such procedure. We sought to establish clinical risk factors that predict DVT post-endovenous laser ablation. Patients who underwent endovenous laser ablation were prospectively followed. Clinical data and post-interventional duplex ultrasound were analysed. A P value <0.05 was accepted as representing a significant difference. From 2007 to 2008, 360 consecutive patients were followed. Nineteen DVTs were found on follow-up ultrasound. Eighteen cases involved either the saphenofemoral or saphenopopliteal junctions; only one case involved the deep venous system. Age >66 (P = 0.007), female gender (P = 0.048) and prior history of superficial thrombophlebitis (SVT) (P = 0.002) were associated with increased risk of DVT postprocedure. Age >66, female gender and history of SVT were significant predictors of DVT post-endovenous laser ablation of saphenous veins.

Early clinical improvement in chronic venous insufficiency symptoms after laser ablation of saphenous veins

We aimed to assess the degree of improvement in chronic venous disease-related symptoms after endovenous laser ablation (EVLA) for saphenous vein insufficiency. The study was conducted as a single-center, single-arm prospective cohort study. The series was comprised of 55 limbs of 38 patients (24 [63%] females, 14 [37%] males; mean age, 45 ± 14 years; range, 22-78 years). All patients were clinically evaluated for limb pain, fatigue, heaviness, itchiness, night cramps, burning sensation, swelling, varices, and the presence of venous ulcers. Post-procedure changes in each symptom were categorized as full recovery, improvement, no change, or worsened. Clinical improvement in one or more symptoms was observed in 96% of the limbs, and full recovery from each symptom ranged from 36% to 80%. The best clinical response was observed in night cramps, with full recovery in 80% of the limbs, while the least responsive was pain, with full recovery in 36%. Overall 25% of limbs showed full recovery from all symptoms. The venous clinical severity score was significantly decreased from a median of 5 (range, 1-21) before treatment to a median of 3 (range, 0-12) after treatment (P < 0.001). A significant association was found between full recovery from pain and older age (P = 0.016) and combined ablation of both saphenous veins (P = 0.010), and between full recovery from burning sensation and the presence of new incompetent perforator veins (P = 0.048) on multivariate analysis. EVLA effectively improves clinical symptoms in patients with chronic venous disease. The degree of symptomatic improvement varies for each symptom.

Abstract 5794: Clinical Risk Factors to Predict Deep Venous Thrombosis Post Endovenous Laser Ablation of Saphenous Veins

Introduction: Endovenous laser ablation of saphenous veins is an alternative to standard surgical vein stripping for the treatment of symptomatic varicose veins. Deep venous thrombosis (DVT) has been reported as a complication of such procedure with a rate of 1 to 5 %. Clinical risk factors to predict DVT post endovenous laser ablation are not well established. Hypothesis: To establish clinical risk factors to predict DVT post endovenous laser ablation. Method: Three hundred sixty consecutive patients who underwent endovenous laser ablation of saphenous veins were followed. Duplex ultrasound was performed within 1 week of the index procedure. DVT was defined as evidence of non-compressibility involving the sapheno-femoral, sapheno-popliteal junctions or any of the deep veins. Comparison between those with and without DVT was performed using step-wise logistic regression (SAS, SAS Institute, Cary, NC) to measure the correlation between continuous and categorical variables. The continuous variables included age, weight, glomerular filtration rate, distance of laser ablation, total energy used and the categorical variables included gender, diabetes mellitus, hypertension, hyperlipidemia, prior stroke, superficial venous thrombosis (SVT), DVT, coronary artery disease, peripheral arterial disease, and pulmonary embolism. Additional iterations were performed to determine the predictive power of various age thresholds. A p value &lt; 0.05 was accepted as representing a significant difference. Result: Nineteen DVTs were found on follow up ultrasound. Eighteen cases involved either the sapheno-femoral or sapheno-popliteal junctions. Only one case involved the deep venous system. Age &gt; 66 (p = 0.007), female gender (p = 0.048) and prior history of SVT (p = 0.002) were associated with increased risk of DVT post endovenous laser ablation. Conclusion: Age &gt; 66, female gender and history of prior SVT are risk factors to predict DVT post endovenous laser ablation. Clinical Risk Factors to Predict DVT Post Endovenous Laser Ablation

Endovenous Laser Ablation of the Saphenous Veins: Bilateral Versus Unilateral Single-session Procedures

To assess the feasibility of bilateral endovenous laser ablation (EVLA) of saphenous veins in a single session with use of diluted lidocaine for tumescent anesthesia. Among 122 consecutive EVLA procedures (112 patients; mean age, 49 years; 75% women) over a 12-month period, there were 75 unilateral procedures (n = 67) and 47 bilateral interventions (n = 45). Tumescent anesthesia consisted of lidocaine diluted to 0.10% for unilateral procedures versus 0.05% for bilateral cases (lidocaine dose <4.5 mg/kg body weight). Procedural data, immediate success rates on an intent-to-treat basis, and outcomes at 3-6-month follow-up were compared between groups with nonparametric tests. Bilateral procedures could be performed successfully with low lidocaine dilutions with a similar success rate (96%) as unilateral procedures (100%). No significant variation in systolic and diastolic blood pressure and heart rate was observed between bilateral and unilateral groups. No patient experienced signs of lidocaine toxicity. After adjusting for length of vein treated, there were no significant differences in the total lidocaine dose used, tumescent anesthesia volume, or procedure duration. Bilateral saphenous vein ablation in a single session appears safe and effective when tumescent anesthesia is given with very dilute lidocaine (0.05%). This approach may help meet patients' requests for simultaneous bilateral treatment and reduce duration of postprocedural discomfort.

Endovenous Laser Ablation of Saphenous Vein is an Effective Treatment Modality for Lower Extremity Varicose Veins

We present our first experiences with the use of a new minimally invasive treatment of lower extremity varicose veins. We studied the occlusion rates of the great saphenous vein (GSV) with laser ablation, its failure rates, and its complications. Sixty-six limbs in 62 consecutive patients were treated and followed-up for 1 year. All of the patients had incompetent GSV proven by means of duplex scanning. The GSV segment from 2 cm distal to the sapheno-femoral junction to just above the knee was ablated by using laser energy. In addition, all patients had stab avulsions of the varicose veins of the leg with Crochet hooks. All patients were followed postoperatively on the 3rd day, 1 month, 3 months, and 1 year after surgery. All patients were treated as day-case surgeries. Among 62 patients studied, 46 patients were women (74%) and 16 were men (26%). The median age of the patients was 53 years (range 28-69 years). Median operation time was 65 min (range 40-140 min). Successful treatment (total obliteration of the GSV on duplex) was accomplished in 64 of 66 limbs (97%). In two cases, recanalization of the lower one-third of the treated segment of the GSV was noted after 3 months. There were no instances of neuropathy or skin burn. Endovenous laser ablation of varicose veins is effective in inducing thrombotic vessel occlusion and is associated with only minor adverse effects. The procedure seems to be a promising alternative for surgical stripping of the GSV.