No abstract

ED (J/cm) of laser delivery is the main determinant of successful GSV ablation following EVLA.

Persistent non-refluxing GSV tributaries at the SFJ did not appear to have an adverse impact on clinical outcome 1 year after successful EVLA of the GSV.

Objective: Endovenous laser therapy (EVLT) is a new minimally invasive treatment for varicose veins employing laser ablation of the long saphenous vein (LSV) under tumescent local anaesthesia. Concerns about thermal injury to perivenous nerves (tibial, peroneal, sural) have prevented its use for saphenopopliteal/short saphenous incompetence. This study assesses heat dissipation around the LSV during EVLT. Methods: In 12 consenting patients undergoing EVLT (Local research ethics committee approved), thermocouples (inserted percutaneously) were positioned (ultrasound control) 3, 5 and 10 mm from the LSV following perivenous injection of tumescent anaesthesia (0.1% lignocaine at room temperature). The 810-nm diode laser delivery system delivered 1-s pulses (12 W power) with 1-s intervals during laser fibre withdrawal at 3 mm/s. Results: The maximum recorded temperatures at 3, 5 and 10 mm were 43.3°C, 42.0°C and 36.0°C, with median temperatures (±interquartile range) of 34.5°C (30.8–40.0), 33.7°C (30.5–39.9) and 31.1°C (30.3–33.3), respectively. Conclusions: Although intravascular laser-tip temperatures of up to 1334°C have been recorded in experimental models of EVLT, these results indicate that heat dissipation into adjacent tissues is minimal. Thus, careful ultrasound-guided injection of adequate volumes of perivenous local anaesthetic and the associated heat-sink effect should allow safe use of EVLT in treating saphenopopliteal/short saphenous incompetence.

Varicose veins are a common problem, conventionally treated by an operation. Within the last few years, minimally invasive techniques have been developed as alternatives to surgery in an attempt to reduce morbidity and improve recovery time. Radiofrequency ablation and endovenous laser ablation are the most promising of these new techniques. This review article looks at the evidence for these techniques and the clinical experience to date and discusses their role in the future treatment of varicose veins.