Тактика лечения больных варикозной болезнью нижних конечностей за последние годы радикально пересмотрена. Хирургическое вмешательство пред-полагает не только полное устранение патологиче-ских очагов, но и минимизацию операционной травмы, возможность проведения процедуры в ам-
Background: The aim of this work was to evaluate the frequency, structure and characteristics of complications after endovenous laser ablation (EVLA). Methods: The study included 1247 consecutive patients (1417 limbs) with superficial venous insufficiency, treated with EVLA procedures with a wavelength of 1470 nm and automatic pull-back traction of the fiber. Control examinations using Duplex ultrasound were carried out on the second day after EVLA, and in 2 weeks and 1 month after the EVLA procedure. In certain situations, including the detection of complications, timing of the follow-up visits varied. Results: In the postoperative period (up to 1 month after the procedure) complications were detected in 69 cases (4.87% of the EVLA procedures). Complications included the following: deep vein thrombosis (1.55%), pulmonary embolism (0.07%), pain syndrome (1.41%), abscess (0.07%), seroma (0.21%), fragmentations of the laser fiber (0.14%), hyperpigmentation (0.14%), and burn of the skin (0.07%) of the total number of EVLA procedures. Conclusions: EVLA is not a unique surgical method of treatment, and it has the same complications as any other surgical intervention. The complications rate in patients was 4.87% of EVLA procedures. Most complications can be avoided by developing a standard regulation on their detection and treatment as early as possible.
Our experimental investigation was aimed at revealing the mechanism behind the action of laser radiation on venous wall under endovenous laser ablation conditions. We determined the critical laser power P cr at which the objective effect of complete denaturation of the vascular tissue collagen was attained for two types of optical fiber in the presence and absence of blood cells. We demonstrated that for the radial optical fiber the presence of blood cells had no effect on the magnitude of P cr , which came to 4.3 ± 0.1 and 5.6 ± 01 W for 1.56 and 1.47 µm lasers, respectively. For the bare fiber and 1.56 µm laser, P cr increased up to 5.2 ± 0.2 W in a blood-filled vessel and up to 7.1 ± 0.2 W when the blood was replaced by a sodium chloride solution. Our data show that the heating and degradation of insufficient veins go on more effectively when the tissue is heated by laser radiation directly absorbed therein, rather than the red-hot carbonized optical fiber tip.
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