Endovenous laser ablation: A comprehensive review

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> To provide an evidence-based overview of endovenous laser ablation and describe its role as an effective and durable technique for the management of superficial venous insufficiency. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> The published literature on the treatment of varicose veins using endovenous laser ablation was reviewed. The literature search focused on the history of endovenous laser ablation, its safety and durability, known complications, and differences in outcomes based on the iterations of fiber type and laser wavelength. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Treatment safety and efficacy of endovenous laser ablation appear to be based on the amount of energy administered over a defined distance, or the linear endovenous energy density. The ideal linear endovenous energy density varies with the laser wavelength and fiber-type. Post-operative pain and bruising may be reduced by the use of higher wavelength fibers or the use of radial or jacket-tip fibers as compared to bare-tip fibers. The incidence of endothermal heat-induced thrombosis remains low and has declined with increasing experience. Reports have demonstrated a greater than 90% technical success rate with saphenous endovenous laser ablation, long-term durability of ablation, and commensurate improvement in quality of life. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Endovenous laser ablation is a safe and durable treatment option for the management of incompetent superficial and perforator veins of the lower extremities. As an endothermal technology, it remains a key component of the standard of care for the treatment of chronic venous insufficiency. </jats:p></jats:sec>

Internal Perivenous Compression for venous insufficiency at the Saphenofemoral Junction: Early and Midterm Results and Operative Pain

“…Endovenous ablation for treating the insufficiency of the VSM was first introduced in 1999. 14,15 Owing to its less invasive nature and favorable outcomes, this procedure has replaced surgical vein stripping and high ligation. Consequently, endovenous ablation is now the standard of care for the surgical management of venous insufficiency.…”

Review on Laser Technology in Intravascular Imaging and Treatment

“…EVLA, a minimally invasive treatment for varicose veins of the lower limbs, has been used more frequently in recent years [ 140 - 143 ]. Varicose veins are caused by reflux of blood due to weakened connective tissue and insufficiency of venous valves.…”

“…During the treatment of the GSV, the laser fiber tip has a safe distance from the femoral vein to avoid major complications such as deep vein thrombosis. In the treatment of SSV, the laser fiber enters from the middle to lower third of calf, with the same precautions for more peripheral access due to the potential for injury to the sural nerve [ 143 ]. To achieve the uniformity of EVLT-induced thermal damage to the vein wall, the vein is compressed only under the influence of tumescent anesthesia until the venous wall is exposed to the surface of fiber.…”

A pre-clinical animal study of a novel mechanical-only ablation device treatment for superficial venous disease

“…In addition to the obvious benefits of reduced pain and faster recovery times with thermal procedures, the durability of both laser and radiofrequency methods have been proven in long-term follow up studies. 1–3…”

“…In addition to the obvious benefits of reduced pain and faster recovery times with thermal procedures, the durability of both laser and radiofrequency methods have been proven in long-term follow up studies. [1][2][3] Injected chemical agents for the treatment of varicose veins has a long history of use. 4 Improvements in this original non-thermal technique over the past number of decades have included the use of synthetic agents, adjunctive compression, and foamed preparations.…”