Endovenous laser ablation: an experimental study on the mechanism of action

Disselhoff, B C V M; Rem, Alex I.; Verdaasdonk, Rudolf M.; Kinderen, D.J. der; Moll, Frans L.

doi:10.1258/phleb.2007.007038

Cited by 84 publications

(75 citation statements)

References 21 publications

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“…Only administration of a relatively high energy per unit of length results in sufficiently high temperatures to cause denaturing of collagen. 33 During endovenous laser ablation, intraluminal temperatures can rise to over 100ºC, 28,[34][35][36][37][38][39] and these temperature profiles are independent of wavelength, i.e. use of different wavelengths does not influence the endovenous temperature profile.…”

Section: Adverse Events N (%)mentioning

confidence: 99%

Resultados de médio e longo prazo do tratamento endovenoso de varizes com laser de diodo em 1940 nm: análise crítica e considerações técnicas

Viarengo¹,

Viarengo²,

Martins³

et al. 2017

J. vasc. bras.

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Resumo Contexto Desde a introdução do laser endovenoso para tratamento das varizes, há uma busca pelo comprimento de onda ideal, capaz de produzir o maior dano seletivo possível com maior segurança e menor incidência de efeitos adversos. Objetivos Avaliar os resultados de médio e longo prazo do laser de diodo de 1940 nm no tratamento de varizes, correlacionando os parâmetros utilizados com a durabilidade do desfecho anatômico. Métodos Revisão retrospectiva de pacientes diagnosticados com insuficiência venosa crônica em estágio clínico baseado em clínica, etiologia, anatomia e patofisiologia (CEAP) C2 a C6, submetidos ao tratamento termoablativo endovenoso de varizes tronculares, com laser com comprimento de onda em 1940 nm com fibra óptica de emissão radial, no período de abril de 2012 a julho de 2015. Uma revisão sistemática dos registros médicos eletrônicos foi realizada para obter dados demográficos e dados clínicos, incluindo dados de ultrassom dúplex, durante o período de seguimento pós-operatório. Resultados A média de idade dos pacientes foi de 53,3 anos; 37 eram mulheres (90,2%). O tempo médio de seguimento foi de 803 dias. O calibre médio das veias tratadas foi de 7,8 mm. A taxa de sucesso imediato foi de 100%, com densidade de energia endovenosa linear (linear endovenous energy density, LEED) média de 45,3 J/cm. A taxa de sucesso tardio foi de 95,1%, com duas recanalizações por volta de 12 meses pós-ablação. Não houve nenhuma recanalização nas veias tratadas com LEED superior a 30 J/cm. Conclusões O laser 1940 nm mostrou-se seguro e efetivo, em médio e longo prazo, para os parâmetros propostos, em segmentos venosos com até 10 mm de diâmetro.

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Section: Adverse Events N (%)mentioning

confidence: 99%

Resultados de médio e longo prazo do tratamento endovenoso de varizes com laser de diodo em 1940 nm: análise crítica e considerações técnicas

Viarengo¹,

Viarengo²,

Martins³

et al. 2017

J. vasc. bras.

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“…Laser irradiation through a fiber held in blood causes the temperature of the laser tip to increase rapidly to temperatures of 800-1,300°C [9,10,[12][13][14]. These high temperatures sometimes cause melting of the tip [9].…”

Section: Hypothesismentioning

confidence: 99%

“…These high temperatures sometimes cause melting of the tip [9]. Such temperatures cause the generation of steam bubbles.…”

Section: Hypothesismentioning

confidence: 99%

“…These bubbles propagate towards the venous wall for several seconds, opposite to the direction of fiber pullback, and collapse at the wall, centimeters distal to the tip. Further, such high temperatures also cause carbonization and even perforation of the venous wall when the fiber tip touches the wall [9][10][11][12]14].…”

Section: Hypothesismentioning

confidence: 99%

“…Here, direct absorption of the scattered laser light by the venous wall [8,9], steam bubble generation at the fiber tip and their subsequent propagation to, and distal collapse at, the wall [10,11], and direct contact of the fiber tip with the wall [12], have been suggested as contributing mechanisms. Notably, however, exceedingly high temperatures of the fiber tip during laser irradiation in blood have also been reported, at 810 nm [9,13], 980 nm [10], and 1,064 nm [14]. For a wavelength of 1,320 nm, such information is not available; however, the recent description of a serious complication [15] strongly supports the conclusion that very high temperatures had occurred.…”

Section: Introductionmentioning

confidence: 99%

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Heat conduction from the exceedingly hot fiber tip contributes to the endovenous laser ablation of varicose veins

et al. 2009

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Lower-extremity venous insufficiency is a common condition, associated with considerable health care costs. Endovenous laser ablation is increasingly used as therapy, but its mechanism of action is insufficiently understood. Here, direct absorption of the laser light, collapsing steam bubbles and direct fiber-wall contact have all been mentioned as contributing mechanisms. Because fiber tips have reported temperatures of 800-1,300°C during endovenous laser ablation, we sought to assess whether heat conduction from the hot tip could cause irreversible thermal injury to the venous wall. We approximated the hot fiber tip as a sphere with diameter equal to the fiber diameter, having a steady state temperature of 800°C or 1,000°C. We computed venous wall temperatures due to heat conduction from this hot sphere, varying the pullback velocity of the fiber and the diameter of the vein. Venous wall temperatures corresponding to irreversible injury resulted for a 3 mm diameter vein and pullback velocities <3 mm/s but not for 5 mm and ≥1 mm/s. The highest wall temperature corresponded to the position on the wall closest to the fiber tip, hence it moves longitudinally in parallel with the moving fiber tip. We concluded that heat conduction from the hot fiber tip is a contributing mechanism in endovenous laser ablation.

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Randomized clinical trial comparing endovenous laser with cryostripping for great saphenous varicose veins

Disselhoff

Kinderen

Kelder

et al. 2008

British Journal of Surgery

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102

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Endovenous laser ablation: an experimental study on the mechanism of action

Cited by 84 publications

References 21 publications

Resultados de médio e longo prazo do tratamento endovenoso de varizes com laser de diodo em 1940 nm: análise crítica e considerações técnicas

Resultados de médio e longo prazo do tratamento endovenoso de varizes com laser de diodo em 1940 nm: análise crítica e considerações técnicas

Heat conduction from the exceedingly hot fiber tip contributes to the endovenous laser ablation of varicose veins

Randomized clinical trial comparing endovenous laser with cryostripping for great saphenous varicose veins

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