Evaluation of great saphenous vein occlusion rate and clinical outcome in patients undergoing laser thermal ablation with a 1470-nm bare fiber laser with low linear endovenous energy density

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Background: Endovenous laser treatment of saphenous veins offers patients a procedure with low rates of complications and an early return to occupational activities. Objective: To compare rates of formation of bruising, of paresthesia along the path of the great saphenous vein (GSV), and of GSV obliteration 30 days after thermal ablation in the thigh, performed with or without tumescence and using two different types of fiber. Methods: This was a prospective study, analyzing three groups of patients who underwent GSV thermal ablation in the thigh, using a wavelength of 1470 nm. Patients in group 1 were treated with a conventional fiber using tumescence; those in group 2 were treated with a conventional fiber without using tumescence; and patients in group 3 were treated with a double radial fiber without tumescence. After 30 days, the rates of obliteration shown by Doppler ultrasonography, of paresthesias, and of bruising were compared. Results: Comparison of the results of thermal ablation of 90 GSVs in the thigh revealed similar rates of obliteration, with no statistical differences. The rate of paresthesia along the path of the GSV in the thigh was higher in the groups without tumescence than in the group with tumescence, but the difference only attained statistical significance for the comparison with the group that was treated with the conventional fiber. There was bruising in all groups, with greater frequency in group 1 (73.33%). Conclusions: Tumescence proved useful for preventing minor neurological injuries, but didn't have any influence on the rates of bruising occurrence or of occlusion of the GSV in the thigh up to 30 days after thermal ablation.

supporting

confidence: 58%

Estudo comparativo da termoablação da veia safena magna na coxa, com e sem tumescência

Erzinger¹,

Araújo²,

Junior

et al. 2016

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“…5 Araujo et al 6 also studied EVLT using the 1470 nm wavelength, showing that by employing a low energy density the incidence of complications could be reduced without significantly impacting the clinical results.…”

Section: Discussionmentioning

confidence: 99%

Fístula arteriovenosa após termoablação com laser endovenoso 1470 nm: relato de caso

Araújo

Guimarães²,

Moreira

2016

Traditional treatment for great saphenous vein (GSV) insufficiency includes high ligation of the saphenofemoral junction and subsequent stripping of the GSV. However, the considerable morbidity and patient dissatisfaction associated with surgical treatment led to development of alternative techniques and intravenous laser treatment (EVLT) has emerged as a minimally invasive alternative to surgery. Formation of arteriovenous fistulas (AVF) during EVLT is extremely rare. In this study we report a case of AVF between a segment of the lateral accessory saphenous vein and the superficial femoral artery that was identified by ultrasound. Initially, two attempts were made at compression with a linear-array transducer without success, then alternatively surgery was performed without complications, leading to resolution of the AVF. This case report highlights the importance of ultrasound follow-up after EVLT, both for monitoring the effectiveness of the method and for diagnosis and early treatment of its complications.Keywords: varicose veins; laser therapy; ultrasonography; arteriovenous fistula. ResumoO tratamento tradicional da insuficiência da veia safena magna (VSM) inclui a ligadura alta na junção safeno-femoral combinada com a fleboextração. No entanto, a morbidade associada à insatisfação do paciente com esse tratamento tem conduzido ao desenvolvimento de técnicas alternativas, e a termoablação com laser endovenoso (EVLT) tornou-se uma alternativa minimamente invasiva à cirurgia. A formação de fístula arteriovenosa (FAV) durante o EVLT é extremamente rara. Neste estudo, relatamos um caso de identificação ecográfica de FAV entre um segmento da veia safena acessória lateral e a artéria femoral superficial. Optou-se inicialmente pela realização de duas tentativas de compressão com transdutor linear, sem sucesso, e alternativamente o procedimento cirúrgico foi realizado sem intercorrência e com resolução da FAV. Esse relato de caso evidencia a importância do seguimento de vigilância ecográfica após o EVLT tanto para o controle da efetividade do método como para o diagnóstico e tratamento precoce de suas complicações.Palavras-chave: varizes; terapia a laser; ultrassonografia; fístula arteriovenosa.

“…The fiber was tractioned manually and continuously, in the caudal direction up to the distal limit of the saphenous vein being treated. 11 After the procedure, dressing was applied, exerting extrinsic compression along the path of the GSV, using cotton wool pads and 7/8 high compression elastic stockings (30-40 mmHg). Patients were discharged from hospital on the same day as the operation, after approximately 2 hours of postoperative observation, with a 5-day prescription for analgesics and nonsteroidal anti-inflammatories.…”

Section: Methodsmentioning

confidence: 99%

Influência da densidade de energia endovenosa linear no sucesso da termoablação endovenosa a laser como tratamento da insuficiência venosa crônica

Heineberg¹,

Brandão²,

Caron³

et al. 2019

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Resumo Contexto Mostra-se relevante a elucidação da influência da densidade de energia endovenosa linear (linear endovenous energy density, LEED) média no sucesso do tratamento da insuficiência venosa crônica por termoablação endovenosa a laser visando diminuir a morbidade desse método. Objetivos Avaliar a influência da LEED média na prevalência de fechamento das safenas após 30 dias do procedimento. Métodos Foram analisados 153 membros inferiores de 118 pacientes de um hospital referência, submetidos a termoablação com laser endovenoso 1470 nm sob anestesia local para o tratamento de insuficiência venosa crônica. Foi calculada a LEED média dos pacientes tratados para determinar se foi necessária uma energia maior que a média para o sucesso do tratamento. Resultados Dos 153 membros inferiores submetidos ao tratamento, houve diferença significativa (p = 0,021) no fechamento da junção safeno-femoral relacionada à LEED média utilizada acima do joelho. Por outro lado, no segmento de coxa não houve diferença significativa. Conclusões A LEED acima da média de 70,57 J/cm apresentou um índice maior de fechamento na junção safeno-femoral. Porém, no segmento de coxa, a densidade não influenciou o resultado, demonstrando que uma energia mais alta do que 70,57 J/cm tende a não ser necessária para o tratamento desse segmento.